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Table 1 Features of complex social programs

From: Implementing health system change: What are the lessons from the African Health Initiative?

• Based on set of theories and assumptions about how an intervention will lead to change
• Achieved through active participation of individuals
• Developed and implemented through long process which may be fallible
• Not necessarily implemented in linear fashion and influenced by respective power of those actors involved in implementation
• Very susceptible to effect of different contexts (e.g. policy timing, organizational culture and leadership, resource allocation, staffing levels and capabilities, interpersonal relationships, and competing local priorities and influences)
• Prone to being changed during process of implementation
• Open dynamic systems in themselves, which are able to change the conditions that enable them to be implemented successfully (generating unintended positive and negative effects)
  1. Source: Mills et al, 2008 [5], adapted from Pawson et al, 2005 [13]