1. A Community Capacity Building
Approach to Health and Nutrition
Austin Mtali, Health Project Manager

2. Concern Worldwide
 Concern works in 25
countries around the world
 Community capacity
building occurs in most of
our projects (health,
education, livelihoods)
Drama event in Chiwaula village in Nkhotakota
Picture by Davis Makhoza

3. Community Capacity Building at Concern
 Concern developed the HeaIth Institution Capacity Assessment
Process (HICAP)
 Targets key community structures
 Strengthens linkages and communication between communities and
health services
 First implemented in Bangladesh Child Survival Program in 2000
 Adapted for rural Village Development Committees in Malawi in 2009
 Will be used in Sierra Leone Child Survival Program, to build the
capacity of Health Management and Ward Development committees

4. Why target community structures?
Organizational capacity
building can be a
valuable tool for
strengthening the
capacity of communities
to engage with each
other on health and
influence health
services
The local health committee in Bangladesh has links with a
wide range of community stakeholders

5. Concern’s Approach to Organizational
Capacity Building
• What Capacity areas need to be built?
Step 1
• Self-assess current capacity levels
Step 2
• Prepare Capacity Building Plan
Step 3
• Implement Plan and Monitor Progress.
Step 4 • M&E: Monthly, Annual, Mid-Term, End

6. • Self-assess current
Step 2 capacity levels

7. The Health Institution Capacity Assessment
Process (HICAP)
HICAP structure:
• 5-6 general capacity areas
 Facilitated self-assessment • Divided into subcategories
approach (indicators), which are the key
 Provides a quantifiable functions of the committee
capacity measure • For each indicator, five possible
 Clearly identifies capacity gaps stages of development
 Development of a capacity- • The committee discusses and agrees
building plan on a score for each indicator
 Encourages regular monitoring • Indicator scores are averaged into a
composite score

8. Example of Capacity Scale

9. Capacity Results for Ward Health Committees
Bangladesh, 2006 - 2009
Capacity Area Baseline Endline
Human Resources 1.9 3.7
Leadership 2.8 3.8
Planning / implementation 2.3 3.4
Coordination / Resource
2.8 3.4
Mobilization
Monitoring and Evaluation 1.9 3.5
Overall Score 2.35 3.55

10. Bangladesh - Results
 From initial 2 pilot districts, approach
was scaled up to 7 more districts
 Significant improvements in health
behaviors and practices
 Increase in municipal funding for
health services from the committees
 Sustainability assessment in initial
districts, five years after the project,
found that committees still had
improved skills and capacity, and
improved self-awareness

11. Adapting the HICAP in Malawi
Replicating
the HICAP in
a rural,
resource-
poor setting in
Malawi
Makuta VDC in Nkhotakota discussing their stages during a
HICAP training. Picture by Felix Katsoka.

12. Concern Malawi – Health and Nutrition
Programme
April 2010 – March 2013, in two districts in Central
Malawi
Objectives:
 Increase availability, access, and utilization of quality child health and
nutrition services
 Improve the knowledge and adoption of household health behaviours
and care-seeking practices
 Strengthen local capacity to plan and manage health activities,
as well as improve linkages between the facility and community for
better accountability.

13. District Council/
Community District Executive Committee
structures are Area
valuable resources District Health Traditional
Development
Office Authority
that are often under- Committee
utilized in health Village
Group Village
Development Health Facilities
Headman
Committee (VDC)
Health
Some of the formal and Village Health
Surveillance Village Headman
informal community Committee (VHC)
Assistants
structures in place in
Malawi to deal with Community
development issues Health Volunteers

14. Village Development Committees
What is the VDC?
 The VDC is a representative
body from a group of villages.
 It provides an important link
between citizens and district
council (government).
 Develops local development
plans for community, but
usually no follow-up
 Health, education often A village clinic structure for CCM services built by the VDC in
Nkhongo group village headman under Mpamantha Health
neglected in favor of Centre in Nkhotakota. Picture by Syphord Mwanza, January
2012.
infrastructure or market support

15. Initial Changes in Capacity
HICAP process in Malawi Initial changes in the VDC
 Developed workplans
 Adapted HICAP tool for VDC
 Filled vacancies
 Facilitate HICAP workshops
 Improved gender balance
with 28 VDC
 Became independent of the
 Partnered with District
chief structure
Community Development
 Started communication with
Office and health extension
community health workers
on training
 Supporting CCM – e.g
building health posts

16. Preliminary Results: VDC capacity scores,
Nkhotakota
Capacity Baseline 6 month follow-up
Participatory Planning 1.74 2.42
Leadership (Governance) 1.69 2.10
Resource Mobilization and
1.29 1.73
Management
Collaboration and Coordination 1.14 1.85
Monitoring and Evaluation 1.00 1.38
Average capacity score: Total 1.37 1.90

17. Benefits of the HICAP tool
 Empowering: Communities develop
their own plans and solutions
 Motivating: Committees encouraged
by seeing their improvement
 Easily adaptable, and not sector
specific: Capacity areas are universal
 Relatively sustainable: Committees
can continue the process on their own A village clinic structure for CCM services built by the VDC
in Nkhongo group village headman under Mpamantha
 Low-cost and easy to implement Health Centre in Nkhotakota. Picture by Syphord Mwanza,
January 2012.
 Can fit well within other trainings

18. Gaps
 How to measure the impact of improvements in capacity
 How does this result in improvements for women and children in our area?
 Not a one-off process – once committees identify their capacity needs,
they need continued support
 Facilitator needs to act as a continued catalyst
 External influences on the organization may be out of the facilitator’s
control
 For example, VDCs no longer receiving funding, elections have not been
held
 The whole system may need capacity building, not just one level

19. Feedback from partners
 Local Government: The capacity building
trainings helps them to identify and address
the gaps in the whole local government system
 Health facility staff: This has promoted
linkages and communication between the
community structure and health providers and
community health workers
 Village headmen: The process has helped
them to understand their roles in relation to Mrs Phiri (Nkhotakota DHO Staff)
during one of the community
other committees
trainings. Picture by Davis Makhoza.

20. THANK YOU
FOR YOUR ATTENTION
THANK YOU
Young boy at Dwambazi health centre, Nkhotakota.
Photo by Gwyneth Cotes