Equity and Empowerment_L. Altobelli_10.17.13


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Equity and Empowerment_L. Altobelli_10.17.13

  2. 2. Dr. Carl E. Taylor, 1917-2010 Photo: L Altobelli FutureGenerations
  3. 3. SEED-SCALE books FutureGenerations
  4. 4. Alma Ata Conference - 1978 HEALTH FOR ALL ? or HEALTH FOR ALL ? FutureGenerations
  5. 5. Alma Ata and its successors GOBI  GOBI-FFF  IMCI  IMCI-N  MNCH  RMNCH  MDGs  A Promise Renewed  FutureGenerations
  6. 6. Dr. Halfdan Mahler, exSecretary General of WHO “We had it wrong in 1978. What came about was ´Hell for all´ as the business of health stole the idea”. - Dr. H. Mahler, 2009 FutureGenerations
  7. 7. Lost and (still not) Found  COMMUNITY  Values of equity and sustainability  Process of HOW to approach the community FutureGenerations
  8. 8. UNICEF Task Force 1990  Dr. James Grant charged Carl and Daniel Taylor to conduct a study and lead a task force to examine the dynamics of social change. FutureGenerations
  9. 9. Core Concept of SEEDSCALE   Find a “seed” of human energy, an activity your community did that it views as a success Grow that seed “to scale” so  More people receive benefits  Quality of life improves  SEED-SCALE is not just a "tool" in the international development toolbox.  It allows communities to use what they have:  What resources they already have,  Where they are with all their constraints FutureGenerations
  10. 10. Basics of SEED-SCALE  5 Criteria  4 Principles  7 Tasks  3 Levels of Scale FutureGenerations
  11. 11. 5 Criteria to Guide Direction The process of change needs guidance and evaluation from 5 perspectives: Equity Sustainability Holism Interdependence Iteration FutureGenerations
  12. 12. Build from Success: Principle #1 Identify what is working, strengthen that. One success leads to a next success; the momentum of change builds. Vs. traditional development: “Fix the failures,” rather than building on what is working, “Identify needs” rather than community capacity FutureGenerations
  13. 13. 3-way Partnership: Principle #2 Top-Down policies and financing provide the supportive environment for Bottom-Up growth. Ideas from Outside-In stimulate Bottom-Up adaptation. Vs. traditional development: “Communities can grow on own or with help from only one partner.” Top-Down Enabling Environment Outside-In Ideas and Mentorship: Change Agents Bottom-Up Community Mobilization Forward Momentum FutureGenerations
  14. 14. Evidence-based Decisions: Principle #3 Success comes when decision-making uses facts gathered locally. Vs. traditional development: Usually decisions are made byWhomever has the power, Or money, Or the strongest opinions. FutureGenerations
  15. 15. Behavior Change: Principle #4 Fundamental change happens when people change behaviors. One behavior change encourages another. Tool:traditional development: Local work Vs. plans. Typically programs seek measurable outputs; results can be manipulated from outside and are FutureGenerations often not sustainable.
  16. 16. A Cycle of 7 Tasks Helps Human Energy Grow Create local coordinatin g committee Identify local successes Study successes elsewhere Gather local evidenc e Create local workplan Implement the workplan Make Mid-course corrections FutureGenerations
  17. 17. Going to Scale is a Journey  SCALE ONE - a SEED system that represents a successful and integrated local experience – empowered community system supported in a three-way partnership FutureGenerations
  18. 18. Going to Scale is a Journey  SCALE-SQUARED - the SEED system becomes an observational learning/teaching center FutureGenerations
  19. 19. Going to Scale is a Journey  SCALE-CUBED - Policy and financing environment for sustainability of successful strategies FutureGenerations
  20. 20. Some Lessons learned From SEED-SCALE applications in the field
  21. 21. 1. S-S is not a linear process of growth Country Program China Peru India Afghanistan Haiti Stage 1 Stage 2 Stage 3 Stage 4 Scale-Cubed Scale-One Scale-Squared Scale-Cubed Scale-Cubed Scale-One->Sqr Scale-Cubed Scale-Squared Visit to Scale-Square* Scale-One Scale-Squared Repeat multiple times Scale-One Scale-Cubed Scale-One Scale-Squared Scale-Squared *Jamkhed Scale-One: SEED center Scale-Squared: Observational training center Scale-Cubed: Policy environment—a self-sustaining network ofFutureGenerations Scale-Squared Centers
  22. 22. PRE-SEED-SCALE: Primary health care in Peru Health Services Network Center Primary Health Care Faciity Regional Health Directorate National Health Programs MUNICIPALI TY Roles & functions poorly defined COMMUNIITES FutureGenerations
  23. 23. SCALE-CUBED: Original Structure of CLAS 1994 Health Services Network Center Regional Health Directorate CLAS – Local Health Administration Committees (private non-profit civil association) SHARED ADMINISTRATION CONTRACT Primary Health Care Faciity Local Health Plan CLAS CLAS Board of Directors MUNICIPALI TY Roles & functions poorly defined COMMUNIITES FutureGenerations
  24. 24. SCALE-ONE: Improve Quality of Relationships with CLAS Health Services Network Center Primary Health Care Faciity Regional Health Directorate Local Health Plan THEN, SCALE-SQUARED: Observational learning/teaching center CLAS MUNICIPALI TY CLAS Board of Directors CWP SECTORIZATIO N STRATEGY CHW ASSOCIATIONS COMMUNIITES COMMUNITY WORK PLANS FutureGenerations
  25. 25. SCALE-CUBED: New CLAS Law 2007 Health Services Network Center Primary Health Care Faciity Roles & functions poorly defined Regional Health Directorate Regional Governme nt Local Health Plan CLAS CLAS Board of Directors Communitybased Organizations MUNICIPALI TY COMUNSA - Club de madres COMUNA - Vaso de leche - Club de madres -- APAFA COMUNSA - Vaso de leche -- Promotor - Club de madres -- APAFA COMMUNITY - Vaso de leche -- Promotor -- APAFA - Community leader -- Promotor - -CHW COMMUNIITES FutureGenerations
