External Validity and Policy AdaptationFrom Impact Evalua.docx

External Validity and Policy Adaptation:
From Impact Evaluation to Policy Design
Martin J. Williams ∗
February, 2018
Abstract
With the growing number of impact evaluations worldwide, the
question of how to ap-
ply this evidence in policymaking processes has arguably
become the main challenge for
evidence-based policymaking. How can policymakers predict
whether a policy will have the
same impact in their context as it did elsewhere, and how
should this influence the policy’s
design and implementation? This paper suggests that failures of
external validity (both in
transporting and scaling up policy) can be understood as arising
from an interaction between
a policy’s theory of change and a dimension of the context in
which it is being implemented.
I survey existing approaches to analyzing external validity, and
suggest that there has been
more focus on the generalizability of impact evaluation results
than on the applicability
of evidence to specific contexts. To help fill this gap, I develop
a method of “mechanism
mapping” that maps a policy’s theory of change against salient
contextual assumptions to

identify external validity problems and suggest appropriate
policy adaptations. In deciding
whether and how to adapt a policy, there is a fundamental
informational trade-off between
the strength of evidence on the policy from other contexts and
the policymaker’s information
about the local context.
∗ Associate Professor in Public Management, University of
Oxford, Blavatnik School of Government. Email:
[email protected] I am grateful for conversations and comments
from Jon Ahlberg, Noam Angrist,
Alex Baron, Maria Barron Rodriguez, Eleanor Carter, Suvojit
Chattopadhay, David Evans, Flavia Galvani,
Frances Gardner, Julie Hennegan, David Humphreys, Robert
Klitgaard, Julien Labonne, Adauto Modesto, Aoife
O’Higgins, Daniel Rogger, and students at the Blavatnik School
and the Escola Nacional de Administração Pública
(Brazil). Any remaining errors are my own. A policy memo
based on this paper with a five-step “how-to” guide
is also available (Williams 2017).
External Validity and Policy Adaptation: From
Impact Evaluation to Policy Design
Abstract
With the growing number of impact evaluations worldwide, the
question of how to ap-
ply this evidence in policymaking processes has arguably
become the main challenge for

evidence-based policymaking. How can policymakers predict
whether a policy will have the
same impact in their context as it did elsewhere, and how
should this influence the policy’s
design and implementation? This paper suggests that failures of
external validity (both in
transporting and scaling up policy) can be understood as arising
from an interaction between
a policy’s theory of change and a dimension of the context in
which it is being implemented.
I survey existing approaches to analyzing external validity, and
suggest that there has been
more focus on the generalizability of impact evaluation results
than on the applicability
of evidence to specific contexts. To help fill this gap, I develop
a method of “mechanism
mapping” that maps a policy’s theory of change against salient
contextual assumptions to
identify external validity problems and suggest appropriate
policy adaptations. In deciding
whether and how to adapt a policy, there is a fundamental
informational trade-off between
the strength of evidence on the policy from other contexts and
the policymaker’s information

about the local context.
In 2015, Zimbabwe’s government rolled out a new HIV
treatment nationwide. The decision
was evidence-based: a range of randomized control trials
(RCTs) had shown the new treatment
to be an improvement over the previous drug cocktail, and the
World Health Organization
(WHO) recommended that it be used as the standard treatment
throughout sub-Saharan Africa.
Yet after the new treatment was rolled out, “reports soon
followed about people quitting it in
droves” (Nordling 2017). It turned out that one of the drugs in
the treatment, efavirenz, caused
significant neuropsychiatric adverse effects (e.g. hallucinations,
suicide ideation) in individuals
with a particular genetic variant. This variant is rare worldwide,
so these adverse effects were
not deemed a major problem by international researchers, but it
happens to be quite common
in Zimbabwe (Masimirembwa et al 2016). Even though the
Zimbabwean government and WHO
had based their decisions on extensive and rigorous empirical
evidence, the policy decision to

include efavirenz had disastrous effects for a significant
fraction of patients - an error that could
have been avoided, since Zimbabwean scientists had previously
identified this genetic variant
and its interaction with efavirenz (Nyakutira et al 2008).
Relying on empirical evidence from
elsewhere without also utilizing local information had led
policymakers in Zimbabwe to make a
costly mistake.
Policymakers worldwide face similar challenges in trying to
apply evidence to policy deci-
sions. With the recent boom in impact evaluations around the
world, policymakers in many
sectors now have at their disposal an overwhelming amount of
evidence about “what works” -
or at least what worked in a particular context. Following the
example set by the medical sci-
ences, the premise of evidence-informed policymaking is that
the design of policy can be based
on evidence of what has worked in other contexts, rather than
each policymaker having to start
from scratch. Yet as impact evaluations have multiplied, it has
become apparent that “the

same” policy can have very different effects in different
populations (Deaton 2010, Pritchett
and Sandefur 2015, Vivalt 2017).1 Similarly, policies shown to
be effective in small trials have
not always been as effective when implemented at scale, even in
the same country (Bold et al
2016, Banerjee et al 2016a). This is the problem of the external
validity of impact evaluations.
Although there is widespread agreement on the importance of
evidence for informing policy de-
cisions, the limited external validity of impact evaluation
evidence poses significant challenges
for policymakers: how can one know if a policy will have the
same effect in this implementation
context as it did elsewhere? And to what extent should
policymakers copy the design of policies
that have worked elsewhere, rather than use local information to
try to adapt them to fit the
1
local context?
This paper begins by proposing a simple and flexible framework
for thinking about these

questions, and about external validity more broadly. A policy
can have a different impact in a
new context than it had in a previous context if part of a
policy’s theory of change interacts with
a difference in contexts. A policy’s theory of change is a set of
logical steps spanning inputs to
activities, outputs, intermediate outcomes, and final outcomes.
Whether this mechanism works
as intended depends at each step on the validity of a set of
contextual assumptions. While these
assumptions may have been true of the context in which a
policy had previously been shown to
work, whether the policy will have the same effects in a new
context depends on whether these
same contextual assumptions hold. Since context can include a
wide range of factors - location,
target group, implementing organization, scale, time period, the
existence of related policy
interventions, etc. - and the theory of change includes factors
related to implementation as well
as impact, this parsimonious framework encompasses the range
of typologies of external validity
failures discussed in existing literature (Deaton 2010,
Cartwright and Hardie 2014, Muller 2015,

Banerjee et al 2016a) and applies equally to issues of scale-up
as well as transporting successful
policies.
Within the topic of external validity, one can further distinguish
between the generalizability
of evidence and the applicability of evidence. Questions of
generalizability are about whether
an impact evaluation’s findings are likely to hold in general in
other contexts (but without a
specific destination context in mind), whereas questions of
applicability are about whether eval-
uation results from one or more other contexts will hold in a
specific destination context. While
the generalizability of evidence is somewhat informative about
whether a policy will work in
a specific context, the multi-dimensionality of both policies and
contexts means that evidence
from elsewhere can never be fully determinative of a policy’s
impact in a new context as even
apparently minor idiosyncratic details can have a major effect
on policies’ effectiveness. The
problem is analogous to the “last mile” problem in public
transportation and service delivery:
evidence from rigorous impact evaluations can get policymakers

significantly closer to the “cor-
rect” policy choice, but there is still a need for structured
guidance on how to bridge the gap
from “what works in general” to “what will work in my
context”.
With this distinction in mind, this paper surveys the existing
literature on external validity
across a range of disciplines. Overall, the academic literature on
external validity has focused
mainly on questions of generalizability, whereas the question of
applicability is the problem with
2
which most policymakers are confronted when trying to use
evidence to design policy. This is
evident in the two main strands of work on external validity.
First, one existing approach
is to estimate the average effect of an intervention across
different contexts by aggregating the
results of multiple studies. This is, broadly speaking, the
approach of replication, meta-analysis,
and systematic review (What Works Network 2014, Vivalt
2017). A second strand focuses

on what evaluators can do to increase the external validity of a
particular study, including
a range of approaches such as formal theory and structural
modeling (Deaton 2010), larger
evaluations (Muralidharan and Niehaus 2016), various
econometric extrapolation techniques
(Angist and Fernandez-Val 2010, Gechter 2016, Kowalski
2016), and integrating “structured
speculation” on external validity into research papers (Banerjee
et al 2016b). While both
strands are informative about the potential applicability of
evidence to specific contexts, their
emphasis on generalizability offers policymakers little
structured guidance on how to bridge the
gap between evidence from other contexts and the inevitable
particularities of specific contexts.
The paper then introduces a method to help policymakers to
bridge the gap between the best
evidence from other contexts - from impact evaluations, meta-
analyses, model-based extrapo-
lations, etc. - and the effective application of this evidence to
policy design and adaptation
in their own context. This method of mechanism mapping builds
explicitly on the paper’s

proposed understanding of external validity as the interaction of
mechanism with context by
juxtaposing 1) the policy’s theory of change with 2) the
underlying contextual assumptions
needed for each step of this mechanism to operate, and 3)
comparing these assumptions to the
actual characteristics of the policymaker’s context. If a
necessary assumption does not hold
in the new context in the same way as it held in the old context,
then the mechanism will be
interrupted and the policy’s impact will differ. The mechanism
mapping process can also be
applied to questions of policy scale-up, since implementing a
policy at scale involves different
contextual assumptions (e.g. implementation quality, resource
requirements, general equilib-
rium effects, political economy) than a small pilot, even if the
pilot was undertaken in the same
geographical location.
Evidence plays a crucial role within the mechanism mapping
process. Undertaking mech-
anism mapping would ideally consist of a systematic process of
seeking empirical evidence to
support contextual assumptions and understand actual

contextual realities through descriptive
statistics, qualitative data, and evidence from relevant impact
evaluations. At the most rigorous
extreme, one could undertake a series of “mechanism
experiments” (Ludwig et al 2011) to val-
3
idate each step of the theory of change and its underlying
contextual assumptions. Where time
or resource constraints make a more thorough process infeasible
but a decision must nevertheless
be made, even conducting a relatively brief mechanism mapping
may help policymakers struc-
ture their judgment and avoid sole reliance on intuitions or
prejudices. As Ravallion (2009)
notes, learning from impact evaluations typically requires both
theory and information from
outside the evaluation; this simple and intuitive diagnostic
process gives policymakers a flexible
framework for marshalling all available empirical evidence
from different sources and of different
levels of rigor in a structured way in support of policy
decisions. Whereas the lack of quanti-

tative data has often hindered evidence-based policymaking in
data-poor contexts, mechanism
mapping’s ability to integrate less formal types of evidence
makes it particularly well suited to
such contexts. Section 3 discusses the application of mechanism
mapping in more detail.
The process of mechanism mapping also feeds directly into
policy adaptation, by identifying
specific aspects of the policy that are likely to work less well
(or potentially better) than in
the policy’s original context. Policy adaptations thus flow
directly from a diagnostic of the
relationship between the policy context and the policy’s theory
of change, so that adaptations
are based on a combination of local, context-specific
information and evaluation evidence from
other contexts. While this combination is a productive way to
generate ideas for adaptation,
it also suggests a fundamental trade-off. Evaluation evidence on
a policy’s effectiveness in
other contexts is likely to be more rigorous than available local
information, but relying on
this evidence from elsewhere requires strict fidelity to the
original policy design. On the other

