Health Research Program
Related Project:
Kuboresha Afya Mitaani
Cudjoe Bennett, Senior Research and Knowledge Management Advisor, Office of Maternal and Child Health and Nutrition, USAID and Rachel Jones, Senior R&D Manager, Jacaranda Health

USAID’s Health Research Program employs process documentation across all its partner projects, including the Kuboresha Afya Mitaani (KAM) Project that is actively documenting the key processes and actions influencing its urban health research project. According to da Silva Wells et al.1 process documentation is a concept that characterizes a combination of tools and processes used to document and learn from activities undertaken during the course of project implementation.

The KAM Project is a three-year implementation research project focused on maternal and child health in two informal settlements in Nairobi, Kenya. During the first year of the project, there were a number of significant local and global changes: management of Nairobi City County health services were taken over by the national government and the COVID-19 pandemic spread throughout the country. In the midst of so much change, process documentation presented an opportunity to capture why decisions were made, who made these decisions, how external factors influenced project activity implementation, and the moments when new information challenged the project to revisit its theory of change. The project is learning that the keys to process documentation are: 1) Establishing tools and processes to ensure team members can continuously contribute and collaborate; 2) Including process documentation as an integral part of every project activity, rather than an afterthought; and 3) Focusing on the activities and processes that relate most closely with the theory of change. 

Establishing tools and processes

Screenshot of KAM project page on Notion
Example of the KAM Project’s Notion page.
Photo credit: Jacaranda Health

The major question the KAM Project had before starting process documentation was related to where it could store this information to ensure it remained accessible, useful, and collaborative. The KAM Project settled on using Google Drive and a tool called Notion. Between these two platforms, the team is able to store and link documents, while adding notes and reflections along the way. Similar to Wikipedia, Notion can be easily edited, used to tell a story of a project, and connect to various “pages” which explain activities and outcomes more deeply. The KAM Project is also bringing its research partners onto its Notion pages to harmonize process documentation. However, it is not the tool itself that is the most important, but having a system and process to continually update and re-visit the story of the project that makes the difference. 

Including process documentation as an integral part of activities

Sub-County Sensitization Meeting with Starehe Sub-County Officials in Nairobi to define project facilities and next steps
Sub-County Sensitization Meeting with Starehe Sub-County Officials in Nairobi to define project facilities and next steps.
Photo credit: Jacaranda Health

The KAM Project is placing an emphasis on process documentation. One example of how it is doing so is by continually updating and documenting its stakeholder mapping. As a project that engages multiple Kenyan government officials and partner organizations, the stakeholder environment is constantly changing. What makes process documentation different from static reports is that as the stakeholder environment changes, the changes (and updated approaches to engagement) should be recorded. For example, the KAM Project documented key decision-makers at the end of 2019 at the county, sub-county, facility, and community levels, gathering information on  who attended project meetings or calls, who was responsible for what, and how they were elected/selected. This document was then updated shortly after the national government assumed control of health services in Nairobi (as Nairobi Metropolitan Services) a few months later. It helped the project adapt quickly by recording not only what happened and who changed positions, but also including individuals’ reflections on the new environment with regards to policy and decision-making. The team could map out which new officials needed to be sensitized to the project and identify others who needed to be engaged to help ensure the project’s success. 

Focusing on processes related to the Theory of Change

The KAM Project’s Theory of Change.
Photo credit: Jacaranda Health

When learning about process documentation, it is easy to get the sense that the idea is to write down EVERYTHING. The facility visit you planned started late? Record this. The meeting had a low or disappointing turnout? Write it down! This level of detail could lead to piles of documents that are never analyzed or incorporated into planning for implementation. In the KAM Project, the team is learning that documentation that relates directly to key aspects of the theory of change are the most useful. For example, the project’s theory of change included facility engagement activities with the aim of increasing quality and data-driven decision-making. When taken in context—documenting how COVID-19 distancing considerations led to reduced attendance at the meeting, or how the meetings’ start was delayed because of a quality dashboard review—the details become more useful. Rather than documenting every single action taken, the project is focusing on the processes and actions that could help the team understand what is working and what should be adjusted, but only those that eventually lead to the project’s ultimate outcomes. Process documentation is, and should be, a key part of implementation research projects. As the KAM Project progresses, the team looks forward to using process documentation to reflect on the project’s theory of change and to bring out learnings across teams, all in a collaborative environment focused on action.