Capacity Strengthening for Global Health: The CORE Group Spring Meeting, April 2013

The CORE Group Spring Meeting was held in Baltimore at the Holiday Harbor Inn. Returning after last year, the event felt more like a reunion than a conference – with familiar faces and a congenial ambience. The theme for this year was Capacity Strengthening for Global Health: Partnerships, Accountability, Integration, Learning. It was a challenge to pull out highlights from a 5-day conference and workshop, but I did my best below:

 

Sustainability

Patricia Murray from Plan and Janet Schooley from PCI presented sustainability assessments in Kenya and Bolivia, respectively.

 

Such assessments seem like a challenge in our field, with attention spans no longer than project cycles and ever changing donor fads. And where “quick wins” trump sustainability. Who pays for the assessment once the project is over and who benefits from the findings? Whose business is it?

 

From both organizations’ experience, it seemed that the organizations benefitted through an increased understanding of their own programs. It was good for staff morale to see that so many program successes had lasted. It helped the organization see what project components ‘stuck’ and which needed more work to achieve sustainability. It also helped the organizations see how it could better factor in sustainability to both program design and M&E plans. In particular, Plan talked about how the study will inform phase out plans for ensuring lasting impact.

 

In the discussion afterwards, the variety of ideas of what sustainability could mean highlighted the need for every project to have its own definitions and specific sustainability goals. For example, many defined sustainability only at the level of the individuals reached, and others at the community level.

 

Integration

Another fascinating presentation was on M&E of integration by Charlotte Colvin and Jennifer Luna. Working from a Global Health Initiative Principle Paper, they defined integrations as:

….The organization, coordination, and management of multiple activities and resources to ensure the delivery of more efficient and coherent services in relation to cost, output, impact, and use….

 

The principle paper highlights that integration is not an intervention in itself, rather it’s an approach. Results from Cochrane reviews so far suggest that integration has promising but mixed results.

 

USAID’s Global Health Initiative has developed a learning agenda around integration to assist efforts in building the knowledge base about what “bundles” of services can be integrated together, according to which model, for optimum cost effectiveness. Integration is especially an issue for M&E efforts, where different health areas approach M&E differently.

 

For example;

  • TB: the focus is on case detection and treatment outcome data to make population based estimates; less emphasis on coverage of interventions/approaches. Relies on prevalence surveys
  • MCH: the emphasis on coverage of interventions and approaches in addition to service delivery statistics; use of DHS for population based indicators

 

Conversation after the presentation focused on the different types of indicators that might be required. Participants highlighted that integration often meant institutionalization, which would be highly dependent on systems factors, and indicator selection would need to reflect this.

 

Community Capacity as an End in Itself

One of the interesting presentations was measurement of community capacity by Dr Carol Underwood, as both a factor to help improve health behavior and health outcomes and as an outcome in itself. This study was based on the Health Communication Partnership in Zambia, a 5-year USAID supported project. The key goals were to enable individuals and communities to take positive health actions and strengthen community-based systems and networks. Strengthening community capacity was a key project strategy.

 

Community capacity is defined as

“The characteristics of communities that influence their ability to overcome barriers and find or cultivate opportunities to address social, economic, political issues”

 

This study was unique as it defined the key domains of community capacity (CC) through first asking the community members themselves and then refining the domains from a literature review to create a scale. The hypothesized pathway for the effect of CC on health outcomes was that interventions would improve CC, CC would then prompt community action and community action would then positively affect health behaviours. The team interviewed almost 5000 people from 24 intervention and 12 control districts (in a post test only design).

 

Individuals in intervention districts had much higher CC scores than those in control districts; and were much more likely to report addressing a health problem in their community. Compared to those who did not report addressing a health problem, those who reported addressing a health problem were: twice as likely to be using a modern contraceptive method; 1.8 times as likely to have received an HIV test and know the answer; and 1.5 times more likely to have had their youngest child sleep under a bed net.

 

This study demonstrates that building community capacity was both a means to an end (improved health behaviors and reported collective action for health) and an end-in-itself – achieving two important social development goals.

A group of us who all went to Jamkhed in 2012

A group of us who all went to Jamkhed in 2012

 

Capacity building according to the World Bank

Dr Leonardo Cubillos Turriago talked to the CORE Group about capacity development in health at the macro level. It is a truism that capacity development is a necessary precondition for project success in every sector. Each year, donors spend more than 20 billion USD on products and activities for capacity building in developing countries, indicating a high level of commitment.

 

However, there are many challenges in capacity development and it’s hard to track efforts. There are a lack of common definitions, no theory of change and a lack of specificity in program planning (who is the best actor to carry out a specific function; whose capacity needs to be built). Results frequently not measured, and when they are reasons for successes are not clearly documented (that is, the same challenges that plague everything).

 

When definitions do exist, they are not consistently useful. For example, the World Bank defines capacity as:“the availability of resources and the efficiency and effectiveness with which societies deploy those resources to identify and pursue their development goals on a sustainable basis.”.

 

To add to this definition, Turriago highlights that capacity development is ideally local driven, whereby actors learn from their own development experience. Specifically, he pointed out that one of the key components of capacity is countries’ ability to work inter-sectorally.

 

Hence, key instruments of change include supporting countries in sharing knowledge and experiences, working in partnership, and to take ownership of efforts.

 

Myself and Lisa Parker (MEASURE Evaluation Project, Futures Group) at the reception at Pier 5, overlooking the Baltimore Habor

Myself and Lisa Parker (MEASURE Evaluation Project, Futures Group) at the reception at Pier 5, overlooking the Baltimore Habor

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2 Comments

  1. Manish Kumar
    Posted May 6, 2013 at 7:06 am | Permalink

    The Core group meeting summary provides useful information about the various intiatives focused on M&E and capacity building aspects.

    I find it relevant to my area of work which is related to knowledge management and health information systems.

  2. Posted May 14, 2013 at 6:53 pm | Permalink

    Excellent summary! Thanks so much for taking the time.

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