hand, using mechanism mapping to identify potential
adaptations makes efficient use of local
information, but making these adaptations decreases the
relevance of evaluation evidence from
elsewhere. The optimal level of adaptation in each case will
depend on the case-by-case balance
between 1) the strength and relevance of evaluation evidence on
the policy from other contexts
and 2) the policymaker’s information about the local context.
This optimal level will thus vary
not only by policy area and country, but also by the information
set of the policymaker and the
nature of the policymaking process.
Of course, a key limitation of mechanism mapping as a tool is
that it relies to an extent
on the judgment of policymakers, as with any other process of
policy design or adaptation.
While this may provide opportunities for policymakers’ biases
or preferences to influence pol-
icy, numerous such opportunities already exist in policy design
and implementation, and the
structured process of comparing the theory of change,
contextual assumptions, and contextual
4

realities can arguably reduce these by making them explicit and
structuring deliberation. An-
other limitation of mechanism mapping it that it yields only
directional predictions of policy
effectiveness rather than precise statistical point estimates of
effect sizes and confidence inter-
vals. In some cases mechanism mapping may not generate an
unambiguous overall prediction
for whether a policy is likely to be more or less effective than it
had been in a previous con-
text, since multiple contextual differences may shift
effectiveness in different directions (i.e. be
opposite-signed). Nonetheless, for many applied policy
purposes - in particular for identifying
aspects of a policy that may benefit from adaptation - a
directional prediction may suffice, and
the use of mechanism mapping does not preclude policymakers
from also making use of more
precise quantitative tools. A practical approach for
policymakers would be to use evidence
on from impact evaluations and meta-analyses on what policies
or interventions are likely to

be most effective as a starting point from which to begin the
process of mechanism mapping,
marshalling context-specific evidence, and adapting policy.
In its emphasis on understanding mechanism-context
interactions, this paper is most sim-
ilar to recent work in public health (Moore et al 2015, Leviton
2017), economics (Bates and
Glennerster 2017), philosophy (Cartwright and Hardie 2014),
and public management (Barzelay
2007), and to “realist” approaches to evaluation in sociology
(Pawson and Tilley 1997). The
contribution of this paper is to 1) present a flexible and
parsimonious conceptual approach to
understanding external validity, 2) survey the existing
literature’s strengths and limitations in
helping policymakers analyze external validity issues in their
own contexts, and 3) link this to a
simple, practical, and intuitive framework for identifying likely
external validity failures which
4) feeds directly into the policy adaptation process. Finally,
mechanism mapping is related to
adaptive policymaking (Pritchett et al 2012, World Bank 2015)
in emphasizing the use of local
information to improve policy design; Section 4 discusses

complementarities between the two
approaches.
In order to focus on issues of external validity and policy
transportation arising from real
differences in context, this paper abstracts from the issues of
the statistical or methodological
accuracy of published impact evaluations that have been the
focus of much of the literature on
replication in the social sciences (Christensen and Miguel
2016). While these issues can also lead
to differences in estimated policy impacts across contexts, they
have been discussed extensively
elsewhere and are conceptually distinct. For brevity, throughout
this paper I therefore discuss
impact evaluations as if they represent true causal estimates of
the policy’s impact in that
5
context, even though policymakers should obviously interpret
published findings through a
critical lens.
The remainder of this paper proceeds as follows. Section 1
defines external validity and

elucidates the understanding of external validity failures as an
interaction of context and theory
of change. Section 2 discusses the limitations of existing
approaches to external validity, largely
arising from the high dimensionality of policies and contexts.
Section 3 describes the process of
mechanism mapping in more detail and gives examples and
practical recommendations, Section
4 discusses adaptation and the fundamental informational trade-
off, and Section 5 concludes.
1 Understanding External Validity
1.1 Defining External Validity
An impact evaluation’s external validity refers to the
extrapolation of its findings beyond the
study sample to another population. This contrasts with the
internal validity of a study, which
is established by the identification of a causal effect via
comparison with a valid counterfactual.
While academics may be concerned about establishing the
extent to which a study has external
validity in general - across all other hypothetical contexts - the
policymaker’s problem is whether
the findings of a study conducted elsewhere would continue

hold in one specific context. In
Cartwright and Hardie’s (2014) framing, an impact evaluation
answers the question “did it
work there?”, while policymakers are interested in the question
“will it work here?” This
section distinguishes between two different types of external
validity: scaling up a policy within
the same target population, and transporting a policy to a
different target population.2
First, one might be interested in extrapolating the findings from
the study sample (the indi-
viduals or units who actually participated in the evaluation) up
to the broader target population
for whom the study’s results are intended to be applicable. Will
a policy have the same impact
on the full target population as it did on a smaller pilot or trial
group? This is the case of
policy scale-up, as represented by panel (a) of Figure 1, and
comprises two distinct aspects.
One aspect of this can be achieved by having a study sample
that is statistically representative
of the study population (usually through random sampling).3
However, in some cases this is not
possible. For example, many pharmaceutical trials are

conducted on healthy individuals even
though these are systematically different than the target
population on important dimensions.
Similarly, Henrich et al (2010) point out that most
psychological studies are conducted on study
6
samples that are Western, Educated, Industrialized, Rich, and
Democratic (WEIRD) - often
North American or European undergraduates - that are among
the least representative sections
of humanity.
In addition to these concerns about the representativeness of the
study sample when scaling
up a policy to the full target population, the second aspect of
scale-up concerns the implemen-
tation and impact of the policy itself. Implementing at scale
may mean implementing through
a government bureaucracy that also implements many other
policies rather than a small and
closely supervised non-governmental organization or academic
research team, which could un-
dermine effectiveness (Bold et al 2016, Cameron and Shah

2017). Treating a higher fraction of
the target population could also lead to higher or lower effects
through spillovers (e.g. Miguel
and Kremer 2004.
Figure 1: Two Types of External Validity
Study
sample
Target
population
Overall population Overall population
Original target
population
New target
population
(a.) External validity for scale-up decisions (b.) External
validity for policy transportation
?
?
??
Second, one might care about whether a policy or intervention
would have the same effect in
a different target population than the original target population.

This is the meaning of external
validity with which policy transportation is usually concerned.
Panel (b) of Figure 1 illustrates
this meaning of external validity. External validity in this sense
concerns the similarity of the
two target populations on key covariates, both observable and
unobservable.
Despite their distinctions, both types of external validity can be
thought of as specific cases
of the same underlying challenge: how to predict whether a
policy will have the same effect(s)
7
in a new implementation context as it did in a previous context.
As discussed further below,
the underlying factors that drive external validity failures of
both types can be understood
with the same framework, and the mechanism mapping approach
to diagnosing them is equally
applicable to both.
1.2 Failures of External Validity
Why might a policy be effective in one context but fail in
another, or vice versa? This paper

proposes a framework that builds on two key concepts. First, a
policy is defined by its theory of
change (also referred to as its mechanism, results chain, or logic
model). This is a mapping of the
policy’s intended mechanism - how it is supposed to work. This
begins with the specification
of the intended final outcomes or ultimate goals of a policy. In
order to achieve these final
outcomes, a series of intermediate outcomes must occur, and a
policy specifies outputs that
the government will deliver in order to trigger these
intermediate outcomes. To deliver these
outputs, government plans to undertake a set of activities, which
require certain inputs (e.g.
financial or human resources, information).4 The steps from the
provision of inputs to the
delivery of outputs comprise the implementation of the policy,
while the link from these outputs
to the policy’s final outcomes via intermediate outcomes
represents the impact of these outputs
on society, or - in Bates and Glennerster’s (2017) terminology -
the behavioral response to the
intervention.

Second, all policies are implemented in a particular context, and
the characteristics of this
context may affect a policy’s effectiveness. Context here refers
not just to location, but also to
the full range of population and other variables that could affect
the policy’s implementation
and impact. While the range of potentially relevant
characteristics is effectively limitless, some
particularly salient dimensions of context include:
• Location, polity, or society in which the policy is being
implemented (e.g. Iceland or India),
together with all the social, cultural, economic, geographic, and
political characteristics
that vary across locations;
• Target groups (e.g. working adults, single mothers, at-risk
teens);
• Time the policy is being implemented, whether the year (e.g.
1965 vs. 2015), season, or
duration since the policy began;
8
• Existence of related policy interventions, including spillovers
from implementation of the

policy in neighboring areas as well as availability of public
services or infrastructure; and
• Implementing organization, including its competence, level of
resources, and political con-
straints.
Combining these two concepts makes it clear how failures of
external validity emerge. A
policy’s theory of change relies on each step actually occurring
and leading to the next step
as intended, both in terms of implementation and impact. Will
the correct level of inputs be
made available as intended? Will the activities needed to create
outputs actually occur with
the requisite quality and sequence? Will society react to these
outputs as hypothesized? The
answer to all of these questions may have been affirmative in
the context in which a successful
impact evaluation was undertaken but transporting the policy to
a new context requires making
assumptions about the answers to these questions in the new
context. The implementation
and impact of a policy are thus a function of the combination of
a policy’s theory of change

with the context in which it is being implemented. If we then
observe that a policy had
one impact in one context but had a different impact in a
different context, then it must be
the case that the differences in context undermined one or more
critical links in the policy’s
theory of change. Identifying these interactions of context and
theory of change is critical to
understanding external validity.
Two examples illustrate the diverse ways in which contextual
differences can undermine
policy impact. The first example comes from Cartwright and
Hardie’s (2014, 80-84) compari-
son of two World Bank-funded programmes: the Tamil Nadu
Integrated Nutrition Programme
(TINP), and the Bangladesh Integrated Nutrition Programme
(BINP). The TINP project was
implemented in the 1990’s and sought to improve child nutrition
in rural Tamil Nadu by simul-
taneously delivering two interventions: supplementary food for
pregnant or nursing mothers and
their children, and nutritional advice to mothers to correct a
misperception that mothers should
reduce rather than increase their food intake during pregnancy.

A rigorous impact evaluation
showed that the project was successful: mothers’ nutritional
knowledge improved, mothers and
children consumed more food, and children malnutrition and
stunting decreased significantly.
Figure 2 maps a simple version of this theory of change.
Following this evaluation, the program was copied and
transported to rural Bangladesh,
where the same problems existed. Yet under BINP, while
mothers’ nutritional knowledge im-
9
Figure 2: Theory of Change: Bangladesh Integrated Nutrition
Programme
Inputs Activities Outputs Intermed. outcomes 1
Intermed.
outcomes 2
Final
outcomes
Gov’t
provides
supp.
food and
nutrition

advice to
mothers
Mothers’
nutrition
aware-
ness
improves
Mothers
decide to
use extra
food for
selves
and
infants
Mother
and infant
nutrition
improves
Procure
food, hire
and train
workers
Funds,
potential
workers
Implementation Impact
Source: Author’s elaboration based on Save the Children
(2003), White (2005), World Bank (2005a), World Bank
(2005b), Cartwright and Hardie (2014).

proved, there was no impact on malnutrition. This was due to a
key contextual difference:
whereas mothers were typically responsible for shopping and
household food allocation deci-
sions in rural Tamil Nadu, in rural Bangladesh men usually
conducted the shopping and their
mothers (the mothers-in-law of the pregnant or nursing women)
controlled household food allo-
cations (White 2005; Cartwright and Hardie 2014). This
difference in contexts interacted with
a key link in the theory of change: the hypothesis that greater
nutritional knowledge in mothers
would lead them to decide to allocate the supplemental food to
themselves and their children,
rather than distributing it to other members of the household.
A second example comes from the Tools of the Mind early
childhood education program,
which aimed to improve executive function (e.g. resisting
temptation, working memory). After
a small but widely publicized RCT in New Jersey showed strong
positive impacts (Diamond et
al 2007), a federally funded scale-up in other states actually
found negative impacts relative to

a control group. Evaluators explained that correctly
implementing the curriculum - “the most
complex we have ever seen” - required two years of training,
ongoing in-classroom teacher coach-
ing, and carefully sequenced implementation of the 60 activities
that comprised the program
(Farran and Wilson 2014, 21). Although teachers actually
implemented the formal components
of the program with relatively high fidelity (as measured by the
number of activities imple-
mented) the closely specified structure of the program did not
fit well into the school day which
- unlike the carefully controlled original RCT - also included
many other non-program activities
and demands on teachers’ attention. While children undertook
many of the structured parts of
10
the Tools of the Mind curriculum, there was little time for them
to undertake the kind of free
play that would have allowed them to internalize the skills
taught in the structured parts of the
program (Farran and Wilson 2014). In this case the interaction
between context and theory

of change that undermined program effectiveness was quite
subtle: implementing the program
in a “real-world” setting necessitated the compression of a
program component that seemed
unimportant but turned out to be crucial.
This framework for understanding external validity also makes
it clear that contextual dif-
ferences do not affect policy impact unless they interact with
the policy’s theory of change.
Although contexts are characterized by an almost infinite
number of dimensions and are thus
all unique, this does not imply that all policies must be designed
with a particular context in
mind, since most of these contextual differences are irrelevant
to the policy’s mechanisms. In
practice, of course, it can be difficult to identify salient
contextual differences and judge their
relevance - the specific interactions that undermined both BINP
and the Tools of the Mind
scale-up may not have been obvious ex ante. Section 3 below
presents a structured approach to
helping policymakers identify which dimensions of context are
likely to affect a policy’s impact.

