The Building Bridges Project from 2008-2011 aimed to strengthen the capacity of civil society organizations (CSOs) in Botswana to deliver HIV/AIDS services through subgrant funding and technical assistance. An evaluation found the CSO partners significantly improved their organizational and technical capacities, which led to substantial increases in HIV-affected individuals receiving services. Key factors in these gains were training, tools, mentoring, and innovative service delivery strategies introduced. However, achieving fully sustainable organizational development proved more difficult than anticipated. Overall, the project successfully strengthened CSOs' ability to provide integrated HIV/AIDS support, though future similar projects would benefit from longer timeframes and a stronger focus on governance and resource mobilization from the start.

1. Building Bridges Project 2008-2011
Building Bridges Between Civil
Society and Government through
Capacity Building of the CSO
Sector: Experience and Results
from Botswana
Carol B. Makoane, MPH
Technical Officer, HIV/AIDS Programs, PCI
This presentation is made possible by the generous support of the American people through the United States Agency for International Development (USAID).
The contents are the responsibility of PCI and do not necessarily reflect the views of USAID or the United States Government.

2. Presentation Outline
I. Building Bridges Overview
II. The Good, The Bad and the Ugly
• Highlights of HIV/AIDS Services
Achievements, Lessons Learned &
Recommendations
• Highlights of Organizational Development
Achievements, Lessons Learned &
Recommendations
I. Conclusions

3. Building Bridges Overview
• In October 2008 PCI was funded by USAID to
implement the 3-year Building Bridges Project.
• Aim: to strengthen the capacity of civil society
organizations (CSOs) in Botswana to deliver
integrated HIV/AIDS care & support services
• Approach: provided sub grant funding and technical
assistance to the CSO partners

4. Why Civil Society Organizations?
• Government can’t do it alone – civil society has
unique strengths that are needed to achieve national
HIV/AIDS goals.
• CSOs have the passion and commitment to bring
services to families in some of the poorest and
hardest-to-reach places, often at low cost.
• They serve as a vital link between families in need,
and government services, reaching into homes to
help people with their daily struggles, and referring
them back to government when needed.
• CSOs have a depth of relationship with their
communities that they can use to motivate people to
use services and change behaviors.

5. Building Bridges Partnerships
• Over the project life, PCI assisted 13
CSOs and two umbrella bodies for
varying lengths of time.
• We also worked closely with MLG,
MOH and district government in
project design, implementation and
monitoring.
Building Bridges CSO Partners :
• Bakgatla Bolokang Matshelo (BBM) - Mochudi
• Botswana Association for Psychosocial
Rehabilitation (BAPR) - Lobatse
• BOCAIP Lesedi - Kanye
• BOCAIP Tumelong - Kumakwane
• Holy Cross Hospice - Gaborone
• House of Hope Trust - Palapye
• Humana Child Aid - Selebi-Phikwe
• Mothers Union Orphan Care Centre - Mahalapye
• Silence Kills Support Group - Selebi-Phikwe
• Tsholofelo Trust - Letlhakeng
• Positive Innovations for the Next Generation
(PING)
• Botswana Network for People Living with
HIV/AIDS (BONEPWA+)
• Botswana Network of AIDS Service
Organizations (BONASO)

6. Building Bridges Strategies
The Building Bridges project used 4 main strategies to
improve the effectiveness, reach and sustainability of
CSO Partners’ HIV/AIDS services:
1. Comprehensive Family Care
2. Community Mobilization
3. Food/Nutrition & Livelihoods
4. Organizational Development

7. Building Bridges Approaches
COMPREHENSIVE FAMILY CARE
• CSO staff and volunteers were trained to visit homes,
administer a family assessment tool and develop an
intervention plan for the entire family.
– provided ongoing services and referrals
– family monitoring
COMMUNITY MOBILIZATION
• PCI trained and mentored 79 Journey of Life Facilitators
and 14 Trainers in ten districts.
– These included government health workers and social
workers, CSO partner staff, and staff from other CSOs
in project districts.
– formed themselves into “District JoL Teams” to
coordinate and follow up on district activities

