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Healthcare systems are increasingly recognised as complex, in which a range of non-linear and emergent behaviours occur. China’s healthcare system is no exception. The hugeness of China, and the variation in conditions in different jurisdictions present very substantial challenges to reformers, and militate against adopting one-size-fits-all policy solutions. As a consequence, approaches to change management in China have frequently emphasised the importance of sub-national experimentation,...
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Nearly all challenges in international development tend to be complex because they depend on constantly evolving human behaviour, systems, and contexts, involving multiple actors, entities, and processes. As a result, both the discovery and scaling of innovations to address challenges in development often involve changes in system behaviour or even system-level transformation. This is rarely a linear process over time and can result in unexpected outcomes. Existing evaluation techniques...
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This article explores the challenges of monitoring and evaluating politically informed and adaptive programmes in the international development field. We assess the strengths and weaknesses of some specific evaluation methodologies which have been suggested as particularly appropriate for these kinds of programmes based on scholarly literature and the practical experience of the authors in using them. We suggest that those methods which assume generative causality are particularly well...
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There is a growing recognition that programs that seek to change people’s lives are intervening in complex systems, which puts a particular set of requirements on program monitoring and evaluation. Developing complexity-aware program monitoring and evaluation systems within existing organizations is difficult because they challenge traditional orthodoxy. Little has been written about the practical experience of doing so. This article describes the development of a complexity-aware evaluation...
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