Finally, although the examples presented here have been of
negative interactions with con-
textual differences, these interactions could just as well be
positive - leading a policy that was
not effective in its original context to be effective in a new
context. As Section 4 discusses later,
policy adaptations can aim not just to mitigate threats from
transportation to a new context
but also to improve their effectiveness.
2 Existing Approaches to External Validity
With this framework in mind, this section surveys a range of
existing approaches to dealing
with external validity. On the whole, it finds that the academic
literature on external validity
provides increasingly insightful answers to questions of the
generalizability of impact evaluations
or bodies of evidence - whether evaluation results from a
specific context will hold in unspecified
other contexts. However, it provides more limited insight into
concerns about applicability of
evidence - whether evaluation results from various other
contexts will hold in the specific context
in which a policymaker is working. Since researchers are
typically highly engaged in the conduct

of impact evaluations and creation of evidence for a generalized
audience of evidence consumers
rather than in trying to apply evidence to specific policy
decisions in specific contexts, it is
11
perhaps natural that the literature on external validity has also
focused more on questions of
generalizability than applicability. Although these existing
approaches can be very powerful
and vary tremendously, from empirical to theoretical and formal
to informal, their common
limitation is their inability to analyze the heterogeneity of
policies’ impacts across more than
a handful of dimensions. This contrasts with the high
dimensionality both of policies and of
contexts (Pritchett 2017), and limits the overall usefulness of
these approaches to policymakers
rooted in specific contexts.
One empirically driven response to the variability of policy
impacts across contexts is to
aggregate numerous studies of the same policy. In its simplest
form, this could be a simple

replication in another context. As the policy is tried and
evaluated in more contexts, it may
become possible to aggregate these results further, through a
systematic review or a meta-
analysis. This empirically driven approach is perhaps most
associated with the evidence-based
policy movement, drawing its inspiration largely from
medicine.5 Aggregation in this way can
yield an average treatment effect across study samples (and if
the samples are representative
of their target population, across these populations) in which
the policy has been studied. But
this estimate is of an average treatment effect in the average
context in which the policy has
been evaluated, which can differ from the policy’s effect in a
specific new context in two ways.6
First, the populations in which the policy has previously been
tried and/or evaluated may
differ systematically from the new context in important ways.
For many social policy interven-
tions, for example, there exist numerous studies from OECD
countries but little or no evidence
in developing countries, and Allcott (2015) has shown that
policy experiments are often con-

ducted first in the most favorable locations, leading to a site
selection bias effect. Policymakers
applying this evidence to their own contexts must therefore ask
“is my context average?” Since
contexts have many dimensions, all contexts are unique in some
ways, and it is unclear how
many and which of these dimensions of a context must be
“average” in order for this average
treatment effect to pertain. This is not to say that systematic
reviews are uninformative: under
a normal distribution one would expect most contexts to be
closer to the average than the ex-
tremes across most dimensions, and so absent any further
information about the new context,
an average treatment effect estimated from other contexts would
be the best predictor of a pol-
icy’s impact. But while this makes systematic reviews a useful
starting point for policymakers,
näıvely adopting a policy that has a positive “headline” average
treatment effect in a systematic
review is likely to backfire in many contexts.7
12

Second, there can be significant heterogeneity in policy impact
across contexts, so that a
policy that has a positive effect on average could have a
negative effect in some contexts. The
main empirical approach to dealing with heterogeneous effects
is to employ sub-group analysis,
which breaks down average treatment effects across important
variables: age, gender, income,
region, implementing authority, and conceivably any other
observable variable on which data
exists. Conducting sub-group analysis, either within a single
study or in a meta-analysis, allows
evaluators to answer the more nuanced question “what works
for whom?” This allows policy-
makers to compare their contexts to others on these covariates,
and provides some guidance
about which dimensions of context might matter for a given
policy.
While this information is useful, sub-group analysis is
inherently limited in the number
of variables along which they can disaggregate results.
Individual studies are limited in the
number of variables they can measure and collect, and sub-
group analysis in meta-analysis

is even further restricted by the limited set of variables that are
common to all (or at least
several) studies. Inevitably, there will be some contextual
variables that mediate a policy’s
effectiveness - who controls household food allocations, the fit
of a curriculum within the existing
school day, the prevalence of particular genetic variants - that
are either difficult to measure
or that evaluators might not think to measure ex ante, and are
thus unobserved. Even where
a given covariate is present across studies, one might question
whether this variable interacts
with the policy in the same way across contexts.8 For instance,
low income might undermine
the effectiveness of a skill upgrading intervention in rich
countries because individuals do not
have time to attend the classes (e.g. if they are working multiple
low-wage jobs, or cannot
arrange childcare), but in a poor country income may not be
correlated with time poverty in the
same way, so the intervention might be more effective. The
validity of proxies may also differ
across contexts: for example, medical researchers sometimes
use genetic data from African-

American populations to extrapolate findings to African
populations, even though African-
Americans are not genetically representative of Africa as a
whole (Rajman et al 2017). While
aggregation of evidence across multiple studies (and use of sub-
group analysis for disaggregation
within this) is indeed informative about the predicted success of
an intervention in any given
context - as Vivalt (2017) shows empirically - even for the most
highly researched interventions
there nonetheless remain numerous potential mechanism-context
interactions that existing data
cannot fully predict.
A second approach focuses not on aggregating evidence across
more contexts, but on mak-
13
ing out-of-sample extrapolations through structural modelling
(Deaton and Cartwright 2016) or
other empirical methods that can, in some circumstances, be
used to extrapolate results from
one study to other populations, by exploiting specific forms of
selection and non-compliance

within RCTs or by adjusting estimated impacts based on
heterogeneity over observed covari-
ates (Angrist and Fernandez-Val 2010, Gechter 2016, Kowalski
2016, Andrews and Oster 2018).
Such theoretical or empirical extrapolation methods take
advantage of variation within the
study sample in order to better understand the underlying causal
processes and extrapolate es-
timates from the actual study sample to other populations.
These methods help researchers and
policymakers further improve the informativeness of the
existing evidence about the predicted
impact of the intervention in a new context, but are also
inherently limited in the number of
variables and types of scenarios across which they can
extrapolate. As Low and Meghir (2017,
34) write:
“Structural economic models cannot possibly capture every
aspect of reality, and any
effort to do so would make them unwieldy for either theoretical
insight or applied
analysis. There will always be some economic choices left out
of any particular model

- the key question is how to judge what aspects to leave out
without rendering the
quantitative conclusions of the model irrelevant.”
Yet as the examples of BINP, Tools of the Mind, and
Zimbabwe’s efavirenz rollout illustrate,
the range of contextual factors that can influence policy impact
is immense. While structural
modeling can therefore provide powerful insights about the
effect of some important contextual
factors, even the best-judged model will only be able to
incorporate a small handful of the
numerous variables that policymakers must consider in policy
design. As with the aggregation
approach discussed above, this is certainly informative for
policymakers in specific contexts,
and is an improvement over simply having the results of an
impact evaluation from another
context without such extrapolation, but still falls short of taking
into account all the potential
mechanism-context interactions with which policymakers must
concern themselves.
Similarly, the design of policy experiments has begun to
deliberately vary aspects of the
policy that are important for understanding external validity,

such as whether it is implemented
by an NGO or government (Bold et al 2016, Cameron and Shah
2017, Angrist 2017). Again,
the limitation is that trials can only feasibly vary one or two
dimensions of a policy without
losing statistical power, while the number of dimensions of
policy and context that could matter
14
- combined with their interactions - is effectively infinite.
Likewise, larger experiments would
certainly improve external validity (Muralidharan and Niehaus
2016), but applying the results
will always require the consideration of contextual differences
for any trial on a scale that is less
than global. Banerjee et al ’s (2016b) proposal for the inclusion
of “structured speculation” on
external validity in reports of impact evaluation results is
perhaps the closest in spirit to the
mechanism mapping approach developed in Section 3 of this
paper, but is fundamentally a tool
for evaluators, not policy designers, since such speculation is
necessarily undertaken without a

specific target context in mind.
The “realist evaluation” approach pioneered in sociology and
social policy (Pawson and
Tilley 1997) shares with the recent external validity literature in
economics an emphasis on
mechanisms and heterogeneity rather than simply establishing
average treatment effects. In
asking “why a program works for whom and in what
circumstances” and seeing the objective
of evaluation as the elaboration of “Context-Mechanism-
Outcome configurations (CMOCs)”,
realist evaluation is also related to this paper’s mechanism
mapping approach, albeit from
the perspective of the evaluator rather than the policymaker.
However, the focus of realist
evaluation is typically on how best to evaluate a program rather
than how to use existing
evidence to design a policy. This difference in target audiences
has perhaps contributed to realist
evaluation being perceived as deeply philosophical as well as
unwieldy and time-intensive in
practice (Marchal et al 2012). In contrast, this study’s
mechanism mapping approach is intended
to be practical and simple enough for policymakers to

incorporate into routine processes of policy
design.9
Finally, debates around external validity are perhaps most
advanced in public health, where
discussions of the interaction between mechanism and context
have become central to thinking
about the transportation and scaling of trial results (Moore et al
2015, Leviton 2017), the
complexity of interventions is widely acknowledged and is
beginning to be explored empirically
(Hawe 2015), systematic reviews routinely take realist
approaches to unpacking mechanisms and
heterogeneity (Jagosh et al 2015, Greenhalgh et al 2016), and a
strong institutional architecture
is seeking to establish reporting conventions and other steps to
embed these new approaches
in research (e.g. Wong et al 2016). While this is a model for
other social sciences and policy
fields to follow in some respects, there is also a need for a
simpler and less resource-intensive
analytical framework that is more accessible for other fields and
policy contexts.
15

