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SCOPE | A Theory of Change

By Sofiya Kostareva

Achieving change in the sphere of global development is no small feat, but rising to the challenge was exactly what SCOPE (Strengthening Care Opportunities through Partnership in Ethiopia) set out to do from the beginning. SCOPE’s mission is to improve the lives of people living with HIV/AIDS in Ethiopia through a partnership between the medical and faith communities: University of Washington’s Department of Global Health, the University of Gondar, Ethiopia, the University Presbyterian Church in Seattle, Washington, and the North Gondar Diocese of the Ethiopian Orthodox Church (EOC).

Through the collaborative engagement of medicine, faith and community partnerships, SCOPE has achieved notable results in a few short years. By embedding their work in the cultural context of the EOC, SCOPE leverages the strength of already existing relationships between people and their priests. “It’s a different dynamic than the one we are used to in the United States,” says Nancy Andrews, one of SCOPE’s co- directors. “Families are much closer with their priests than they are with their doctors,” she adds. Considering that a majority of people in Gondar identify as Orthodox and priests far outnumber medical doctors, this makes pregnant women more likely to confide in their religious leaders- resulting in a powerful window of opportunity for change. SCOPE taps into this dynamic by funding global health fellows to build bridges between the medical and religious communities. Their goal is to partner with local faith leaders for outreach, education and training around the importance of antenatal care and HIV/AIDS testing.

SCOPE began as “a series of serendipitous connections,” as Nancy puts it. During a regular worship service at University Presbyterian Church an internationally renowned speaker challenged the congregation to do something in response to the global HIV/AIDS crisis, and so Nancy responded.  She wasn’t sure what to do at first, but soon met Dr. King Holmes (Chair of the Department of Global Health at the University of Washington) through a mutual acquaintance and their work began. While it may seem a similar serendipity brought ORS Impact’s Paula Rowland on to SCOPE’s board of directors, her background in Global Health and experience in outcome-based planning was what culminated in this Senior Associate’s critical involvement in developing a Theory of Change for SCOPE.

Shortly after joining their board, Paula observed that some of the questions SCOPE was wrestling with could be clarified through work in which she specialized. She teamed up with Jane Reisman, founder and President of ORS Impact, to facilitate the creation of an outcome map that articulated their Theory of Change. By outlining the set of linkages among strategies, outcomes and goals an organization sets, a Theory of Change is useful in uncovering underlying beliefs in how an organization affects change. This tool not only guides strategic direction, but can also be used to direct measurement and communication for fund development.

The process began with Paula doing thorough background reading to fully understand the organization’s mission, activities and accomplishments.  “We are respectful of the work that’s been done,” she emphasizes, “…we don’t assume that strong processes haven’t been put into place.”

By compiling existing information from SCOPE’s grant proposals, newsletters, and board meeting minutes into a set of strategies, outcomes and goals, Paula and Jane facilitated the group in creating “so-that chains”.  The participants were asked to create a map linking sticky notes which showed various components of SCOPE’s work. This process, which generally includes multiple interactive workshops, allowed the organization to tell the story of how they believed the components worked together to achieve change. Used as an iterative technique, it let SCOPE “…reflect on what they’ve been doing, where they want to go, and was helpful in discerning whether they were on the right path,” Paula states.Scope TOC process 2

To help unpack the complex interactions between strategies, outcomes and goals, ORS Impact often employs various frameworks. One of these, which the company developed- Impact, Influence, Leverage and Learning- focuses on providing a wider aperture for understanding the kind of outcomes that are meaningful to community and systems change, where an organization can logically make a difference, and thus what to hold themselves accountable to. This framework was used to help SCOPE gain clarity around their current and future work.

For example, SCOPE employs three strategies to bring about systemic change: training priests and religious women, funding global health fellows, and developing partnerships to strengthen this work. While SCOPE works in the global health sphere, their mission is not to be direct providers of HIV/AIDS care, but rather to

influence the local health system,

leverage the power of partnerships between the medical and faith communities,

learn from the experience to be able to scale up the model to increase their influence;

all on the way to the achieving the overall

impact of improving the lives of people in Ethiopia affected by HIV/AIDs.

The Impact, Influence, Leverage and Learning framework used in the creation of SCOPE’s Theory of Change clarified standards of accountability to measure themselves against and simultaneously pushed for celebrating success, refocusing efforts and building momentum.

“We knew what we were doing, but we didn’t know where we were going,” says Nancy of this well-received process. “We are a diverse organization, but this outcome map got everyone on board to tell the same story.”

To find out more about the amazing work done by SCOPE, visit their website at


Missions Accomplished