Sector Healthcare
Duration 3 years (2021–2024)
Scale ₹8.5 crore · 4 districts
Type Composite sample

This walkthrough analyses a composite sample report based on patterns observed across multiple maternal health programme assessments. It demonstrates how the nine principles apply in practice — where this type of report typically succeeds, and where common weaknesses emerge.

P1 Theory of Change
Strong
P2 Context
Strong
P3 Methods
Adequate
P4 Proportionality
Strong
P5 Evidence
Adequate
P6 Attribution
Weak
P7 Ethics
Strong
P8 Learning
Strong
P9 Transparency
Adequate
Section 1: Problem Statement & Theory of Change
P1 — Strong
"Maternal mortality in the target districts remained at 167 per 100,000 live births — nearly double the state average. Analysis of health facility data and community surveys identified three primary drivers: delayed recognition of danger signs, inadequate transportation to referral facilities, and gaps in emergency obstetric care availability. The intervention hypothesised that community-level health education, combined with a transport voucher scheme and facility staff training, would address all three delays..."

What works here: The report opens with a specific, quantified problem grounded in local data — not a generic statement about maternal health. The three-delay framework provides a clear causal mechanism linking the problem to the intervention design. Each programme component maps to a specific causal pathway.

Assessment: This section demonstrates strong alignment with Principle 1. The theory of change is clearly documented, assumptions are stated (community willingness to use vouchers, facility readiness for increased referrals), and the causal logic is testable.
Section 4: Attribution & Impact Claims
P6 — Weak
"As a result of the programme, institutional deliveries increased from 42% to 71% in target areas over the three-year period, and maternal mortality declined from 167 to 118 per 100,000 live births. These improvements demonstrate the significant impact of the CSR intervention on maternal health outcomes in the target districts."

The problem: Despite strong foundations in earlier sections, the report makes direct attribution claims without adequate causal reasoning. During the same period, the state government expanded its Janani Suraksha Yojana programme, a national conditional cash transfer scheme for institutional deliveries. District health infrastructure also received significant government investment.

The report presents correlation as causation. Institutional deliveries rose across the state during this period (from 58% to 69% statewide), suggesting that much of the observed increase in target areas may reflect broader trends rather than programme-specific impact.

Assessment: This section does not meet Principle 6 requirements. The report fails to consider counterfactuals or alternative explanations, makes no attempt at contribution analysis, and claims impact for changes that are partly attributable to concurrent government programmes. A credible report would quantify the programme's contribution relative to the state trend, acknowledge the limits of attribution, and distinguish between areas where the programme plausibly accelerated change and areas where baseline trends explain the result.
Section 6: Learning & Adaptive Management
P8 — Strong
"The transport voucher component, initially designed as a cash reimbursement, showed low uptake in Year 1 (23% of eligible women). Qualitative inquiry revealed that families lacked upfront cash to pay for transport. In Year 2, the programme shifted to pre-paid vehicle arrangements with local transport providers. Uptake rose to 67%. This adaptive approach was not envisaged in the original design and required renegotiation with implementing partners..."

What works here: This section demonstrates genuine reflexivity. The report honestly describes a component that wasn't working, explains why (drawing on qualitative evidence), documents the adaptation, and presents the result. This is precisely the kind of learning that makes impact assessment valuable beyond accountability.

Assessment: Excellent alignment with Principle 8. The willingness to document failure and adaptation — rather than presenting a sanitised narrative of success — is a hallmark of credible impact assessment. This section also strengthens the report's overall credibility.

Key Takeaways

This walkthrough illustrates a pattern common across healthcare impact reports: strong programme design and contextual understanding coexisting with weak causal reasoning. The report does many things well — its theory of change is clear, its ethical framework is robust, and its willingness to document adaptation is commendable.

However, the attribution claims in Section 4 undermine the report's overall credibility. An accreditation committee reviewing this report would likely return it as "Accredited with Conditions," requiring revision of the attribution and impact claims to acknowledge alternative explanations and provide a more honest contribution analysis.

The lesson is instructive: a report can be excellent in eight of nine principles and still face accreditation conditions on the basis of a single critical weakness — particularly in causal reasoning, where over-claiming impact is the most common and most consequential failure in CSR reporting.

← Back to all use cases Next walkthrough: Digital Literacy →