3 Mechanism Mapping
3.1 Basic Process and Example
Although these techniques for assessing and improving the
external validity of impact evaluation
evidence are important to help guide policymakers towards
policies and interventions that are
more likely to be successful, evidence-based policymakers are
still faced with the challenging
task of diagnosing potential mechanism-context interactions
that could influence the policy’s
effectiveness in their context. If external validity failures arise
from interactions between a
policy’s theory of change and its context, then it follows that
diagnosing such failures requires
a way to examine a policy’s theory of change alongside its
context. Furthermore, if contexts
have numerous dimensions, for many of which hard data may
not be available, then a useful
framework also needs to be able to integrate high-quality,
rigorous evidence (“observables”) as
well as softer, potentially tacit or local information
(“unobservables”). This section introduces

a mechanism mapping approach that fulfills both criteria. I
introduce this method by first
presenting the approach itself, then giving a brief example.10 I
then discuss some practical and
conceptual issues, including the role of empirical evidence, then
suggest some ways in which this
tool can be integrated into processes of policymaking and
evaluation in order to complement
other approaches to evidence-based policy.
The first step of mechanism mapping is to lay out the theory of
change, or mechanism,
through which the policy had its measured impact in the
previous context. As discussed in
Section 1, this can be thought of as a causal chain leading from
a policy’s initial inputs to
its intended final outcomes, via activities, outputs, and
intermediate outcomes. The second
step is to lay out the most important or salient contextual
assumptions underpinning each step
of this chain. These are the characteristics of the context that
are required for the policy to
actually function as the theory of change intends. If the policy
in question had been shown
to be successful in another context, then presumably these

assumptions would have been valid
in that context. The third and final step is to lay out the
corresponding actual contextual
characteristics for each step of the chain, highlighting any
differences between actual contextual
characteristics and the contextual assumptions necessary for the
policy to function as intended.
These differences in context - whether negative or positive - are
what policymakers can use to
predict whether the policy will have a similar, smaller, or larger
impact on the final outcomes
than it did in its previous context, as well as pinpointing the
stage at which the theory of change
16
is likely to be interrupted (and thus which aspects of the policy
may need to be adapted, as
Section 4 discusses later).
To illustrate the approach, consider the Bangladesh Integrated
Nutrition Programme (BINP)
discussed above, which had an identical design to the World
Bank’s earlier TINP project in Tamil
Nadu.11 The intended final outcome of BINP was to improve

mother and infant nutrition. To do
so, government was to provide two main outputs: nutritional
advice delivered to pregnant and
nursing mothers, and the distribution of supplementary food to
mothers to take home. These
outputs would lead to the final outcome via two sets of
intermediate outcomes: first, mothers’
nutritional awareness would improve, alongside their receipt of
the supplemental food; and
second, mothers would then decide to use the supplemental food
for themselves and their infants
(as opposed to giving it to other family members, i.e. program
“leakage”). In order to produce
these outputs, the government required inputs of adequate
financial resources to purchase the
food and pay personnel, as well as a logistical system and
potential pool of extension workers
to deliver the food and nutritional advice. Key activities for
transforming inputs into outputs
could include procuring the food, hiring and training workers,
and conducting outreach to
eligible mothers.
The contextual assumptions required for this theory of change
to work are listed in the

second row of Figure 3. Sound implementation requires that
government: dedicate adequate
financial and human resources to the project; procure and
distribute food and hire workers
effectively, including quality assurance as well as prevention of
excessive corruption, and train
workers adequately; and deliver these outputs to a pool of
eligible mothers predictably and in
a timely fashion. Impact then requires that mothers are able to
attend the sessions and trust
the advice they are being given; that mothers actually control
household food allocation; and
that the supplementary food, if consumed, will actually lead to
the desired improvement in
nutrition. In the Tamil Nadu context, these assumptions were
presumably valid - hence the
impact evaluation finding that TINP significantly improved
mother and infant nutrition (World
Bank 2005b).
The third row of Figure 3 contrasts these contextual
assumptions to the actual contextual
characteristics of the new context, in this case rural Bangladesh.
Recall that BINP succeeded

in distributing food and nutritional advice to the mothers, and
that mothers’ nutritional aware-
ness did actually improve as a result, but that the program failed
to improve mother and infant
nutrition because most of the supplementary food went to other
family members. The key
17
Figure 3: Theory of Change: Bangladesh Integrated Nutrition
Programme
Inputs Activities Outputs Intermed. outcomes 1
Intermed.
outcomes 2
Final
outcomes
T
he
or
y
of
c
ha
ng

e Gov’t
provides
supp.
food and
nutrition
advice to
mothers
Mothers’
nutrition
aware-
ness
improves
Mothers
decide to
use extra
food for
selves
and
infants
Mother
and infant
nutrition
improves
Procure
food, hire
and train
workers
Funds,
potential
workers

Food and
advice
delivered
to target
mothers
in timely
fashion
Mothers
able to
attend
sessions,
trust
advice
Mothers
control
house-
hold food
allocation
More
food will
improve
nutrition
Adequate
procure-
ment,
logistics,
training
processes
Funds
will be
dedicated

and
suitable
workers
available
C
on
te
xt
ua
l a
ss
um
pt
io
ns
Food and
advice
delivered
to target
mothers
in timely
fashion
Mothers
able to
attend
sessions,
trust
advice

Mothers
do not
control
house-
hold food
allocation
More
food will
improve
nutrition
Adequate
procure-
ment,
logistics,
training
processes
Funds
will be
dedicated
and
suitable
workers
available
A
ct
ua
l c
on
te

xt
Source: Author’s elaboration based on Save the Children
(2003), White (2005), World Bank (2005a), World Bank
(2005b), Cartwright and Hardie (2014).
contextual assumption that did not hold in Bangladesh was that
mothers controlled house-
hold food allocation, and would thus be able to act on their
improved nutritional awareness.
This broke the link between Intermediate Outcome 1 and
Intermediate Outcome 2; since In-
termediate Outcome 2 was not achieved, neither was the Final
Outcome. If the designers of
BINP had carried out a mechanism mapping when transporting
the successful TINP program
to Bangladesh, perhaps they would have uncovered this crucial
but implicit assumption.
3.2 Practical and Conceptual Issues
Each of these three steps - the theory of change, contextual
assumptions, and actual charac-
teristics - are associated with important conceptual and practical
challenges. The first is how
to decompose a policy or program into a theory of change. In
many cases, policymakers in

new contexts can establish this based on the original impact
evaluation or meta-analysis on
18
which they are basing the transportation or scale-up of the
policy (although many published
impact evaluations do not fully specify their intended theory of
change or evidence supporting
this mechanism, leaving it partially to the policymaker in the
new context to specify this causal
chain). While this can be challenging, theories of change (and
related tools such as logic mod-
els, results chains, and logframes) are an intuitive and
commonly taught tool of policymaking
in many evaluation textbooks (Gertler et al 2016), government
manuals (HM Treasury 2011),
and donor guidelines (DFID 2012). In practice, the aspect of
laying out theories of change
that policymakers often find most challenging is related to
classification of causal steps (e.g.
activities vs. outputs, etc.), which for the purpose of mechanism
mapping matters less than
isolating each link in the causal chain.

Of course, some policies are more complicated than others. For
clarity, mechanism mapping
is here illustrated using the type of simple, linear theory of
change that adequately characterizes
many impact evaluations. Theories of change can of course be
much more intricate, for example
by mapping out multiple components of a multi-faceted
program. Supplementary Appendix A
presents an example of a policy whose theory of change
contains 55 distinct steps across multiple
interlocking components. Since each of these 55 steps is
numbered and has its precursor steps
clearly identified, the same basic procedure of juxtaposing the
contextual assumptions against
actual contextual characteristics for each step can be applied
(albeit perhaps in the form of a
table rather than underneath each step in the theory of change,
for reasons of visual clarity).
Similarly, mechanism mapping can be adapted to policies that
are intended to lead to mul-
tiple final outcomes (e.g. a cash transfer that is intended to
increase consumption and improve
child school attendance); to examine the likelihood of negative
outcomes or side effects of the

policy (Bonell et al 2014); and to shed light on questions of
multiple competing mechanisms.
This involves laying out multiple parallel mechanism maps
representing different potential path-
ways to the positive or negative outcomes, then analyzing each
to identify which seem most
plausible and which key contextual assumptions or
characteristics seem most important. Sup-
plementary Appendix B presents an example theory of change
from a Botswanan NGO that
mapped out parallel theories of change against sets of
contextual assumptions in order to ex-
amine competing mechanisms and scenarios leading to both
positive and negative potential
outcomes as part of the intervention adaptation process prior to
transporting an intervention
from Kenya to Botswana. Finally, some policies are not just
complicated but also complex
in that their implementation involves a significant degree of
uncertainty, simultaneity, and/or
19
feedback. While complex policies are inherently more difficult
to create theories of change for

(as well as to conduct impact evaluations on), Davies (2004),
Rogers (2008), and De Silva et al
(2014) provide examples and guidance for mapping theories of
change for complex interventions,
which all share the common feature of breaking interventions
down into a set of logical steps
and are thus amenable to mechanism mapping.
A second conceptual challenge confronting policymakers is how
to identify which are the
most salient contextual assumptions to consider, since the high
dimensionality of context makes
it unfeasible to consider all such assumptions. Although this is
ultimately a matter of judgment,
four practical guidelines suggest themselves:
1. Results from sub-group analysis of impact evaluations or
meta-analysis may give insights
into common determinants of program effectiveness and thus
shed light onto key assump-
tions. For example, a meta-analysis of food supplementation
programs showed that pro-
grams where supplements were delivered at feeding centers
found lower average leakage
of food to other family members (15 percent) than when food

was delivered at home (64
percent), suggesting that assumptions around intra-household
food allocation are key to
the success of such policies (Kristjansson et al 2015).
2. Many dimensions of context are frequently salient and should
be taken into consideration
for almost any policy: demographic and socioeconomic
characteristics of the target pop-
ulation; resource availability; political support and resistance;
social and cultural norms;
the effectiveness of implementing organizations; potential for
corruption or resource diver-
sion; geographic accessibility and other logistical issues; etc.
The UK government Magenta
Book (HM Treasury 2011) and Ravallion (2009) provide lists of
aspects of context for pol-
icymakers to consider when transporting a program.
3. Important contextual factors specific to a particular policy
are often implied by the pol-
icy’s theory of change (Moore et al 2015). For instance, laying
out BINP’s theory of
change makes it clear that decisionmaking over household food
allocation is a key contex-

tual assumption, and doing a mechanism map for the Tools of
the Mind early childhood
education program scale-up would have made it clear that
assumptions were necessary
about the fit of the program into the existing school day.
4. Participatory policymaking processes, where input from
affected stakeholders such as im-
pacted populations (Parker et al 2008) or implementing staff
(Leviton and Trujillo 2016)
20
is systematically sought during the policy design process, are
especially well suited to
identifying salient contextual assumptions, since directly
affected or involved individuals
are likely to be able to more accurately envision the
practicalities of the policy’s impact
and implementation.
A third practical challenge - establishing actual contextual
characteristics to compare to
these assumptions - is another aspect of mechanism mapping
where empirical evidence is crucial.
In addition to compiling evidence on impact from existing

impact evaluations or meta-analyses,
policymakers can also gather new data by (to return to the BINP
example) examining budget
data and political context to shed light on resource availability,
investigating the performance
of the implementing agency’s procurement processes,
conducting a survey of eligible mothers’
trust of the state and baseline level of nutritional knowledge,
undertaking (or reading existing)
qualitative research on household food allocation decisions in
rural Bangladesh, and discussing
with public health experts the prevalence of diseases that might
inhibit infants from absorbing
nutrients properly. Bates and Glennerster (2017) present several
excellent examples of using
simple descriptive data, some gathered in just two weeks, to
validate contextual assumptions.
Impact evaluation results from other contexts and systematic
reviews can enter into mechanism
mapping via the contextual assumptions row, as policymakers
can use the results of that eval-
uation to document the extent to which the contextual
assumptions held in that context, and
possibly even to investigate how variation in these contextual

