Planning with Evaluation in Mind: Using Program Theory and Evaluation Factors to Increase Effectiveness in Complex Community Health Engagement

A dynamic and complex defense landscape, combined with an increase in the use of non-combat operations, has resulted in the US military’s adoption of non-traditional approaches to global defense strategy. In response to increasing stability concerns, one approach the Department of Defense (DoD) has leveraged is health security through global public health engagement to address social and environmental determinants of health. However, global health as a defense-based security mission uniquely transcends interdisciplinary boundaries by including a necessary defense security cooperation strategy, along with the adoption of an international development framework, and a global public health approach to community-based change.

Complex global public health and international development programs employ systemic change processes, requiring the use of non-linear methodologies in planning, implementation, and evaluation to understand the system and the system relationships that are affected, intentionally or unintentionally, by program activities (Ulrich, 2010). The theories of change derived from public health, international development, and contemporary security cooperation frameworks utilize non-linear planning, implementation, and evaluation frameworks, suggesting that DoD global health engagement (GHE) interventions and activities should reflect the application of systems and complexity-based program frameworks to support a non-linear theory of change. However, the predominant use of vertical disease programs, blueprint planning, and oversimplified implementation models and the lack of contextual relevance suggest gaps between how the DoD understands complex change and, ultimately, how it plans for and measures intervention success.