1Viroj TangcharoensathienInternational Health Policy Program,MOPH, Thailand8thGCHP, Helsinki, June 2013Developing andsustaining HiAP capacities:what challenges?
2Topics• Terminology and characteristics– Capacity, capacity development– Organizational capacity• Barriers and enable factors to capacitydevelopment in developing countries• HiAP capacities and capacity development
3I. Terminology: capacity, capacitydevelopment and organizationalcapacities
4Capacity and capacity developmentOECD 2006: challenges of capacity development• Capacity– the ability of people, organisations and society as a whole to managetheir affairs successfully.• Capacity development– the process whereby people, organisations and society as a wholeunleash, strengthen, create, adapt and maintain capacity over time.– Capacity development is used in preference to the traditionalcapacity building.• The “building” metaphor suggests a process starting with a plain surfaceand involving the step-by-step erection of a new structure, based on a preconceived design.
5Capacity and capacity developmentUNDP http://mirror.undp.org/magnet/policy/glossary.htm• Capacity– Skills, knowledge, resources needed to perform a function.• Capacity development– The process by which individuals, groups, organisations, institutionsand countries develop their abilities, individually and collectively, to perform functions, solve problems and achieve objectives.• Capacity building– Differs from capacity development in that the latter builds on a pre-existing capacity base.
6Capacity and capacity developmentWorld Bank:http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTCDRC/0• Capacity – Resources, efficiency and effectiveness the societies deploy theseresources to identify and pursue their development goals on asustainable basis.• Capacity development – Locally driven process of transformational learning by leaders,coalitions and other agents that leads to actions that supportchanges in institutional capacity areas—ownership, policy, andorganizational—to advance development goals.
7Capacity and capacity developmentIn brief, capacity means– ability to perform functions, solve problems andset and achieve objectives• It recognizes that national capacity is not just the sumtotal of individual capacities;• The concept is complex that “weaves individualstrengths into a stronger and more resilient fabric…If countries and societies want to develop capacities, theymust do more than expand individual skills. They alsohave to create the opportunities and incentives for people to use and expand individual skills”.
88UNDP INNE model:Individual, Node(organization), Networkand Enablingenvironment--
9Organizational capacityMorgan 1997• The organization can1. learn, adapt to changing environment: “self-renewing capacity”2. form relationships with other organizations, synergistic effort toachieve objectives.• The organization has1. an effective programs on recruitment, development and retentionof staff to perform critical functions.2. ability to legitimize its existence3. a structure, technology and set of procedures that enable the staffto carry out critical functions.4. a set of culture, values, norms and motivation which rewardsperformance5. the ability, the resources and the autonomy to focus on amanageable set of objectives over a reasonable period of time
10II. Barriers and enabling factors to capacitydevelopment in developing countries
11Barriers to capacity development: OECD2006I. Poor enabling environment– Poor economic policy towards pro-poor growth.– Weak parliamentary scrutiny and sanction of theexecutive branch.– Lack of effective citizen voice, weak social capital (trust)low participation in political systems, unclear and arbitrarily enforced “rules of the game”, lack of respect for humanrights.– Entrenched corruption (political and administrative) incore government organisations.– Entrenched and widespread clientelism orpatrimonialism, weakening the pursuit of organisations’ formal tasks
12Barriers to capacity development: OECD2006II. Government ineffectiveness– Poor capacity for economic and public financialmanagement, low levels of transparency and accountability.– Absent, non-credible and/or rapidly changing governmentpolicies, and overload of reform and change initiatives.– Unpredictable, unbalanced or inflexible funding andstaffing.– Poor public service conditions: low salary in relation toliving standards; outmigration of qualified staff; excessivereliance on donor-funded positions.– Verbal commitment to performance-oriented culture, lackof rewards for performance and of sanctions for non-performance
13Enabling to capacity development: OECD2006• Strong pressures for improvements from clients, politicalleaders• Change management is approached in an integrated manner,strategic and proactive: communication, sequencing, timing,feedback loops, celebration of victories, and recognition of problems.• Visible leadership for change, clear mission, encouragesparticipation, explicit expectations about performance, andrewards well-performing staff (recognition, pay, and promotions based on merit).• Organisational innovations are tried, tested and adapted.
14III. HiAP capacities and capacitydevelopment
15HiAP institutional core capacities• Generate evidence: power of evidence– Health and health equity implications of public policies– Effective story telling to the public,• Forming public opinion and social consensus• Politicians are sensitive to public opinion• Translate evidence :– Political agenda and evidence based policy formulations– Advocates, lead, cheerlead (Taylor 2013)– Convening stakeholders: ownership and consensus bldg• Thai National Health Assembly: (Health Expectations 2012; 1: 87-96)• Support implementations– Partnership and enable intersectoral actions– Effective M&E and feedback loops• Opportunistic skills– for window of opportunities
16Some good practices• Constitutional mandates, high level policies– HIA for major public private investment with potentialhealth implication• Ethical and moral responsibility by all countries– Exporting hazardous chemicals, material• Lending organization:– WB policy against tobacco related lending• 3F1L concept: WHO Bulletin 2009, 87:72-4– Full time, full commitment, full funding and long termmission• Invest in people, institutions and capacity building inresource-poor settings:– IOM 2009: U.S. Commitment to Global Health
17Some good practices• Global reporting: useful for benchmarkingand monitoring progresses– Code of marketing breast milk substitutes– WHO Global Code of practice on internationalrecruitment of health personnel– State of World Children– UNDP HDR– WB Worldwide Governance indicators