This document discusses capacities and capacity development for health in all policies (HiAP). It defines key terms like capacity, capacity development, and organizational capacity. It outlines barriers to capacity development in developing countries like poor governance and ineffective government. Enabling factors include strong pressures for change and visible leadership. Core HiAP capacities are discussed, like generating evidence, translating evidence into policy, and supporting implementation. Some good practices are highlighted, such as constitutional mandates for health impact assessments and global reporting for benchmarking progress.

1. 1
Viroj Tangcharoensathien
International Health Policy Program,
MOPH, Thailand
8th
GCHP, Helsinki, June 2013
Developing and
sustaining HiAP capacities:
what challenges?

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Topics
• Terminology and characteristics
– Capacity, capacity development
– Organizational capacity
• Barriers and enable factors to capacity
development in developing countries
• HiAP capacities and capacity development

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I. Terminology: capacity, capacity
development and organizational
capacities

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Capacity and capacity development
OECD 2006: challenges of capacity development
• Capacity
– the ability of people, organisations and society as a whole to manage
their affairs successfully.
• Capacity development
– the process whereby people, organisations and society as a whole
unleash, strengthen, create, adapt and maintain capacity over time.
– Capacity development is used in preference to the traditional
capacity building.
• The “building” metaphor suggests a process starting with a plain surface
and involving the step-by-step erection of a new structure, based on a pr
econceived design.

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Capacity and capacity development
UNDP 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, institutions
and countries develop their abilities, individually and collectively, to p
erform functions, solve problems and achieve objectives.
• Capacity building
– Differs from capacity development in that the latter builds on a pre-
existing capacity base.

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Capacity and capacity development
World Bank:
http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTCDRC/0
• Capacity
– Resources, efficiency and effectiveness the societies deploy these
resources to identify and pursue their development goals on a
sustainable basis.
• Capacity development
– Locally driven process of transformational learning by leaders,
coalitions and other agents that leads to actions that support
changes in institutional capacity areas—ownership, policy, and
organizational—to advance development goals.

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Capacity and capacity development
In brief, capacity means
– ability to perform functions, solve problems and
set and achieve objectives
• It recognizes that national capacity is not just the sum
total of individual capacities;
• The concept is complex that “weaves individual
strengths into a stronger and more resilient fabric…If c
ountries and societies want to develop capacities, they
must do more than expand individual skills. They also
have to create the opportunities and incentives for pe
ople to use and expand individual skills”.

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UNDP INNE model:
Individual, Node
(organization), Network
and Enabling
environment--

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Organizational capacity
Morgan 1997
• The organization can
1. learn, adapt to changing environment: “self-renewing capacity”
2. form relationships with other organizations, synergistic effort to
achieve objectives.
• The organization has
1. an effective programs on recruitment, development and retention
of staff to perform critical functions.
2. ability to legitimize its existence
3. a structure, technology and set of procedures that enable the staff
to carry out critical functions.
4. a set of culture, values, norms and motivation which rewards
performance
5. the ability, the resources and the autonomy to focus on a
manageable set of objectives over a reasonable period of time

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II. Barriers and enabling factors to capacity
development in developing countries

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Barriers to capacity development: OECD2006
I. Poor enabling environment
– Poor economic policy towards pro-poor growth.
– Weak parliamentary scrutiny and sanction of the
executive branch.
– Lack of effective citizen voice, weak social capital (trust)
low participation in political systems, unclear and arbitrari
ly enforced “rules of the game”, lack of respect for human
rights.
– Entrenched corruption (political and administrative) in
core government organisations.
– Entrenched and widespread clientelism or
patrimonialism, weakening the pursuit of organisations’ f
ormal tasks

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Barriers to capacity development: OECD2006
II. Government ineffectiveness
– Poor capacity for economic and public financial
management, low levels of transparency and accountabilit
y.
– Absent, non-credible and/or rapidly changing government
policies, and overload of reform and change initiatives.
– Unpredictable, unbalanced or inflexible funding and
staffing.
– Poor public service conditions: low salary in relation to
living standards; outmigration of qualified staff; excessive
reliance on donor-funded positions.
– Verbal commitment to performance-oriented culture, lack
of rewards for performance and of sanctions for non-
performance

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Enabling to capacity development: OECD2006
• Strong pressures for improvements from clients, political
leaders
• Change management is approached in an integrated manner,
strategic and proactive: communication, sequencing, timing,
feedback loops, celebration of victories, and recognition of pr
oblems.
• Visible leadership for change, clear mission, encourages
participation, explicit expectations about performance, and
rewards well-performing staff (recognition, pay, and promoti
ons based on merit).
• Organisational innovations are tried, tested and adapted.

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III. HiAP capacities and capacity
development

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HiAP 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

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Some good practices
• Constitutional mandates, high level policies
– HIA for major public private investment with potential
health 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 term
mission
• Invest in people, institutions and capacity building in
resource-poor settings:
– IOM 2009: U.S. Commitment to Global Health

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Some good practices
• Global reporting: useful for benchmarking
and monitoring progresses
– Code of marketing breast milk substitutes
– WHO Global Code of practice on international
recruitment of health personnel
– State of World Children
– UNDP HDR
– WB Worldwide Governance indicators