factors was related to the policy’s
effectiveness. When the mechanism mapping is being conducted
for a scale-up of a policy that
has already been trialed on a small scale in the same location,
the mechanism mapper may
even have quite detailed evidence on these issues, and so the
search for new empirical evidence
can focus on the aspects of context that are changing with the
larger-scale implementation:
the effectiveness of the implementing agency, general
equilibrium or spillover effects, political
economy issues, etc. One could even imagine policymakers
conducting quick and cheap “mech-
anism experiments” (Ludwig et al 2011) to validate each step of
the theory of change prior
to beginning full-scale implementation, or (less ambitiously)
follow Rigterink and Schomerus
(2016) in compiling evidence from existing evaluations on the
validity of some aspects of the
policy’s theory of change in cases where no impact evaluation
of the full theory of change has
yet been conducted. In practice, of course, the available
evidence on each of the contextual
assumptions, and hence each step of the theory of change, is

likely to vary in terms of rigor
and depth. Mechanism mapping thus provides an integrative
framework for policymakers to
21
apply all available evidence - from RCTs to administrative data
to qualitative research to expert
judgment - to their policy decisions, and the same basic process
can be scaled up or down in
terms of detail in order to fit within policymakers’ time,
resource, and information constraints.
As a procedural matter, a practical way for policymakers to
conduct mechanism mapping
is in a nested manner. The analyst begins by identifying only
the most salient steps in the
policy’s theory of change along with accompanying contextual
assumptions and characteristics,
following the guidance above. This presents a top-level picture
of the overall fit of the policy’s
required assumptions with the context’s actual characteristics.
At this stage, it is likely that
some steps of the theory of change will have a better fit than
others (as in Figure 3). From this

top-level view, each of these links in the mechanism can then be
broken down and analyzed
in more detail. Where the contextual assumptions seemed to fit
well at the overall stage - for
instance, the activities or outputs steps of Figure 3 - breaking
down the mechanism serves as a
further plausibility check. For instance, an ex ante mechanism
map of BINP could have thought
in more detail about the steps involved in procuring and
distributing food, in hiring and training
workers, and in coordinating these two program elements, and
what resources and bureaucratic
processes and skills would be required to execute them. Where
the contextual assumptions do
not seem to fit well at the top-level stage - for instance in
Figure 3’s intermediate outcome
of mothers and infants consuming the extra food themselves -
going into more detail can help
the analyst identify the root cause of the disjuncture. In the
BINP case, this was that TINP’s
synergy between advice and food distribution to mothers would
not apply in Bangladesh. Being
more precise in pinpointing the problem simplifies the problem
of adaptation discussed in the

next section. Continuing this nested approach to mechanism
mapping even further in detail
could be especially useful for bureaucratic planning processes,
by linking a program’s theory of
change to a detailed set of tasks to be performed and
coordinated.
While mechanism mapping is intended primarily as a tool for
policymakers to use prospec-
tively to predict the impact of transporting or scaling up a
policy that has been successful
elsewhere, mechanism mapping is also of potential value to
evaluators and to policymakers de-
signing policy from scratch. First, it can be useful in the
retrospective evaluation of policies
by helping evaluators to show clearly the intended and actual
mechanism(s) through which a
policy had its impact (or non-impact). Showing intended versus
actual mechanism maps in this
way can help evaluators clarify their own thinking and also
make the evaluation more informa-
tive to readers and policymakers from other contexts. Second,
prospective mechanism mapping
22

(e.g. during trial design or in a pre-analysis plan, as in the
example discussed in Appendix B)
can help evaluators ensure that they collect the data necessary
to assess each of the contextual
assumptions ex post, along with potential undesirable outcomes
and the alternative mechanisms
that might bring them about. This process can even be useful in
cases where the policy being
trialled is completely new, rather than transported from
elsewhere or scaled up. Third, mech-
anism mapping can help evaluators make null results more
informative, by specifying which
aspects of the policy (if any) worked as intended, where the
causal chain broke down, and what
future trials should (or should not) considering adapting.
Of course, an important limitation of mechanism mapping for
evaluation purposes is that
mechanism mapping is only intended to yield directional
predictions about overall policy im-
pacts, unlike statistical methods that can yield point estimates
and other more precise infor-
mation. However, directional predictions are still useful for
many purposes - in particular for

optimizing policy design. Finally, the process of being explicit
about a policy’s theory of change
and the fit between its contextual assumptions and actual
characteristics is also important for
policymakers who are designing policies from scratch, without
the aid of a successful trial from
elsewhere. While the lack of prior evidence makes this
inherently more uncertain, particularly
in terms of accurately specifying the theory of change, the same
basic structure and concepts
may be helpful nonetheless.
4 Policy Transportation and Adaptation
The external validity of impact evaluations is often framed as a
question of “would the same
policy work in another context?” In practice, however, it is
usually necessary to make at least
some adaptations to a policy in order for it to work in a new
context. These can be superficial,
as in the translation of program materials into a different
language, or more substantive, for
example by adapting the nutrition advice component of BINP to
include not just mothers
but their husbands and mothers-in-law. Even where such
adaptation is not strictly necessary,

appropriate adaptations may sometimes be able to optimize an
already effective program. But
the number of adaptations that could be made to a policy or
intervention is nearly infinite -
which aspects should be targeted for adaptation, and which left
alone? And how much should a
policy that was successul in another context be adapted, since
adaptations risk changing aspects
of the policy that make it effective?
23
Across social science disciplines, these questions of adaptation
are even less well studied
than questions of external validity, with only ad hoc (if any)
discussion of how external validity
concerns should be addressed through adaptations. For example,
Bates and Glennerster (2017)
present a framework for analyzing external validity and several
applied examples, but potential
adaptations resulting from their diagnostics are mentioned only
briefly (both in the framework
and their discussion). The literature is most advanced in social
policy and applied psychol-

ogy, where there is a well-worn debate on the trade-offs
between fidelity to evidence-backed
interventions versus cultural adaptation of programs (Castro et
al 2010), although even this
literature offers little guidance to policymakers beyond
conducting focus groups and small-scale
pilots. A small literature examines this debate empirically, by
comparing the effectiveness of
various policies or programs according to whether they were
newly designed (“homegrown”),
transported but adapted, or transported without adaptation. The
results are mixed: Hasson
et al (2014) compare 307 German and Swedish social
interventions and find that novel and
adapted programs are more effective than programs that are
transported without adaptation,
while Leijten et al (2016) find no difference on average between
homegrown and transported
parenting interventions across a range of countries, and Gardner
et al (2015) find that several
branded parenting interventions developed in the United States
and Australia are at least as
effective in non-Western countries even with little adaptation.
Of course, the challenge of trying

to use meta-analytic methods to ascertain the optimal level of
adaptation is that it is unclear
exactly what changes in context the adaptations were
responding to, or how appropriate the
adaptations were. As with policy choice, knowing the average
effectiveness of adapted policies
is less useful for policymakers than guidance in identifying
which adaptations are likely to be
necessary and effective in their specific context.
The diagnostic aspect of mechanism mapping helps fill this gap
confronting policymakers.
Since mechanism mapping as a diagnostic tool focuses on the
interaction between a policy’s
theory of change and differences in context, the diagnosis of
whether a policy is likely to be
as effective in a new context as it was elsewhere inherently
involves highlighting the aspects of
the policy that should be targeted for adaptation. In the case of
BINP, for example, Figure 3
makes it obvious that the key aspect where adaptation was
necessary was the nutritional advice
component, and specifically the individuals to whom this was
targeted. The mechanism map

alone is not sufficient to determine exactly what the adaptation
should be - whether it is possible
to simply include husbands and mothers-in-law through the
existing delivery mechanism, for
24
example, requires additional context-specific knowledge and
feasibility investigations, as in any
policy design process - but it does identify which aspect of the
policy is problematic, and why.
Similarly, Figure 3 makes clear that the other steps in BINP’s
theory of change fit well with
the contextual assumptions and previous context in which the
program had been evaluated,
suggesting that there is little need for adaptation in these
respects. The design of the resulting
adapted policy is thus informed both by evaluation evidence
from other contexts - through the
aspects of the original policy that were maintained in the new
context - as well as by local,
context-specific knowledge - through the aspects that were
adapted.
The same framework can also be used to identify adaptations
that might be necessary (or

potentially detrimental) in scaling up a policy that was
successful in a small-scale trial. Most
obviously, contextual assumptions that held in the trial may not
hold when implementing at
scale. For example, government agents may require different
incentive or monitoring schemes
than non-governmental agents in order to elicit similar effort
levels (Cameron and Shah 2017),
or incentive schemes that were effective for non-governmental
implementers in small trials may
be unfeasible for political economy reasons when implemented
at scale (Bold et al 2016), ne-
cessitating adaptation of the policy for scale-up. Similarly,
adaptations might be imposed by
the scale-up process itself, as in the Tools of the Mind scale-up
where implementation at scale
in schools without close experimental control led unstructured-
but-crucial components of the
program to be crowded out by other demands on school time.
Where such enforced adaptations
or risks can be foreseen in advance, mechanism mapping
provides a framework for thinking
through their potential consequences and thus possible
mitigating measures.

Of course, making even apparently superficial adaptations to an
intervention also creates
new potential mismatches between the contextual assumptions
for the adapted theory of change
and contextual realities. In practice, then, policymakers need to
repeat the diagnostic process
outlined in the previous section on the adapted theory of
change, then potentially re-adapt, and
so on in an iterative process. In this way, mechanism mapping
complements another recent inno-
vation: adaptive policymaking, which views policy design and
evaluation as an iterative process
of experimentation with tight feedback loops (Pritchett et al
2013, World Bank 2015). As a
policy diagnostic tool that focuses on mechanism, context, and
their interaction, mechanism
mapping can be integrated with adaptive policymaking
processes to help connect experimen-
tation to a more precise diagnosis of the barriers to the
effectiveness of previous iterations of
a policy, thus adding precision to the experimental search
process. Specifically, policymak-
25

ers can use the weakest assumption link in the theory of change
(as identified by mechanism
mapping) as the starting point for adaptive experimentation.
Similarly, since monitoring and
data collection strategies are typically based a policy’s theory
of change or logframe, the data
that organizations generate during adaptive policymaking
processes often closely aligns with
the evidence required to make mechanism mapping more
empirically rigorous.
With respect to the second question, on the optimal extent of
adaptation, mechanism map-
ping’s simultaneous use of evaluation evidence from other
contexts and knowledge of the local
context highlights a fundamental trade-off. On one hand,
evaluation evidence on a policy’s
effectiveness in other contexts is likely to be more rigorous
(especially in causal identification)
than information about the local context. However, relying on
this evidence requires strict
fidelity to the original policy design, implying that
policymakers should refrain from making
adaptations as much as possible. On the other hand, using

mechanism mapping to identify
potential adaptations can make efficient use of local
information, which (even if less rigorous) is
specific to the context in question. However, using this local
information to make adaptations
decreases the relevance of evaluation evidence from elsewhere.
There is therefore a trade-off
between evidence from other contexts and local knowledge of
the current context, making it
unclear how quick policymakers should be to make adaptations
when they have identified a
difference in context. Should adaptations be made in response
only to major differences, or also
to minor ones? And what constitutes a major or minor
difference?
Figure 4: The Fidelity-Adaptation Spectrum
More
adaptation
More
fidelity
Homegrown
policy
Substantive
adaptations