8. Building Bridges Approaches
FOOD/NUTRITION & LIVELIHOODS
• PCI conducted a review of food/nutrition & livelihoods
strategies, gaps and opportunities in Botswana
• 66 CSO staff and volunteers were trained and mentored in
vegetable production and honey production, through
partnership with Ministry of Agriculture.
– Two-tiered approach - NGO centre-based gardens or
apiaries serve as demonstration sites, to teach
community members how to establish their own
backyard gardens or beekeeping projects.
– Food for Life model
– Honey for Life model
• 13 CSO staff were trained in entrepreneurship skills

9. Organizational Development: Description
• At the start of the program, and at stages
throughout the project, partners’ service delivery and
organizational capacity were assessed.
• Capacity building plans were developed with the
partners, with some activities to be implemented by
PCI and others by the partners themselves.
• The capacity building approach combined training,
technical assistance, mentoring, provision of
equipment/software, development of a variety of
tools, as well as sub grant funding.
• PCI linked partners to local expertise from
government, other civil society organizations, and
private sector

10. Organizational Development: Description
• Technical capacity building was conducted alongside
organizational capacity building to ensure that
progress was made on both simultaneously, as they
are interdependent.
• Priority was first given to HIV/AIDS Technical
Capacity, Financial Management and Monitoring,
Evaluation and Reporting.
– This was to ensure that partners could meet minimal
requirements to deliver services, while effectively
managing their sub grant funds and fulfilling data
reporting requirements.
• While support for these areas continued, capacity
building was then provided in areas of Governance
and Leadership, Human Resource Management and
Resource Mobilization.

11. Measuring Local Capacity Strengthening
The Bad? The Ugly?

12. Building Bridges Final Evaluation
• Aim of the Final Evaluation: to identify
achievements & lessons learned that can help show
ways forward for future programs
• External consultant Dr. Ann Brownlee worked as a
team with PCI staff.
• Over a 5-week period starting in April 2011, Dr.
Brownlee & the evaluation team conducted key
informant interviews and focus group discussions
with CSO partners and beneficiaries in project sites,
as well as with district and national government.
• The team also conducted further analyses of data
gathered on PEPFAR indicators over the project life.

13. Final Evaluation Key Challenge
• There was limited availability of quantitative data on
the CSO partners’ capacity and service quality at the
start of the project. This made it difficult to quantify
life-of-project changes.
– The capacity assessment methodology used at the start
of the project featured self-assessment, and aimed to
build ownership of capacity gaps, and consensus on ways
forward.
• While powerful as an organizational change tool, it is
not as effective for quantifying change over time.
– This is a weakness of many organizational capacity
assessment tools: although they produce numerical
scores, the reliance on self-assessment without sufficient
objective verification of capacity, makes a tool less useful
for measuring change over time.

14. Rapid Organizational Capacity Assessment (ROCA)
• Tool developed by PCI to provide a rapid participatory
technical and organizational capacity assessment for Civil
Society Organizations (CSOs)
– Used 10 selected domains rated on a scale of 1 to 4
– Used focus group discussions with key stakeholders of
partner organizations
– Scoring completed by partner stakeholders facilitated
by a consultant; scoring based on consensus
– Identification of capacity needs in the process
– Did not give a clear picture of the partner’s level of
capacity due to self-reporting; and partners overstated
how well they were doing

15. How was this challenge addressed?
• The Final Evaluation team developed a rapid
assessment tool featuring externally verifiable
measures of change*
• Using this tool, CSO partners were assessed on
baseline capacity retrospectively, and on present
capacity.
• Data from the assessment was supplemented by
review of existing project data and through other
types of information gathering conducted for the
Final Evaluation.
*adapted in part from the organizational capacity assessment tool developed by AED
through the USAID-funded Capable Partners project

16. The Good
Measuring Local Capacity Strengthening

17. IV. Highlights of Organizational
Development Achievements,
Lessons Learned &
Recommendations

18. Organizational Development: Successes
The graph above presents the overall organizational capacity scores by partner, for both
2008 (in retrospect) and for June 2011, the final month for partner support under Building
Bridges. Each of the Building Bridges CSO partners achieved substantial gains in overall
organizational capacity over the project period.

