Using narrative approaches to assess
animal and community health
interventions in Laos: Most Significant
Change
Learning about project impacts through people’s stories
Fèvre, Sonia; Southammavong, Fongsamouth; Kaesombath, Lampheuy; Chittavong,
Malavanh; Drew, Anne; Kongmanila Daovy; Vannasy, Sypachan; Chialue, Lithua
PENAPH Technical Workshop, 13 December 2012

• About Most Significant Change
(MSC)
• Introduction to Laos Ecohealth and
Village Extension Project
• Methods & results using MSC in Laos
Ecohealth project
• Lessons learnt
Outline

MSC is a type of participatory monitoring and evaluation. It
involves the collection of stories of change from the field, and the
systematic selection of the most significant of these stories by
groups of stakeholders & staff… Once changes have been
captured, various people… read the stories aloud and have…
in-depth discussions about the value of these reported changes.
What is MSC ?
(The ‘Most Significant Change’ (MSC) Technique. A Guide to Its
Use. Davies & Dart 2005)

• Qualitative
• Uses stories
• Strength-based learning
• Not indicator-based
• Ongoing cycle (story collection/selection/feedback, then
collect again)
• Fits into project cycle to evaluate and help plan future
activities
Aspects of MSC

1. Define purpose for doing MSC
2. Collect stories (about 10-15 per collection cycle) and translate key points
3. Decide on 3-5 themes and classify the stories
4. Discuss each story and select most significant one for each theme (selection)
5. Document/record reasons for these choices
6. Feedback – to team, communities, managers, etc – some of most significant
changes seen in project
7. Make recommendations for action
8. Adapt project activities based on discussions
Not just about collecting stories – focus is also on how we select what we think is
significant
Key steps in MSC

6
‘ ‘Looking back over the last year…’ – It refers to a specific time
period.
‘… what do you think was...’ – It asks respondents to exercise their own
judgment.
‘the most important (or significant)…’ – It asks respondents to be
selective, not to try to comment on everything, but to focus in and
report on one thing.
The key question for MSC interviews
‘…change…’ – It asks
respondents to be more
selective, to report a
change rather than static
aspects of the situation or
something that was present
previously.
‘…because of your
involvement with the
project?’ – Helps establish
boundaries.

Feedback and ethics
• Skills of interviewer
• Sharing and dissemination of stories within the organisation, with project
participants, storytellers, etc
• Offer choice of anonymity
• How stories used for monitoring purposes
• How MSC is combined with other M&E
• Acknowledging the difference between media interviews and MSC stories
• Understanding benefits and limitations of strength based approaches
a) Who we choose to tell the stories
b) Who selects the stories
c) How we select the stories (what criteria)

• It can build staff capacity in
analysing data and
conceptualising impact – what
impact have we had so far?
• It can be used to monitor and
evaluate bottom-up initiatives
that do not have predefined
outcomes against which to
evaluate
Strengths of MSC – “rich picture”
• Easy to communicate across cultures
• Easy to integrate with other project activities eg. village
visits

• It captures outcomes which are more
emotional/less tangible
• It captures non-predicted outcomes –
maybe we are having an impact we
didn’t expect (good or bad)
• It brings out people’s values and what
they think is important
• It allows people telling & selecting
stories to discuss what we think is
important, & review core values of our
work
Strengths of MSC – “rich picture”

Population Health
• 30 % of population lacks access to basic medical
care
• 40% + children malnourished
• High risk of malaria, dengue fever, avian influenza
Agriculture and Veterinary Capacity
• 89 % of HH keep at least one species of livestock
• Lack of veterinary expertise (less than 80 vets
nationwide, cf. Canada 11,386 vets)
Laos – Quick facts
Human population: 6.7 million, 80% rural

Laos

Village Ecohealth & Veterinary
Extension Project

Animal health services
▫ 72% respondents vaccinated cattle/buffalo
▫ 15% brought in new animals, 39% of them separated animals first
▫ Only 11% respondents had received visits from animal health
worker in past 6 months
Communities in Xaythany District
(2010 Baseline survey)

• Training and mentoring of
Primary Animal Health workers
• Livestock clinics for training
and outreach
• Livelihoods project with low-
income farmers – poultry
• Rabies campaign
• Community Health Days

Training and mentoring for Primary Animal Health Care
Workers
Livestock clinic in Somsamai village,
courtesy of Anne Drew
PAHW Refresher Training, courtesy of Anne
Drew