Full
fidelity
Superficial
adaptations
Optimal policy with better evidence from other contexts
Optimal policy with better information about local context
There is no universally optimal solution to these questions,
because the characteristics of
a specific context - however apparently minor or idiosyncratic
they are - can undermine the
effectiveness of even the most evidence-backed policy, yet
policymakers’ ability to foresee these
interactions is limited (hence the need to evaluate policies and
use evidence in the first place).
26
That said, the respective roles of evidence and local information
suggests that the optimal
extent of adaptation will vary from case to case, depending on
several factors.
First, to the extent that available impact evaluation evidence on
the policy is strong, con-

sistent, and from similar contexts, policymakers should make
fewer adaptations (all else equal).
These factors reduce the uncertainty associated with a policy’s
impact in its current form, thus
increasing the risk that adaptations could backfire. For example,
Evans and Popova (2015),
Pritchett (2017), and Vivalt (2017) show that some types of
development interventions exhibit
much greater variance across trials, suggesting that some
interventions are more sensitive to
contextual differences than others and thus presumably have a
greater need for adaptation.
Second, the greater the policymaker’s information about the
local context - whether in the
form of formal evidence and data, or simply familiarity and
tacit knowledge - the more a policy-
maker should be willing to adapt a policy, since this knowledge
allows for better identification
of negative or positive context-mechanism interactions as well
as suitable adaptations. This im-
plies that the optimal level of adaptation in a specific case will
vary not only by policy area and
country, but also by the information set of the policymaker:
ceteris paribus, a policymaker with

less familiarity, information, or ability to gather information
about the target context should
generally make fewer adaptations to a transported policy than a
policymaker who either has or
can obtain more detailed contextual information.
Third, the optimal level is also likely to vary according to the
nature of the policy process.
An extensive participatory policy design process that engages
key stakeholders and beneficiaries
will elicit more local information and is more likely to lead to
useful adaptations than a quick
decision made by an individual policymaker (Parker et al 2008,
Leviton and Trujillo 2017). For
instance, although the World Bank based the design of BINP on
its successful program in Tamil
Nadu, the Bank’s own evaluation found that the view that
“project design and implementation
should have sought to broaden the target audience for its
nutritional messages. . . was expressed
by BINP fieldworkers and women themselves in project areas
during field visits” (World Bank
2005b, 9). When such participatory processes are not practically
or politically feasible, or when
policymakers do not have time to gather extensive data on

actual contextual characteristics
and are thus forced to rely on their own knowledge,
policymakers should weight evidence from
elsewhere relatively more heavily and thus usually make fewer
adaptations.
Finally, making appropriate adaptations to a policy requires
understanding not only of the
context but also of the policy’s mechanism, since what matters
for impact is the interaction
27
between mechanism and context. While better understanding of
the mechanism is unrelated to
the optimal level of adaptations to a policy (unlike better
contextual information), one would
expect it to lead to more successful adaptations. This is an area
in which bureaucratic expertise
and research - in particular high-quality evaluations or
systematic reviews that are able to
trace mechanisms - can be especially useful. Effective policy
adaptation thus stems not just
from contextual knowledge, but from its combination with
rigorous evidence and professional

judgment.
5 Conclusion
As the harm caused by the neuropsychiatric interaction between
the HIV drug efavirenz and
the rare genetic variant common in Zimbabwe’s population
became evident, some of the same
scientists who predicted the problem designed a strategy to
address it. “[T]he current ‘one
size fits all’ [efavirenz] dose strategy in sub-Saharan Africa
needs to be carefully reevaluated by
considering integration of an individualized therapeutic
approach” that combines individualized
testing, monitoring, and dosing adjustment (Masimirembwa et al
2016, 4). As one of the
scientists, Collen Masimirembwa, stated: “It’s not a bad drug.
We just know it can be improved
in Africa” (Nordling 2017, 20).
Just as the spread of precision medicine promises to move
medical treatment beyond one-
size-fits-all recommendations, so too is it necessary for impact
evaluators and policymakers
to find ways to make evidence-based policymaking more
responsive to the particularities of

specific contexts. While impact evaluations and systematic
reviews provide excellent starting
points for doctors and policymakers alike, even before the
advent of precision medicine actual
medical practice has always required doctors to combine
rigorous research evidence with their
individual expertise and judgment for each case (Deaton 2010).
While the rapidly growing
external validity literature has focused largely on the
generalizability of a policy from a specific
context, the relevant question for policymakers is the
applicability of evidence to their specific
context. This requires an understanding of the interactions
between a policy’s theory of change,
as supported by contextual assumptions, and the actual
characteristics of the context to which
a policy is being transported.
This article has introduced mechanism mapping as a flexible
and conceptually simple diag-
nostic tool to help policymakers assess the fit of evidence-based
policies with their own contexts.
28

Similarly, the same basic procedure can be applied to simple
policies with a linear theory of
change and only one outcome of interest, or to complex policies
with numerous potential out-
comes and feedback loops. This diagnostic process also feeds
directly into the identification of
potential policy adaptations, by identifying the specific features
of a policy that are likely to be
problematic in the new context.
The rapid growth of evidence-based policy has created a rich
pool of rigorous impact evalua-
tions, and a growing literature on external validity has provided
theoretical and empirical tools
for generalizing these results beyond their original context.
However, this paper has highlighted
the paucity of guidance to policymakers on how to solve the
“last mile” problems of policy
transportation and scale-up: the need to bridge the inevitable
gap between the best evidence
available from other contexts and the particularities of their
own context, and whether and
how to adapt evidence-based policies to better fit these
contextual idiosyncrasies. While the
mechanism mapping framework is potentially useful in this

regard, there is a need for more
and better research on key questions like how policymakers tend
to make these contextual-fit
assessments and adaptations in practice, how they update their
beliefs and make adaptations
based on this, and how research and institutional structures can
improve their judgment in these
regards. Questions like these represent the basis for an
intellectually rich and policy-relevant
agenda for researchers and practitioners alike.
Notes
1I use the terms policy, intervention, and program
interchangeably throughout, since the distinctions between
them are not relevant for this paper’s purposes.
2For a more technically precise discussion of these issues, see
Deaton and Cartwright (2016).
3Random sampling is of course only sufficient for
representativeness with large enough sample sizes, but as
stated above, this article abstracts from this and other statistical
issues.
4While there are numerous different disciplinary and
institutional approaches and terminologies associated
with elaborating theories of change (e.g. DFID 2012, De Silva

et al 2014), the aim of this paper is not to
adjudicate the debate between these various approaches, nor to
suggest a best practice for doing so. Rather, this
paper takes a simple approach in order to focus on the core
concepts. This approach can equally be applied to
theories of change written in different formats.
5The Cochrane and Campbell Collaborations and the UK
government’s What Works Network are the most
prominent repositories of systematic reviews and meta-analyses.
6Meta-analysis is intended to capture real variation from
differences in context as well as random statistical
variation from chance; as discussed previously, the latter is
outside the scope of this paper.
29
7This point is not meant to caricature the views of authors of
systematic reviews, most of whom have ap-
propriately nuanced views of how systematic reviews should be
used by policymakers, but simply to clarify the
conceptual limitations of the “headline” average treatment
effect that readers often focus on.
8More precisely, the correlation of observables with
unobservables may differ across contexts. A further

limitation of sub-group analysis is of course the issue of limited
power and the risk of false positives arising from
multiple testing (Petticrew et al 2012), but such statistical
issues are beyond the scope of this paper.
9Pawson and Manzano-Santaella (2012) criticize the quality of
many evaluations that claim to be realist,
particularly for their over-reliance on descriptive, qualitative
data.
10The policy memo accompanying this paper (Williams 2017)
presents a simplified “how-to” five-step guide to
mechanism mapping for policymakers.
11This example is based on Cartwright and Hardie’s excellent
exposition (2014, 80-84), as well as on Save the
Children (2003), White (2005), World Bank (2005a), and World
Bank (2005b). This article’s discussion of TINP
and BINP and their contexts is of course simplified for clarity
and brevity.
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Appendix A Example of a Complicated Theory of Change
Figure A1: Theory of Change: Supply Chains 4 Community
Case Management (SC4CCM)
55
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ne
d
in
s
up
po
rt
iv
e
su
pe
rv
is
io
n
an
d

th
e
pr
oc
ed
ur
es
a
nd
pr
oc
es
se
s
fo
r

CC
M
p
ro
du
ct
su
pp
ly
c
ha
in
37
.

