Table 1 Revised programme theory with CIAMO configurations
Context | Intervention Component | Actor and Mechanism | Outcome |
|---|---|---|---|
Demand-side | |||
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) |
Supply-side | |||
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) |