Community mobilisation
Rabies vaccination days,
photos courtesy of Anne Drew
Community Health Day,
Senoudom village

Project aims
• Local partners are empowered to provide relevant, good quality
training and support to village animal health workers
• Primary animal health workers (PAHWs) have good basic skills in
animal healthcare and help improve the health of animals in their
communities
• Communities take an active role in improving the health and
management of their livestock and contributing to human and
animal disease prevention
• Farmers adopt integrated approaches to animal raising and
farming which contribute to increased productivity, better access to
markets, and food security
Using MSC to assess to assess
animal and community health
interventions in Laos

• Interviewees: project participants activities (PAHWs, Community
Health Days)
• 23 stories collected from 3 villages over 2 weeks (January –
February 2011)
• Interviewers: project team and new members
Story collection

Story themes
• Animal health care
• PAHW skills and
knowledge
• Environment and human
health

• Stories classified by theme
• Each story read and discussed by selection team (key project team
members) – project purpose, story teller’s focus, etc
• Iterative selection process, leading to final selection of 3 stories: one story
per theme
* Stories excluded if
• unreliable
• not enough detail
• not a story of change
Story selection: 1 day

I am a Primary Animal Health Worker, and I attended the Community Health Day in my village. I was
selected to become a PAHW because I submitted an application after the project team came to my
village, and I was one of the three chosen. In 2010 I went for training at Nabong Faculty of
Agriculture. It was my first training in veterinary health care. I learned about the use of vet
equipment like syringe and needle, livestock crush, and how to inject in muscle and under skin. I learned
about disease, how to use medicine to prevent disease and for treatments.
After I completed the training, I worked at my village, but mainly on my own animals, because I
was afraid to work on other people’s animals, and most people did not trust me yet. Then the
project organized a second training last August 2010. Then I understood the work better, because it
helped me review past lessons, and also learn new lessons. We practiced with animals, assessing
the health of normal animals and signs of disease. We learned animal restraint, wound treatment,
about vaccination, and use of medicines.
Now I feel more confident working in my village. I have successfully cured animals, and am gaining
more trust. Experts from the project come to visit and supervise regularly, and that increases my
confidence and gives me more experience in improving animals’ health, little by little.
Mr Labou, Hat Viengkham village
Example story selected
Skills and Knowledge theme

Example: story selected
Skills &
knowledge
Story has good examples, clear information
about before / after through what PAHW has
learnt, what he thinks is significant, and how
project can continue to support him

Theme: PAHW Skills and Knowledge - Mr. Labou
• objective 1: the second training especially gave him
confidence, he mentions that experts from the project
come to visit and supervise in the village
• objective 2: he mentions specific
skills learned: use of medicines,
disease diagnosis
• objective 3: He talks about
lessons learned by the community
How did the stories support our
project objectives?

Conclusions: What have we learnt from MSC?
• PAHWS (Primary Animal Health workers) continue to be enthusiastic and are
serving their communities. They are still asking for more training and support
in vaccination, injury treatment, obstetrics etc.
• Community members tell us they highly value having PAHWs in their villages,
as PREVIOUSLY many of them had no-one to turn to if their animals were
sick. They say their animals are healthier now.
• Community members (teachers, village chiefs and other villagers) have said
they have changed habits since we conducted COMMUNITY HEALTH DAYS
last year. For example, one man moved all his livestock away from his house
to reduce disease transmission. Many women have said they wash their
hands before touching food AND cook their meat more thoroughly now.

• Choice of interviewers and interviewer training are
important for ensuring reliable, well told stories
• Details of a story can be verified at the time of
collection e.g. if farmer says ‘less animals die now’ we
need to ask ‘how many died before – when, and how
many died this season’, when, how, why, etc.
General
Conclusions
• Stories which highlight certain activities more than others show that
conditions in those areas made for effective activities… we can learn
from this
• MSC is most effective as part of a combination of mixed method
evaluation approaches
• Given technical limitations (limited laboratory facilities, etc), it is easier to
collect participatory data than clinical monitoring of animal health… how
can we better merge the two approaches?

Thanks to partners:
Faculty of Agriculture, National University of Laos
Faculty of Environmental Science, National University of Laos
District Agriculture and Forestry Office
Xaythany Department of Health
Thanks to funders:
Canadian International Development Agency (CIDA)
Canadian Food Inspection Agency
Congrès Vétérinaire
Sonia Fèvre
sonia.fevre@vwb-vsf.ca
www.vetswithoutborders.ca