Tr
an
sp
or
ta
ti
on
an
d
ot
he
r
re
so
ur
ce

s
av
ai
la
bl
e
to
co
nd
uc
t
su
pe
rv
is
io

n 46
. S
tr
ea
m
lin
ed
pr
oc
ed
ur
es
fo
r
pr

ov
id
in
g
fe
ed
ba
ck
a
nd
s
up
er
vi
si
on

to
th
e
CH
W
s
ex
is
t a
nd
a
re
do
cu
m
en

te
d
39
. S
ta
ff
re
sp
on
si
bl
e
fo
r
pr

ov
id
in
g
lo
gi
st
ic
s
fe
ed
ba
ck
r
ep
or
ts

ar
e
t
ra
in
ed
a
nd
pr
od
uc
e
re
po
rt

s
52
. G
ov
er
nm
en
t
de
si
gn
at
es
a
b
ud

ge
t
lin
e
/
o
r
do
no
r
pr
ov
id
es
s
uf
fic

ie
nt
fu
nd
in
g
fo
r
pr
og
ra
m
a
nd
t
ho

se
fu
nd
s
ar
e
al
lo
ca
te
d
an
d
di
sb
ur
se

d
w
he
n
ne
ed
ed
44
. S
tr
ea
m
lin
ed
p
ro
ce

du
re
s
fo
r
or
de
ri
ng
, r
ep
or
ti
ng
,
in

ve
nt
or
y
co
nt
ro
l,
st
or
ag
e
an
d
di
sp
os

al
o
f e
xp
ir
ed
/
da
m
ag
ed
h
ea
lth
p
ro

du
ct
s
ex
is
t a
nd
a
re
d
oc
um
en
te
d
25

. C
H
W
Su
pe
rv
is
or
s
kn
ow
o
f a
nd
di

st
ri
bu
te
in
ce
nt
iv
es
w
he
n
ap
pr
op

ri
at
e
47
. D
ef
in
ed
C
H
W
in
ce
nt
iv
e

sy
st
em
th
at
in
cl
ud
es
s
up
pl
y
ch
ai

n
pe
rf
or
m
an
ce
ex
is
ts
a
nd
is
do
cu

m
en
te
d
13
. C
H
W
s
ro
ut
in
el
y
co
lle

ct
a
nd
re
po
rt
ti
m
el
y,
ac
cu
ra
te

lo
gi
st
ic
s
da
ta
33
. S
ta
ff
a
t
re
su
pp

ly
po
in
t/
s
ar
e
tr
ai
ne
d
in
pr
oc
ed

ur
es
a
nd
p
ro
ce
ss
es
fo
r
CC
M
p
ro
du

ct
s
up
pl
y
ch
ai
n
19
. S
ec
ur
e
an
d
su
it

ab
le
s
to
ra
ge
co
nt
ai
ne
rs
o
r
sh
el
vi

ng
fo
r
CC
M
pr
od
uc
ts
a
re
pr
oc
ur

ed
w
he
re
ne
ed
ed
34
. C
H
W
s
ar
e
tr
ai

ne
d
in
pr
oc
ed
ur
es
a
nd
pr
oc
es
se
s

fo
r
CC
M
p
ro
du
ct
s
up
pl
y
ch
ai
n
17

. L
M
IS
fo
rm
s
or
ot
he
r
da
ta
co
lle
ct

io
n
to
ol
s
ar
e
av
ai
la
bl
e
fo
r
CH
W

s
CH
W
s
ha
ve
u
sa
bl
e
an
d
qu
al
it
y
m

ed
ic
in
es
a
va
ila
bl
e
w
he
n
ne
ed
ed
fo

r
ap
pr
op
ri
at
e
tr
ea
tm
en
t o
f c
om
m
on
c

hi
ld
ho
od
ill
ne
ss
es
*
Si
ck
c
hi
ld
re

n
re
ce
iv
e
ap
pr
op
ri
at
e
tr
ea
tm
en
t
fo

r
co
m
m
on
c
hi
ld
ho
od
il
ln
es
se
s*
2.
C

H
W
s,
or
p
er
so
n
re
sp
on
si
bl
e
fo
r

CH
W
r
es
up
pl
y,
kn
ow
h
ow
, w
he
re
, w
ha

t,
w
he
n
an
d
ho
w
m
uc
h
of
ea
ch
p
ro

du
ct
t
o
re
qu
is
it
io
n
or
r
es
up
pl
y

an
d
ac
t a
s
ne
ed
ed
3.
C
H
W
s
ha
ve
a
de

qu
at
e
st
or
ag
e:
co
rr
ec
t
co
nd
iti
on
s,
s

ec
ur
it
y
an
d
ad
eq
ua
te
s
pa
ce
.
Sy
st

em
P
er
fo
rm
an
ce
To
ol
s
/
R
es
ou
rc
es

Kn
ow
le
dg
e
/
Sk
ill
s
Pr
oc
es
se
s
Fu
nd

in
g
Co
m
m
un
ic
at
io
n
/
In
fo
rm
at
io
n

Po
lic
y
/
St
ra
te
gy
G
oa
ls
a
nd
O
ut
co

m
es
GF
D
C
1
51
. M
an
uf
ac
tu
re
rs
h
av

e
in
fo
rm
at
io
n
on
e
st
im
at
ed
de
m
an

d
fo
r
ac
ce
pt
ab
le
fo
rm
ul
at
io
ns
o

f C
CM
pr
od
uc
ts
, i
nc
lu
di
ng
v
ia
bl
e
pr

ic
e
po
in
ts
A
49
. S
uf
fic
ie
nt
fu
nd
in
g

fo
r
pr
oc
ur
in
g
co
m
m
od
it
ie
s
ar
e
av

ai
la
bl
e
50
. S
tr
ea
m
lin
ed
p
ro
ce
du
re

s
fo
r
ro
ut
in
e
qu
an
ti
fic
at
io
n
an
d
pi

pe
lin
e
m
on
ito
ri
ng
ex
is
t
an
d
ar
e
do

cu
m
en
te
d
48
. H
ig
h-
qu
al
it
y,
c
hi
ld

-a
nd
su
pp
ly
c
ha
in
-
fr
ie
nd
ly
C
CM

pr
od
uc
ts
a
re
a
va
ila
bl
e
fr
om
gl
ob

al
, r
eg
io
na
l,
or
lo
ca
l
m
ar
ke
tp
la
ce
30

. H
ig
h-
qu
al
ity
, c
hi
ld
-
an
d
su
pp
ly
c
ha

in
fr
ie
nd
ly
CC
M
p
ro
du
ct
s
ar
e
on

N
EM
L
27
. P
ro
du
ct
sp
ec
ifi
ca
tio
ns
a

re
de
te
rm
in
ed
fo
r
pr
oc
ur
em
en
t
41
. C

CM
p
ro
du
ct
se
le
ct
io
n
is
b
as
ed

on
s
ta
nd
ar
d
tr
ea
tm
en
t
al
go
ri
th
m
s

an
d
su
pp
ly
c
ha
in
co
ns
id
er
at
io
ns

40
. R
eg
is
tr
at
io
n
of
n
ew
h
ig
h-
qu
al
ity

, c
hi
ld
-
an
d
su
pp
ly
ch
ai
n
fr
ie
nd
ly

CC
M
p
ro
du
ct
s
oc
cu
rs
16
. T
oo
ls
a

nd
r
es
ou
rc
es
n
ee
de
d
to
im
pl
em
en
t

pr
oc
ed
ur
es
a
re
p
ro
vi
de
d
29
. R
ou
ti

ne
qu
an
ti
fic
at
io
n
fo
r
pr
oc
ur
em
en
t

is
d
on
e
28
. F
un
ds
a
re
a
llo
ca
te
d
fo

r
pr
oc
ur
em
en
t
ba
se
d
on
q
ua
nt
ifi
ca
ti

on
a
nd
di
sb
ur
se
d
re
gu
la
rl
y
8.
R

es
up
pl
y
po
in
t/
s
ha
ve
a
de
qu
at
e
st

or
ag
e:
co
rr
ec
t c
on
di
tio
ns
,
se
cu
ri
ty
a

nd
ad
eq
ua
te
s
pa
ce
9.
S
ta
ff
a
t
al

l r
es
up
pl
y
po
in
ts
a
re
m
ot
iv
at
ed
an

d
pe
rf
or
m
t
he
ir
r
ol
es
in
t
he
C

CM
p
ro
du
ct
su
pp
ly
c
ha
in
a
s
ex
pe
ct

ed
43
. S
ta
ff
re
sp
on
si
bl
e
fo
r
qu
an
ti

fic
at
io
n
a
re
tr
ai
ne
d
42
. V
is
ib
ili

ty
o
f
pr
og
ra
m
, s
up
pl
y
an
d
de
m
an
d

da
ta
ex
is
ts
32
. M
ec
ha
ni
sm
fo
r
co
m

m
un
ic
at
io
n
be
tw
ee
n
st
ak
eh
ol
de
rs
e

xi
st
s
31
. F
un
di
ng
a
nd
pr
oc
ur
em
en
t

cy
cl
es
a
re
al
ig
ne
d
15
. T
im
el
y
pr

oc
ur
em
en
t
of
q
ua
lit
y
CC
M
p
ro
du
ct
s

oc
cu
rs
6.
A
de
qu
at
e
qu
an
ti
ti
es
o
f C
CM

pr
od
uc
ts
a
re
av
ai
la
bl
e
at
a
ll

di
st
ri
bu
ti
on
p
oi
nt
s
in
c
ou
nt
ry
1.
N

ec
es
sa
ry
, u
sa
bl
e,
q
ua
lit
y
CC
M
p
ro

du
ct
s
ar
e
av
ai
la
bl
e
at
C
H
W
re
su
pp

ly
p
oi
nt
/s
24
. S
up
er
vi
si
on
to
ol
s
ar

e
av
ai
la
bl
e
54
. U
ni
t/
s
ex
is
ts
t
ha

t
pl
an
, m
an
ag
e
an
d
co
or
di
na
te
re
so
ur

ce
s,
s
er
vi
ce
s,
co
nt
ra
ct
s,
b
ud
ge
t,

p
er
so
nn
el
e
tc
.
E
B
26
. C
H
W
s
ha

ve
kn
ow
le
dg
e
of
in
ce
nt
iv
es
10
. T

oo
ls
a
nd
re
so
ur
ce
s
ne
ed
ed
to
im
pl

em
en
t
pr
oc
ed
ur
es
a
re
pr
ov
id
ed
18
. A

pp
ro
pr
ia
te
an
d
se
cu
re
st
or
ag
e

sp
ac
e
fo
r
CC
M
pr
od
uc
ts
is
av
ai
la

bl
e
45
. S
tr
ea
m
lin
ed
t
ra
ns
po
rt
at
io

n
pr
oc
ed
ur
es
f
or
m
ai
nt
ai
ni
ng
ve
hi

cl
es
a
nd
d
is
tr
ib
ut
io
n
/
co
lle
ct
io
n

of
g
oo
ds
e
xi
st
a
nd
ar
e
do
cu
m
en

te
d
36
. D
ri
ve
rs
a
re
t
ra
in
ed
in
S
C
tr

an
sp
or
t,
a
pp
ro
pr
ia
te
p
ro
du
ct
ha
nd

lin
g
&
m
ai
nt
en
an
ce
pr
oc
ed
ur
es
a

nd
t
ra
ns
po
rt
at
io
n
sc
he
du
le
20
. T
ra
ns

po
rt
is
m
ai
nt
ai
ne
d
on
a
re
gu
la

r
ba
si
s
fo
r
pu
rp
os
e
of
CC
M
p
ro
du

ct
di
st
ri
bu
tio
n
35
. S
pa
re
pa
rt
s

ar
e
av
ai
la
bl
e
fo
r
m
ai
nt
en
an
ce
of

t
ra
ns
po
rt
4.
G
oo
ds
a
re
r
ou
tin
el
y
tr

an
sp
or
te
d
be
tw
ee
n
re
su
pp
ly
p
oi
nt

s
an
d
CH
W
s
22
. A
de
qu
at
e
tr
an
sp
or

t
pr
oc
ur
ed
o
r
hi
re
d
w
he
n
ne
ce
ss

ar
y
fo
r
pu
rp
os
e
of
CC
M
p
ro
du
ct

di
st
ri
bu
ti
on
11
. R
el
ia
bl
e,
t
im
el
y

an
d
ap
pr
op
ri
at
e
tr
an
sp
or
t
is
a
va

ila
bl
e
to
d
is
tr
ib
ut
e
or
c
ol
le
ct
go

od
s
be
tw
ee
n
re
su
pp
ly
p
oi
nt
a
nd
C

H
W
s
23
. S
ki
lle
d
dr
iv
er
s
ar
e
av
ai
la

bl
e
w
he
n
an
d
w
he
re
ne
ed
ed
21
. F

ue
l
pr
oc
ur
ed
w
he
n
ne
ce
ss
ar
y
fo
r
pu

rp
os
e
of
CC
M
p
ro
du
ct
di
st
ri
bu
ti

on
7.
T
ra
ns
po
rt
is
av
ai
la
bl
e
to

di
st
ri
bu
te
o
r
co
lle
ct
CC
M
p
ro
du
ct

s
as
re
qu
ir
ed
to
re
su
pp
ly
p
oi
nt

s
Le
ad
o
n
ac
ti
vi
tie
s
In
vo
lv
ed
b
ut

n
ot
le
ad
In
flu
en
ce
t
hr
ou
gh
a
dv
oc
ac
y

Source: Reproduced from SC4CCM (n.d.).
37
Appendix B Example Theory of Change with Competing Mech-
anisms and Potential Negative Outcomes
One important consideration in the policy design process is the
uncertainty of how a policy will
work in practice - i.e., the potential for multiple competing
mechanisms. Some of these potential
impact pathways may lead to positive outcomes while others
lead to null or even negative
outcomes. In its simplest form, the process of mechanism
mapping can help policymakers
understand the plausibility of their intended mechanism.
However, the same logic can be

applied to assess the plausibility of multiple mechanisms, some
of which may lead to negative
rather than positive outcomes.
To illustrate this, consider the theory of change constructed in
2016 by the Botswanan NGO
Young 1ove for its planned transportation of the “sugar
daddies” informational intervention on
teenage HIV infection risk in Kenya (Dupas 2011) in Figure A2.
It considers the potential
for eight different competing mechanisms, half of which would
lead to unintended outcomes in
terms of HIV rates, pregnancy incidence, and school attendance.
Although this theory of change
does not exactly follow the suggested mechanism mapping
structure, it does explicitly consider
the key assumptions underlying each step of the eight potential

mechanisms. Many of these
assumptions are framed as empirical questions on which
additional descriptive data could be
collected to help establish the plausibility of each of these
mechanisms, and indeed the NGO did
collect descriptive data on many of these assumptions prior to
beginning the trial (Noam Angrist,
personal communication, 19 February 2018). While Young
1ove’s example shows that the basic
concepts underlying mechanism mapping are intuitive and can
be implemented even without
explicit reference to the tool, the structured guidance in
undertaking this process presented in
this paper may nonetheless be useful for other organizations and
policymakers.
This example also illustrates the feasibility of the mechanism
mapping process for policy-

makers in the Global South and elsewhere. Young 1ove
developed this theory of change through
a six-month collaborative process led by its Batswana staff,
which reportedly helped increase
understanding of the program, surfaced key assumptions, and
led to adaptations to the original
design of the policy in Kenya (Angrist, personal
communication, 19 February 2018).
38
Figure A2: Theory of Change: Young 1ove
Inputs
Botswana
Partners &
Ministry

