This article reports on the results of a collaborative action research project (2010-12) in which 10 development organizations (nine Dutch and one Belgian), together with their southern partners, explored different actor-focused Planning, Monitoring and Evaluation (PME) approaches with the aim of dealing more effectively with complex processes of social change. A major challenge that organizations were trying to address during this action research pertained to the demonstration of observable results in complex contexts where such results are not always easy to measure or to quantify and where causal links between cause and effect cannot always be predicted. Drawing from recent literature, the article presents an analytic framework to assess the effectiveness of a PME approach in dealing with complex social change. This framework is then used to explore how actor-focused PME approaches can help international development programmes to manage complex processes of social change by stimulating processes of real-time results-based learning.

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Summary In recent decades, a growing number of low‐income countries (LICs) have experimented with voluntary community‐based health insurance (CBHI), as an instrument to extend social health protection to the rural poor and the informal sector. While modest successes have been achieved, important challenges remain with regard to the recruitment and retention of members, and the regular collection of membership fees. In this context, there is a growing consensus among policymakers that there is a need to experiment with mandatory approaches towards CBHI. In some localities in Tanzania, local actors in charge of community health funds (CHFs) are now relying on what is best described as quasi‐mandatory enrolment strategies, such as increasing user fees for non‐members, automatically enrolling beneficiaries of cash transfer programmes and enrolling the exempted groups (people who are entitled to free healthcare). We find that, while these quasi‐mandatory enrolment strategies may temporarily increase enrolment rates, dropout and the non‐payment of contributions remain important problems. These problems are at least partly related to supply side issues, notably to inadequate benefit packages. Overall, these findings indicate the limitations of any strategy to increase enrolment into CBHI, which is not coupled to clear improvements in the supply and quality of healthcare.