  26. 26. SCALE-SQUARED: Improve Quality of Relationships and Teach Health Services Network Center Primary Health Care Faciity Regional Health Directorate Regional Governme nt Local Health Plan CLAS MUNICIPALI TY CLAS Board of Directors Communitybased Organizations SECTORIZATI ON STRATEGY CHW ASSOCIATION COMUNSA - Club de madres COMUNA - Vaso de leche - Club de madres -- APAFA COMUNSA - Vaso de leche -- Promotor - Club de madres -- APAFA COMMUNITY - Vaso de leche -- Promotor -- APAFA - Community leader -- Promotor - -CHW COMMUNIITES CWP COMMUNITY WORK PLANS FutureGenerations
  27. 27. 2. SEED-SCALE is used in various levels a. As a framework for program managers to guide decision-making (with emphasis on 4 principles and 5 criteria) b. As a methodology for community action (7 tasks, especially the work plans) FutureGenerations
  28. 28. 3. Each local partner can be considered as a separate “community”  The seven tasks can be applied to each rural community to arrive at a Community Work Plan.  The seven tasks can also be applied to help organize the work of each health facility or municipality (organize a “management team”, identify past successes, visit other successes, do a self-evaluation, create a work plan for “quality improvement”, take action and monitor with mid-course corrections) as in “SECTORIZATION” FutureGenerations
  29. 29. 4. Getting started – pick “communities” with energy present    Not all communities (or health services) respond to initiatives from the outside. Solution : Contact a broad number of sites in order to identify those with a momentum for social change already underway. The goal is to have the initial successes within enthusiastic communities to lead way to interest in other communities to also get on board. FutureGenerations
  30. 30. 5. The most resource-poor communities and women participate first    Poorest communities most likely to organize themselves and start taking their own action. Avoid the temptation of giving handouts to these communities. Women´s Action Groups and women are key for capturing and channeling community-level energy. FutureGenerations
  31. 31. 6. Role of Change Agent in the Three-Way partnership - Principle #2 A PVO can help create good relationships with the government by building webs of partnership between community and government:  Amplify the impact of government outreach or extension programs  Build capacity of people in communities to communicate and work with government.  Connect community dreams/desires with government resources.  Educate the government about community FutureGenerations empowerment in development.
  32. 32. 7. Sustainability of Scale-Squared Centers through partnerships  The most successful Scale-Squared Centers (Observational training centers) are those that create partnerships with the private sector or become a business to generate income that provide incentive to continue scaling-up activities. FutureGenerations
  33. 33. 8. Compatibility with the Logical Framework Method  SEED-SCALE is not very compatible with logframes.  But there is a solution. FutureGenerations
  34. 34. 9. Generation of local energy & resources provide better costeffectiveness  Better results for less cost when projects rely on sustainable resources in communities (energy) and government (policy and financing).  Corollary: costs are more effectively invested when there is a high level of flexibility to adjust to emerging processes as communities move forward. FutureGenerations
  35. 35. 10. The top-down as real partners in development – may take time  Officials (administrators, doctors, etc.) are usually the main obstacles to forming an effective three-way partnership.       Habit of authority and control. Corruption. Threatened by new initiatives not under their control. Officials see balanced partnerships with community or experts as unnecessary. Need for long-term advocacy, champions inside and outside of government. Need to organize consortiums of in-country NGOs, donor agencies and other local experts to develop and implement on-going advocacy with the government. FutureGenerations
  36. 36. 11. Alignment with other new global development paradigms  SEED-SCALE shares a general orientation with other global commitments for giving greater emphasis to national programs and local ownership as opposed to dependence on or control by the donor community, particularly referring to the Paris Declaration on Aid Effectiveness. FutureGenerations
  37. 37. HOW SEED-SCALE IS DIFFERENT SEED-SCALE Key Resource: Planning Mindset: Planning Process: Who Does the Work: Primary Stakeholder: Traditional Development Human Energy Money Growth in Nature WorkplanBudget 3 Partners Engineering a Building BudgetWorkplan Professionals Community Donor who gives money Build on Success Fix Problem/Meet Needs Evidence Power, Opinions & Habit Behavior Change Measurable Results Success Evaluated by: Strengthen 4 Principles Budget Compliance Process: Iterative Learning Do It Right the First Time Mentoring Control Approach: Guided by: Major Outcome: Management Mode: FutureGenerations
  38. 38. “Our greatest mistake has been to oversimplify the Alma-Ata vision of primary health care… Real social change occurs when officials and people with relevant knowledge come together with communities in joint action around mutual priorities.” -- Dr. Carl E. Taylor, Co-founder, Future Generations www.seed-scale.orgFutureGenerations www.future.org www.future.edu