During the upcoming academic year, the Gill Lebovic Center and the Center for Community Health Integration (CCHI) will partner on a new line of work that brings system dynamics tools directly into the theory-driven evaluation of health policies and programs. Between June 1st and June 12th, GLC researchers Lina Rodriguez and Edlyn Rochon will work with the CCHI modeling team, led by Peter Hovmand, to lay the foundation for our collaboration.
Our joint work will initially focus on applying system dynamics (SD) tools to complement a theory-driven evaluation of a coaching program for quality improvement in Honduras, which our center recently completed in collaboration with the Salud Mesoamerica Initiative. Our evaluation of the Honduras coaching intervention found that shifting from punitive, top‑down supervision to data‑driven, supportive coaching enabled frontline teams to use quality‑improvement tools more effectively and contributed to notable gains in service quality, especially for cervical cancer screening, despite chronic resource constraints and pandemic disruptions.
Initially, the collaboration will focus on three things: applying SD tools to explain why cervical cancer screening improved while antenatal care remained flat; learning from null results in antenatal care rather than treating them as failures; and helping decision-makers explore system redesign options that respect existing constraints.
This is the first step in a broader agenda between both centers to further integrate system dynamics with theory-driven evaluations, such as realist and theory-of-change evaluations. We expect “marrying” SD and contemporary evaluation approaches will ensure that causal explanations are not only plausible and empirically grounded, but also explicit about how change unfolds over time in complex health systems. Our goal is to show how feedback structures already latent in realist and theory-driven evaluations can be formalized, calibrated (including with qualitative data anchored in a reference model), and used with policy-makers to explore system redesign options.
We see this collaboration as an opportunity to build a shared workflow that evaluation, health policy and system researchers, together with system dynamics teams can use to stress-test program theories, make temporal dynamics visible, and support better informed decisions about institutional reforms in complex primary care systems.