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Table 1 Revised programme theory with CIAMO configurations

From: Integrated delivery of family planning and childhood immunisation services in routine outreach clinics: findings from a realist evaluation in Malawi


Intervention Component

Actor and Mechanism



Underserved communities in hard-to-reach areas (C)

Monthly provision of integrated FP services in routine outreach clinics (I)

Women (A) are motivated to attend outreach clinics due to relatively short travel distances (M1)

Increased access to FP services (O)

Some husbands are not supportive of FP (C)

Integration of FP and childhood immunisation services (I)

Women (A) feel confident that they can access FP services without their husband knowing (M2)

Women (A) choose discreet MCMs (M3)

Women opt to use injectables (O)

Some husbands support birth spacing for financial reasons (C)

Integration of FP and childhood immunisation services (I)

Women (A) feel confident to accept MCMs when these are offered (M4)

Same-day uptake of MCMs (O)


The health services needed by women and children are not available in underserved communities (C)

HSAs are trained on the outreach clinics’ client flow, and on childhood immunisation and FP services (I)

HSAs (A) are empowered by their knowledge of FP injectables (M5)

HSAs provide FP injectables (O)

HSAs (A) are confident they can provide the services needed (M6)

Integrated services are provided at outreach clinics (O)

Limited health service providers work in rural areas and a high demand for services in routine outreach clinics (C)

Volunteers support HSAs in maintaining the client flow in outreach clinics (I)

HSAs and volunteers (A) are motivated by team work (M7)

HSAs (A) are motivated by feeling their work is valued and recognised (M8)

Routine outreach clinics are located in hard to reach areas (C)

No defined intervention (I)

Some HSAs (A) are unwilling to walk long distances to reach remote outreach clinics (M9)

Understaffing in some outreach clinics (O)