Lessons Learned in Organizational Capacity Building under Health Systems 20/20


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Health Systems 20/20 has carried out 20 activities in the past five years where the focus has primarily been on building organizational capacity to strengthen a range of organizations including research institutions, government agencies, NGOs, training institutions, and consulting firms.

Presenter: Fred Rosensweig

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Lessons Learned in Organizational Capacity Building under Health Systems 20/20

  1. 1. better systems, better health Lessons Learned in Organizational Capacity Building for Health Systems Strengthening Better Health Systems: Strategies that Work Presentation series at the Global Health Council Fred Rosensweig April 3, 2012Abt Associates Inc.In collaboration with:I Aga Khan Foundation I Bitrán y AsociadosI BRAC University I Broad Branch AssociatesI Deloitte Consulting, LLP I Forum One CommunicationsI RTI International I Training Resources GroupI Tulane University’s School of Public Health
  2. 2. Agenda Definition of capacity building Overview of Health Systems 20/20 capacity-building activities Our methodology for determining lessons learned Lessons learned Summary
  3. 3. Definition of Capacity BuildingSystem-level capacity building has three levelsof intervention Individual level – knowledge and skills Organizational level – single organization System level – multi-organizational in nature
  4. 4. 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
  5. 5. Three Broad Types of OrganizationalCapacity-building Activities Comprehensive capacity building covering core organizational competencies Strengthening capacity of central government agencies Targeted organizational capacity building in a specific technical area
  6. 6. Examples of Organizations HealthSystems 20/20 Has StrengthenedGovernment Research Institutions HIV/AIDS Office in MOH (DRC)  HSPI (Vietnam) NAC Secretariat (Liberia)  ISED (Senegal) MOH Health Economics and  ECSA (regional) Financing Directorate  Regional School of Public Health (Afghanistan) in Benin (regional) MOH HIS Directorate (Namibia)  HEARD (South Africa)NGOs/Consulting Firms Education and Training Institutions AFENET (regional)  Kinshasa School of Public Health PROSALUD (Bolivia) (DRC) Health Systems Action Network  National TB and Leprosy (global) Training Center in Zaria (Nigeria)
  7. 7. Characterizing Health Systems 20/20Capacity-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
  8. 8. 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
  9. 9. Lessons Learned
  10. 10. Four Categories of Lessons1. Role of organizational capacity building in HSS2. Targeted organizational capacity building3. Design of organizational capacity building activities4. Practice of organizational capacity building
  11. 11. Role of Organizational CapacityBuilding in HSS1. Organizational capacity building should be aimed at those organizations whose role is to strengthen the health system
  12. 12. Organizations to Strengthen inContext of HSS Role and Functions Illustrative OrganizationsLeadership/stewardship Offices in MOH (e.g., HIV/AIDS, NAC)Research Universities, research institutesTechnical assistance NGO, consulting firms, universitiesTraining Training institutionsAdvocacy NGOsStandard setting Professional organizations, MOH
  13. 13. Role of Organizational CapacityBuilding in HSS2. 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
  14. 14. Targeted Organizational CapacityBuilding3. 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
  15. 15. Targeted Organizational CapacityBuilding4. 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
  16. 16. Design of Organizational CapacityBuilding Activities5. 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
  17. 17. Core Organizational Competencies Technical Organizational Competence Resource Management Mobilization Technical Governance Assistance and Training
  18. 18. Focusing on the Whole Organization“As a result of all of this assistance, one of the greatest thingswe have achieved is cohesion in the network. Without thegovernance assistance, as well as the development of some ofthe fundamentals, it is highly likely that the network would havecrumbled in the first year. We have different institutions, differentcultures, and different ways of doing things and yet we havemaintained cohesion and I attribute a lot of that to the assistanceto the Health Systems 20/20 project.” David Mukanga, AFENET Executive Director
  19. 19. Design of Organizational Capacity-Building Activities6. 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?
  20. 20. Design of Organizational Capacity-Building Activities7. 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
  21. 21. Design of Organizational Capacity-building Activities8. Define benchmarks for success and milestones for measuring progress at the beginning and update on an ongoing basis
  22. 22. 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
  23. 23. Practice of Organizational CapacityBuilding9. 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
  24. 24. Practice of Organizational CapacityBuilding10. 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
  25. 25. Practice of Organizational CapacityBuilding11. 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
  26. 26. Practice of Organizational CapacityBuilding12. 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
  27. 27. Practice of Organizational CapacityBuilding13. 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
  28. 28. SummaryWe have improved our understanding in some keyareas: 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
  29. 29. 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?
  30. 30. better systems, better health Thank you www.HealthSystems2020.orgAbt Associates Inc.In collaboration with:I Aga Khan Foundation I Bitrán y AsociadosI BRAC University I Broad Branch AssociatesI Deloitte Consulting, LLP I Forum One CommunicationsI RTI International I Training Resources GroupI Tulane University’s School of Public Health