Capacity, Country Ownership, Sustainability, and the Quest for the Holy Grail_Sarriot_Arscott-Mills_5.2.12

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  • Other definitions (i.e. financial viability, organizational capacity, policy alignment), identify potential determinants of sustainabilityProjects can contribute to the process, or hinder it, but ultimately neither control nor define it.We can, however, measure progress on hypothesized determinants of sustainability during our projectsMore than one configuration can support the same sustainable outcomeAllowing systems to find their own new equilibrium might be more important than enforcing the best approach
  • Planned CD works best when
  • In the real world—CD is often a combination of all three approachesRecognize the contribution of intangibles--largely unrecognized as contributing to capacity but values, vision, management style and org culture have a huge impact on CD.
  • Ability of “outsiders” to influence CD is very circumscribed. Donors and outside actors are not the prime movers when it comes to endogenous societal dynamics.System perspective is important because it increases understanding of how parts interact and clarifying boundaries and linkages.
  • In the real world—CD is often a combination of all three approachesRecognize the contribution of intangibles--largely unrecognized as contributing to capacity but values, vision, management style and org culture have a huge impact on CD.
  • In the real world—CD is often a combination of all three approachesRecognize the contribution of intangibles--largely unrecognized as contributing to capacity but values, vision, management style and org culture have a huge impact on CD.
  • Narrative:We don’t need to belabor the importance of sustainability for the GHI.<Nota: do not read the slide.>Obviously, sustainability is a key element of impact—if not in the short term, certainly in the long term.Without sustainability, local stakeholders become cynical of development efforts and this encourages secondary agendas if not corruption.As we will see, sustainability is a determinant of the ability to scale up effective interventions in a cost-effective manner.So, it is of high importance to the GHI, but is this a new concern?


  • 1. Capacity, Ownership& the Quest for the Holy Grail Spring Meeting May 2, 2012 Sharon Arscott-Mills & Eric Sarriot
  • 2. Agenda• Introduction• Word Game: “Pick your Theory!”• Thinking about capacity and ownership• Current Development Assistance Trends• The Holy Grail• Practical Conclusions• Case Study – or - Q&A
  • 3. Top Recent References• Capacity, Change and Performance. Study report. Heather Baser and Peter Morgan. With Joe Bolger, Derick Brinkerhoff, Anthony Land, Suzanne Taschereau, David Watson and Julia Zinke. April 2008• Capacity Development in Practice. Edited by Jan Ubels, Naa-Aku Acquaye-Baddoo and Alan Fowler. Earthscan. 2010Also:• Capacity and capacity development: coping with complexity. Derick W. Brinkerhoff, with Peter J. Morgan. Public Admin. Dev. 30, 2–10 (2010)• Learning purposefully in capacity development: Why, what and when to measure. By Alfredo Ortiz and Peter Taylor. International Institute for Educational Planning• Understanding pathways for scaling up health services through the lens of complex adaptive systems. Ligia Paina and David H Peters. Health Policy and Planning 2011;1–9
  • 4. Context of our Concern?
  • 5. “Pick your Theory”A rapid word game on capacity-ownership and sustainability concepts
  • 7. Overview Conceptual Framework (Brown and Lafond, MEASURE Evaluation)Capacity Levels Performance Sustainability T Health SystemHealth System Performance I M Sustainable Organization Organizational E Health Performance System Health Personnel Performance Program Performance Personnel Improved Health Status SustainedClient/Community Client/Community Client/Community Capacity Behavior Change Behavior Change External Environment Cultural- Social- Economic- Political - Legal - Environmental
  • 8. OCVAT Capacity Areas Capacity (& Viability) Areas Governance & Legal Structure Program Management Technical Capacity Grants & Sub-grantee Management Project Management Monitoring & Evaluation (M&E) Financial Management Human Resources Office Operations Information Technology (IT) Resource Mobilization Networking Communications
  • 9. 5 dimensions of capacity (Brinkerhoff – case studies’ review)Brinkerhoff Comments• Commit and engage Stewardship, leadership• Technical Capacity Self explanatory• Relate and attract support Linkages ++; Cf. SF/non-$ Viability• Learn and Adapt 5th Discipline; resiliency; sustainability?• Diversity and coherence “Fit”? Live with tensions in plans, adaptation, multiple agendas, navigate environment…
  • 10. • Capacity ‘that works’ is not just a matter of individual skills or internal organizational arrangements. These factors might be relevant building blocks – some would call these competencies or capabilities – but they do not constitute real capacity.• Effective capacity is visible and exists when people identify and act on issues of shared concern. And thus real capacity lives between actors and in the ways that they deal with each other to solve problems or to realize their ambitions. In doing so, they build up relational competencies and generate trust which, for example, reduces transaction costs. If collaboration works well – and it is not guaranteed and is seldom conflict-free – stakeholders become less likely to treat each other according to general stereotypes with prejudices that cloud communication and reinforce wrong interpretations of behaviour.• Seeing capacity as a living property of relationships is an important practitioners’ lens.Source: Boesen, Chapter 11 in CD in Practice
  • 11. 2 dimensions of organizations (Boesen in: CD in Practice, Chapter 11)
  • 12. OwnershipLatent variable or Oxymoron? – “Excuse me. May I measure your ownership? Thank you.”Current Thinking—specifics may matter more than the conceptual packaging. 1. Political Will 2. Institutional and Community Ownership 3. Capabilities 4. Shared AccountabilityBack to relationships, power, trust … properties in a system (not in the program). Discussion on McKinsey Initiative at
  • 15. Internal/External ; Functional/Political Approaches to CD (Boesen)
  • 16. 3 approaches to CD (Brinkerhoff) What the RFP says, and our1. Program / Project proposals promise… – When: consensus, resources, executive control, functional/technical/structural objectives What often happened over2. Incrementalism / “Muddling through” the last 60 years… – When: unstable context, uncertain commitment, unpredictable arrangements, confused strategy How sustainability and ownership largely happen3. Emergence – “when lack of state presence and resources create space for other actors” (Brinkerhoff) – When agents self-organize around new attractors (vision, scenario, interests, habits)?
