Abt Associates Inc. In collaboration with:I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health
better systems, better health
Better Health Systems: Strategies that Work Presentation series at the Global Health Council
Fred RosensweigApril 3, 2012
Lessons Learnedin Organizational Capacity Building for Health Systems Strengthening
Agenda
Definition of capacity building Overview of Health Systems 20/20 capacity-building
activities Our methodology for determining lessons learned Lessons learned Summary
Definition of Capacity Building
System-level capacity building has three levels of intervention Individual level – knowledge and skills Organizational level – single organization System level – multi-organizational in nature
Health Systems 20/20’s Focus
Regional and country-level organizations that enable health system strengthening• National government agencies that have stewardship role• Research institutions that provide evidence for HSS• NGOs and consulting firms that provide TA• Education and training institutions that train health system
leaders Strengthened 24 organizations over six-year period
Three Broad Types of Organizational Capacity-building Activities
Comprehensive capacity building covering core organizational competencies
Strengthening capacity of central government agencies
Targeted organizational capacity building in a specific technical area
Examples of Organizations Health Systems 20/20 Has Strengthened
Government HIV/AIDS Office in MOH (DRC) NAC Secretariat (Liberia) MOH Health Economics and Financing Directorate (Afghanistan) MOH HIS Directorate (Namibia)
NGOs/Consulting Firms AFENET (regional) PROSALUD (Bolivia) Health Systems Action Network (global)
Research Institutions HSPI (Vietnam) ISED (Senegal) ECSA (regional) Regional School of Public Health in Benin (regional) HEARD (South Africa)
Education and Training Institutions Kinshasa School of Public Health (DRC) National TB and Leprosy Training Center in Zaria (Nigeria)
Characterizing Health Systems 20/20 Capacity-building Activities
Almost all multi-year in nature Most led by team leader skilled in organizational
development and change management Wide range of organizational types Both new and well established organizations Covered a wide range of settings including fragile
states Majority in Africa
Methodology to Develop Lessons
Review of documentation Interviews with team leaders (16) Interviews with heads of client organizations (9) Analysis of interview data and determination of
lessons learned Validation with capacity-building and HSS specialists
Lessons Learned
Four Categories of Lessons
1. Role of organizational capacity building in HSS
2. Targeted organizational capacity building3. Design of organizational capacity building
activities4. Practice of organizational capacity building
Role of Organizational Capacity Building in HSS
1. Organizational capacity building should be aimed at those organizations whose role is to strengthen the health system
Organizations to Strengthen in Context of HSS
Role and Functions Illustrative Organizations
Leadership/stewardship Offices in MOH (e.g., HIV/AIDS, NAC)
Research Universities, research institutes
Technical assistance NGO, consulting firms, universities
Training Training institutions
Advocacy NGOs
Standard setting Professional organizations, MOH
Role of Organizational Capacity Building in HSS
2. Success of HSS efforts depends on both overall management and technical capacity of organizations that strengthen the health system
Without management capacity to set direction, plan and implement activities, and manage resources, technical capacity-building will have limited impact
Targeted Organizational Capacity Building
3. Select the right partner for targeted organizational capacity-building activities Functional management and administrative
systems Leadership commitment to use strengthened
capacity Staff buy-in and commitment Willingness to engage as full partners
Targeted Organizational Capacity Building
4. Targeted capacity building in HSS approaches requires a strong learning-by-doing component at each stage and a willingness by partner to engage and learn Qualitative data collection and analysis are more difficult
to master Capacity-building process must be led by senior expert in
methodology Most capable partners are busy and have limited time to
engage
Design of Organizational Capacity Building Activities
5. Take a holistic and comprehensive approach and focus on full range of organizational competencies Starts with needs assessment Reflected in intervention plan Basis for monitoring and mid-course adjustments Interconnectedness of interventions
Core Organizational Competencies
Management Systems
GovernanceTechnical As-sistance and
Training
Resource Mobiliza-tion
Technical Competence
Organizational Development
Focusing on the Whole Organization
“As a result of all of this assistance, one of the greatest things we have achieved is cohesion in the network. Without the governance assistance, as well as the development of some of the fundamentals, it is highly likely that the network would have crumbled in the first year. We have different institutions, different cultures, and different ways of doing things and yet we have maintained cohesion and I attribute a lot of that to the assistance to the Health Systems 20/20 project.”
David Mukanga, AFENET Executive Director
Design of Organizational Capacity-Building Activities
6. When creating a new or nascent organization, ensure it has a viable business model
In other words, does the organization offer programs and services that others are willing to support?
Design of Organizational Capacity-Building Activities
7. Design capacity-building activities so the client organization has the incentives to engage in the capacity-building process Tied to longstanding relationships Tangible incentives Offers potential business opportunities Attractiveness to funders
Design of Organizational Capacity-building Activities
8. Define benchmarks for success and milestones for measuring progress at the beginning and update on an ongoing basis
Illustrative Organizational Capacity-building Indicators
Accepted and understood strategy to guide decision-making Adequate number of qualified staff with clear roles and responsibilities to
carry out key functions Leadership that can provide direction and align actions with strategy Management capacity to plan, budget, and implement activities Key management systems (financial, IT, HR, and procurement) in place
and functioning Effective relationships with other organizations established Governance structure that provides oversight and checks and balances Ability to mobilize resources to carry out mandate and be financially viable
Practice of Organizational Capacity Building
9. Form a partnership with host organization by ensuring trust and collaborative engagement “During the design phase we had a series of discussions with the Health Systems 20/20 team. We explained our problems, provided our recommendations and suggestions. We also had inputs from the Health Systems 20/20 team…we listened to their recommendations and saw flexibility from their team. It was a consensus agreement from both parties that led to successful outcomes.”
Dr. Salehi, Afghanistan HEFD
Practice of Organizational Capacity Building
10. Maximize use of local consultants and organizations and provide appropriate supervision Consistent with spirit of country ownership Local expertise exists in many countries with some
exceptions (e.g., organizational development) Effectiveness depends on providing direction and
necessary supervision
Practice of Organizational Capacity Building
11. Ensure buy-in and commitment from senior leadership by:
Agreement on assessment dimensions Review and approval of all consultants Regular check-ins Communication with others in the organization Responsiveness to client’s priorities
Practice of Organizational Capacity Building
12. Be flexible and adapt the approach and interventions to emerging needs
“While the consultancy had objectives, it wasn’t very rigid. Many times with consultants – they are not flexible. The project is designed before they even get involved and they want to carry it out as it was written. But you encounter rocks in the road; things change. The good thing about this consultancy was that they were flexible. You can’t always do everything that was in the original plan.”
Luis Fernandez, Executive Director, PROSALUD
Practice of Organizational Capacity Building
13. Tailor all interventions to the country context, size and sophistication of client organization, and resources available
Stage of growth State of the country Time required Availability of qualified local consultants
Summary
We have improved our understanding in some key areas: How organizational capacity building contributes to HSS Which organizations to strengthen in the HSS context What organizational capacities to strengthen How to design and implement comprehensive and targeted
capacity-building activities
Measurement remains an Achilles heel
Final Questions
Should donors be investing in organizational capacity building?
What agreement can be reached on the measures we should use?
How can we better document and communicate the value of these investments?
Abt Associates Inc. In collaboration with:I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health
better systems, better health
www.HealthSystems2020.org
Thank you