Buy-in
Curriculum
Facilitator
Training
Funding
Support
Staff
Outputs
Facilitators
reach the
in-school
youth and
deliver the
curriculum
Intermediate outcomes
Youth are able to negotiate condom use with an age mate,

youth believe that condoms reduce the risk of
HIV/Pregnancy, youth have access to condoms, youth have
comprehensive knowledge on correct & consistent condom
use - [**], Age mates advocate for protection as a function
of perceived risk, Youth fear pregnancy with an age mate
who is unable to provide
Youth delay sexual debut, or refrain from sex
Condom use during sex increases
Age-mates are 9 times less risky (HIV), Age-mates are less
likely to have acute HIV (40x), consistent and correct condom
use
School attendance increases
Anal sex – receptive anal sex is 18 times more risky than
vaginal sex, young adults are 6 times less likely to have HIV,
acuteness is ambiguous (MCP lower, young adults are more
likely to default), anal sex will not result in pregnancy

Oral sex – Less likely to result in pregnancy/HIV
Ultimate outcomes
[**]Youth fear pregnancy with an older partner [socially
unacceptable], Older partners have greater incentive to prevent
pregnancy [marital status, MCP, social stigma, consent laws]
RELATIVE RISK INFORMATION CAMPAIGN – Intended
outcomes
Youth shift from older partners to age mates
HIV: youth aren’t exposed to social stigma at school,
youth have time and resources, youth’s health is not
compromised – [****]
Pregnancy: All of the above + Schools are not
suspending youth from schools, youth don’t have
competing preferences

Youth continue to have sex with older partners
Youth were getting income from older partners or
young adults, youth lose the income they were getting
in the shift to age-mates, youth perceive school as an
add value to income generation, youth need or want
long-term income, school-going peer effect: girls want
to spend more time at school with partners
[**]youth & their young adult partners have (financial &
social) access to condoms
HIV: [****]
Pregnancy: [****] + Schools are not suspending youth
from schools, youth don’t have competing preferences
HIV: [****]

Youth have resources to attend school
Condom use during sex increases Pregnancy | HIV rates
decrease
Youth shift from older partners to young adults
Youth have alternative sex [oral, anal]
Youth intended or had older sexual partners, Youth have
agency over partner selection, youth internalize that higher
HIV risk in older partners means own personal risk, youth’s
priors on HIV rates for older sexual partners are lower than
actual risk – [*], youth perceive the cost of HIV as higher
than the benefits of going with older partners,, youth
perceive age-mates as the safest age group, youth perceive
agency over condom usage with age mates
Youth believe alternative sex is relatively less risky,
alternative sex is more accessible and has higher agency -
[***], youth fear pregnancy with an age mate who is
unable to provide

Pregnancy rates decrease| HIV rates decrease [P > 75%]
Anal sex – Although age-mates are 9 times less likely to have
HIV, receptive anal sex is 18 times more risky than vaginal
sex, anal sex will not result in pregnancy, age-mates less
likely to have acute HIV (40x)
HIV: [****]
Condom use during sex increases Pregnancy decreases| HIV
rates decrease
[*]youth perceive the cost-benefit of young adults (the
‘sweet and sour spot’) as optimized over age-mates & older
partners, youth perceive agency over condom usage with
young adults

Youth receive “income sweet spot” – enough income
to have resources to attend school but not enough to
present a long-term source of income, youth need or
want long-term income (threshold effect, longevity)
Pregnancy | HIV rates decrease
Consistent and correct condom use
School attendance increases [P > 50%)Youth have alternative
sex [oral, anal]
[***]Youth fear pregnancy with an older partner [socially
unacceptable], youth believe alternative sex is relatively
less risky, Older partners have greater incentive to prevent
pregnancy [marital status, MCP, social stigma, consent
laws]
Pregnancy rates decrease| HIV rates ambiguous

Anal sex: Receptive anal sex is 18 times more risky than
vaginal sex, HIV acuteness is ambiguous (high MCP, more
adherence), anal sex will not result in pregnancy
Oral sex: Less likely to result in pregnancy/HIV
HIV: see anal sex ambiguity
Youth intended or had sex with older partners, Youth have no
agency over partner choice, Youth renegotiate incentives,
youth prioritize benefits conditional on minimizing risk,
youth perceive agency over condom usage with older
partners
Pregnancy rates decrease| HIV rates decrease

The dominant mode of HIV transmission is sexual intercourse
Youth are
attentive,
Facilitators
are credible
&
charismatic
Facilitators
cover the
key points
& activities
in the
curriculum
Youth were getting income from older partners, youth
lose the income they were getting in the shift to
celibacy, youth perceive school as an add value to
income generation, youth need or want long-term

income, girls are not distracted by sexual partner (s)
School attendance increases [P > 50%]Youth have alternative
sex [oral, anal]
[***]
Pregnancy rates decrease| HIV rates ambiguous
Anal sex – receptive anal sex is 18 times more risky than
vaginal sex, young adults are 6 times less likely to have HIV,
likely to default), anal sex will not result in pregnancy
HIV: see anal sex ambiguity
HIV: [****]

[*]Youth associate any sex with any type of partner as
riskier than the benefits
Youth are
able to
identify
men in
their 30s &
40s as
having
high rates
of HIV
Source: Reproduced from Young 1ove (2016).
39
Inputs

Botswana
Partners &
Ministry
Buy-in
Curriculum
Facilitator
Training
Funding
Support
Staff
Outputs
Facilitators
reach the
in-school
youth and
deliver the

curriculum
Intermediate outcomes
[**] Youth associate age-mates with ‘safety’, youth don’t
mind pregnancy with an age-mate – socially acceptable
Condom use during sex decreases
Unprotected sex is more likely to result in pregnancy – [***],
Age-mates are 9 times less risky (HIV), Age-mates are less
likely to have acute HIV (40x) -less likely to have be engaged
in MCP, more likely to adhere to ART
School attendance increases [P>25%]
[***] - Young adults are 6 times less risky (HIV), HIV
likely to default)
Ultimate outcomes
[**] Youth don’t fear pregnancy with an older partner who

can provide
RELATIVE RISK INFORMATION CAMPAIGN – Unintended
outcomes
Youth shift from older partners to age mates
HIV: [see probability]
Pregnancy: Youth are exposed to social stigma at
school, youth have time and resources, youth’s health
is compromised, schools are suspending youth from
schools, youth have competing preferences
Youth were getting income from older
partners, youth lose the income they were
getting in the shift to age mates,
youth want or need income for school attendance and
wellbeing, youth pursue other economic opportunities
for income, youth have limited time for attendance
School attendance is ambiguous

[**], youth associate young adults with some degree of
‘safety’-relative to older partners, youth are unable to
negotiate condom use with a young adult, youth don’t mind
pregnancy with a young adult [able to provide, socially
acceptable]
HIV: [see HIV ambiguity]
Pregnancy: youth are exposed to social stigma at
school, youth have limited time and resources, youth’s
health is compromised, schools are not suspending
youth from schools, youth don’t have competing
preferences
HIV: Youth are exposed to social stigma at school,
youth have limited time and resources, youth’s health
is compromised
Pregnancy: All of the above + Schools are suspending
youth from schools, youth have competing preferences

Condom use during sex decreases/remains the same Pregnancy
rates increase | HIV rates decrease [P:50% -75%]
Youth shift from older partners to young adults
[*]Youth perceive age-mates as the safest age group
Condom use during sex decreases/remains the same Pregnancy
increases| HIV rates decrease [P: 50 – 75%]
Youth intended or had older sexual partners, Youth have
agency over partner selection, youth internalize that higher
HIV risk in older individuals means own personal risk, youth’s
priors on HIV rates for older sexual partners are lower than
actual risk, youth perceive the cost-benefit of young adults
(the ‘sweet and sour spot’) as optimized over age-mates &
older partners
School attendance decreases
Youth have young adult partners who provide
income, youth perceive school as an add

value to income generation, youth perceive
attendance as unnecessary to their income
generation capacity, youth attend school less in order
to spend time with young adult partners
Pregnancy | HIV rates increase
[***] - Older partners are 9 times more likely to have HIV,
HIV acuteness is ambiguous (MCP rates are higher, although
older partners are more likely to adhere to ART)
School attendance remains the same
Pregnancy | HIV rates increase
Older partners are 9 times more likely to have HIV, HIV
acuteness is ambiguous (MCP rates are higher in older

partner, although older partners are more likely to adhere)
Youth are
attentive,
Facilitators
are credible
&
charismatic
Facilitators
cover the
key points
& activities
in the
curriculum
Youth have older partners who provide
income, youth perceive school as an add
value to income generation, youth perceive
attendance as unnecessary to their income
generation capacity, youth attend school less in order

to spend time with older partners
Youth intended or had sex with older partners, youth have
agency over partner choice, Youth now know that older
partners are beneficial (sugar), youth seek out older
partners in order to get incentives, youth perceive the costs
of HIV as being lower than the benefits received from older
partners, youth’s priors on HIV rates for older sexual
partners are higher than actual risk, youth have a defeatist
attitude towards HIV risk
HIV: youth are exposed to social stigma at school,
youth have limited time and resources, youth’s health
is compromised
Pregnancy: All of the above + Schools are suspending
youth from schools, youth have competing preferences

Condom use during sex stays the same
Youth don’t mind pregnancy with an older partner who can
provide
Youth continue to have sex with older partners
Youth intended or had sex with older partners, Youth have
no agency over partner choice, Youth renegotiate
incentives, youth perceive the cost of HIV as being lower
than the benefits they are getting from older men, youth
don’t internalize that higher HIV risk in older individuals
means own personal risk
Pregnancy | HIV rates remain the same
No shifts made.i.e. Youth are still having sex with older
partners, condom use patterns are the same
Everything is constant
School attendance remains the same

Everything is constant
Condom use during sex decreases/remains the same
Youth are unable to negotiate condom use with an older
partner, youth don’t believe that condoms reduce the risk of
HIV/Pregnancy, youth don’t have comprehensive knowledge
on correct & consistent condom use, Youth don’t fear
pregnancy with an older partner who can provide, youth
don’t fear contracting HIV (ART freely available)
Youth are
able to
identify
men in their
30s & 40s
as having
high rates
of HIV

More youth seek out older partners
Notes
1. Pregnancy fluctuations reflect pregnancy incidences
2. Under all anal sex scenarios pregnancy rates will always
decrease
40

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