Most Significant Change

In February 2012, the Safe Birth in Cultural Safety team carried out a series of most significant change interviews with traditional midwives, apprentices, indigenous community health promoters, birth centre users, and core members of our team in Xochis. These interviews were part of the project evaluation and aimed to explore what were the most significant changes our users and participants had witnessed or experienced themselves over the course of the intervention.

For this exercise, we adapted Rick Davies and Jess Hart’s participatory approach to monitoring and evaluation of social change projects and programs, whose core components were laid out on “The Most Significant Change Technique (MSC)-A Guide to its Use” (2004). This method has been applied in development programs in different settings, by a range of government agencies and NGOs. As in our case, it yields useful information on personal experiences of key stakeholders, social changes, and developments on the ground, from the perspectives of those involved with the project. The nature of this approach helps understand both hard and soft indicators, encourages reflection at all levels, and provides meaningful input to guide project managers and field coordinators with little cost and in timely fashion.

All instruments included questions about the most significant changes experienced since the beginning of the project, both at a personal level and in specific roles within the study, as well as examples of those changes and how they came about. We also asked traditional midwives for an evaluation of their teaching and learning experiences, how these could be improved, and what was needed for the apprentices to work without supervision. Team members on the field pre-selected a group of responses that conveyed, in their view, key changes from the study. These selections were then analyzed and discussed by team members and managers at different levels.

In our Voices section, we offer short summaries of people’s responses to provide a more in-depth understanding of the Safe Birth in Cultural Safety project from within the communities and beyond the primary and secondary impact indicators.