  • 17. SustainabilityWHICH LEADS US TO THE
  • 18. Do we need a system perspective in Health? E.g. Sustainability Assessment in an Urban Health System, Bangladesh (Concern / CEDARS) ADB, DfID, USAI MOLGRD D, etc. MOHFW Chairman City Government Health Platform MOHFW District & Sub- Health Inspector (MESPCC) District (in absence of Med Off.) NGO Health Health Department Providers Govt & Private Health Social & religious Facilities leaders Commissioner Private Community pharmacists organizations Ward Health Committee Teachers Youth volunteers Traditional health providers
  • 19. Behavior of Agents & Behavior of a System
  • 20. Sustainability in Health System Strengthening is…• A (emerging) property of a system, embedded in a larger environment – in which interdependent actors, – through negotiated and coordinated social interactions, – which allow the expression of their respective and collective capabilities, – maintain and improve the health of a vulnerable population.
  • 21. Toward Sustainability:Coaching Progress Toward a New Equilibrium (vision, ownership, capacity, relations, resources) Social Capital Expression of collective capacity to sustain outcomes
  • 23. Practical Guidance on Capacity Development:• CD is about altering the access of people to authority, resources and opportunities• Sustainability, capacity, ownership are: – Latent – Heavily Endogenous• CD is often a combination of all three approaches – Planned CD works best under certain conditions – Incrementalism works best in unstable contexts and where choice of strategy is difficult to clarify. – Emergence is usually evident where donor funding was not involved.
  • 24. Practical Guidance cont’d• Primum non nocere: projects create two shocks (coming in, coming out)• Recognize the contribution of intangibles-- values, vision, management style and organizational culture on CD.• Recognize the fallacy of “one best way” approaches• Incorporate flexibility and learning; role of “accompaniment” / coaching• Pay attention to the people-in-context
  • 25. REMEMBER!• Ability of “outsiders” to influence CD is very circumscribed.• Maintain a “system perspective” “How sustainable the system is depends on its proficiency in keeping its stakeholders happy, both at specific points in time and over an extended period.” (Brinkerhoff)
  • 26. An Existential Dilemma: Projects vs.Real Life• Progress in GHI language and USAID Forward thinking – But… the {time*project*ownership*sustainability} equation still often unsolvable in RFA/RFP language.• We know this is not how it’s going to happen – But… that’s what the RFA asks for. – … and that’s how our marketing colleagues told the story.
  • 27. There is no escape from our Existential Dilemma!• Project commitment and institutional (NGO) commitment• Can’t ensure Ownership? How about Honesty?• Best practices are exemplified every day – Maximize the best aspirations of RFAs/RFPs – Minimize the worst perverse effects of project-driven development – Involve stake-owners early in facing your unintended effects – Choose approaches and tools which strengthen system processes and learning• Evaluation is a powerful and undervalued education tools – Project Grantees, sure. – Are we taking the time to make it useful to capacity, ownership and sustainability? – Are we doing enough to make it educative to our donors?
  • 28. Before heading for the development of capacity, ownership and…. TheHoly Grail… aCASE STUDY DISCUSSION
  • 29. THANK YOU.
  • 30. Sustainability: A High Concern for the Global Health Initiative• GHI— [Implementation of the Global Health Initiative: Consultation Document] – “The challenge of the next decade and beyond is to take these impressive accomplishments to the next level by helping countries achieve long-term sustainability in their health services.” – “Building on a long tradition of U.S. government global health leadership and the unprecedented level of commitment manifested in recent years, the Obama Administration’s Global Health Initiative has the opportunity to move global health to a new level of effectiveness, with a vision of long- term sustainability led by partner countries.”
  • 31. 1 slide only on measurement!• OCAT, OCVAT, MOST, ISA, ETC. – Useful, but when?• Validity of a “Latent Variable”*: Do measures guide right action?• Measuring ownership and capacity vs. capacity to own questions and measures? * Brinkerhoff
  • 32. Know Thyself (or what Thy Project Can Do) Emergence of Planned CD Sustainability More complex More orderly Sustaining Appropriate and Promoting Proper and safe population health sustainable utilization of administration of through political staffing of NGO / services immunizations in and institutional Clinic / District facilities changes Office Sustainably District capacity in Municipal Financial Building individual promoting an producing and allocation of tax accountability of technical skills essential nutrition utilizing revenue to health committees package at information support Health household level Department with livelihood interventions Developing and Diversifying and Strengthening Building essential Meeting managing new scaling up NGO leadership in NGOs management registration partnerships Mission structures and criteria for small while keeping functions in local CBO/NGO focus on accepted NGO public goodComplexity Matrix: Geyer and Rihani