Stage 5: Select and design interventions
The stakeholders next select and design interventions that will address the root causes of priority gaps or build upon the successful performance elements discovered during the previous stage. See Tips for Meeting to Select and Design Interventions in the Tools section.
In Stage 4, when root causes are identified in terms of performance factors, potential solutions become clear. For example, if supervisors do not know the expectation for how many supervisory visits they are supposed to make because they don’t have a job description that communicates this expectation (organizational systems and incentives—clear performance expectations), the solution may be to develop a clear job description and communicating these job expectations to supervisors.
Step 5.1: Propose and select interventions
The aim of this step is to agree on the general interventions, not to design each intervention (which may require additional expertise). The stakeholders need to agree upon selection criteria first, then brainstorm possible interventions, and finally use the criteria to select the priority interventions. Possible intervention selection criteria include:
- Response to root cause(s): Above all, the intervention(s) selected must respond to the root cause(s) of the problem.
- Affordability: Do the necessary resources exist to follow through with this intervention and maintain it? Are there other ways to act on this intervention that might cost less? Can someone advocate for more resources to be allocated to this area?
- Feasibility: Are systems in place to support this intervention? Is it realistic and within the control of the organization/health facility?
- Time available: How long will the intervention take to implement and demonstrate results? Do you have enough time? Are there constraints on the time frame?
- Appropriateness/acceptability: Will the health facility staff (or clients) agree with and support the intervention? Did they suggest the intervention? Are they aware of what is being proposed?
- Benefit: Are the benefits of the intervention worth the resources necessary to implement it?
See job aid on Possible Interventions to Address Missing Performance Factors in the Tools section.
After determining selection criteria and brainstorming possible interventions, the team will prioritize and select the interventions by comparing each intervention to the criteria and deleting those that do not match the criteria. Each intervention or set of interventions must address at least one root cause of a gap or strength.
As with prioritizing gaps, it often helps to prioritize and select interventions by using a 5-point scale to rate each intervention according to your selection criteria. For example:
Step 5.2: Develop an intervention design plan
During this step, the team reaches agreement on a design plan for each intervention, including the process or steps to be used to design the interventions, who is responsible for each step, and the time frame. An Intervention Design Plan Format is included in the Tools section.
It will be important to ensure equality of opportunity and nondiscrimination in the development of the interventions and assignment of roles and responsibilities between women and men.
Some interventions are low-cost, easy to implement, and can produce rapid results without needing an intervention design plan.
Step 5.3: Develop, field test, and produce the final version of the interventions
The nature and extent of testing will depend on the scope involved, the type of intervention, and the time and resources available. For example, you would not pretest a strategic planning intervention, but if an intervention requires a major production or management effort or entails significant costs, then the development team should produce and test a prototype version of the intervention and/or materials before moving to final production and implementation.
Testing includes reviews with users, clients/customers, and subject-matter experts, or actual trials with members of the target audience in the environment in which the intervention will take place. Testing may reveal major weaknesses in the intervention design or materials and provide the necessary feedback to make revisions before final production. Based on the test data and feedback, revise the workplan as necessary.
The last part of this step is to package the final version of the intervention and/or materials and prepare for implementation. Interventions may be ready for implementation at different times. For example, you may implement one intervention while another is still in the planning stages.