19. The graph above presents the organizational capacity scores by domain for all the
partners combined, for both 2008 (in retrospect) and for June 2011, the final month for
partner support under Building Bridges.
Gov: Governance
P.Mgt: Program Management
HR: Human Resource
TC: Technical Capacity
FM: Financial Management
NC: Networking /Collaboration
PMER: Project M&E/Reporting
RM: Resource Mobilization

20. Building Bridges capacity building resulted in substantial improvement in all domains for the
CSO partners, with the greatest changes in HIV/AIDS Technical Capacity, Monitoring,
Evaluation & Reporting, and Project Management.
+42+49+32
Organizational Development: Successes

21. Organizational Development:
Lessons Learned & Recommendations
• Organizational capacity assessment should come at
the very beginning of future projects and should:
– use “new generation” capacity assessment tools that
incorporate objective verification, thus enabling
quantitative comparisons over time
– incorporate quantifiable measures of program service
quality
• Measurement frameworks for future projects with a
strong OD component should incorporate impact
indicators that link improved organizational capacity,
service quality and beneficiary outcomes

22. Organizational Development:
Lessons Learned & Recommendations
• “Since the OD process must be intensive to achieve
full impact, future programs with a strong OD focus
should include one or two full-time staff members,
sufficient cross-training of technical staff in OD and,
if feasible, a long-term relationship with a highly
skilled OD consultant firm, for full impact.”
(FE Report)
• “Future programs should build in “achievement of
sustainability” as a clear program objective, require
cost-sharing, and provide capacity building on
resource mobilization and governance early on.”
(FE Report)

23. Organizational Development:
Lessons Learned & Recommendations
• Increasing financial sustainability of local NGO partners
is a slow and costly process
• Challenges to strengthening NGO financial sustainability
unique to Botswana include:
– the presence of few donors given Botswana’s “middle
income” status,
– absence of Global Fund, and
– lack of tax incentives for private companies to make
charitable donations.

24. Organizational Development:
Lessons Learned & Recommendations
• “Three years is short for this type of process…Future
capacity building projects should be funded for five
years, at minimum.” (FE Report)
• “Future programs should work closely with the GOB,
key donors, and other HIV/AIDS stakeholders to
develop mechanisms for closer coordination to help
insure rational distribution of available resources and
continue to explore possibilities for major
partnerships with the private sector.” (FE Report)
• Governance has proven to be a key driver of
organizational effectiveness and sustainability, yet it
has also proven one of the most difficult areas to
change. Training and mentoring have not been as
effective as in other capacity areas.

25. III. Highlights of HIV/AIDS Service
Achievements, Lessons Learned &
Recommendations

26. Data on PEPFAR indicators gathered through the project’s M&E system
showed that the number of HIV infected or affected adults and children
who were provided with at least one care service by the 11 CSO partners
almost doubled, increasing from 5,759 to 10,273.
The majority of these clients were “registered” with a CSO and received
comprehensive, ongoing care and support services over the project life.

27. Data on this PEPFAR indicator showed that the number of HIV positive
clients provided with a minimum of one clinical service increased almost
3-fold, from 1,285 to 3,815 comparing 2009 with the first 3 quarters of
2011.
The majority of these clients were “enrolled” with a CSO and received
comprehensive, ongoing services over the life of project.

28. From 2010-2011, 36% more
vulnerable children, and 29% more
adults received psychosocial support.
From 2010-2011, 131% more
vulnerable children and 41% more
adults received protection and legal
aid services

29. How were HIV/AIDS service delivery increases achieved?
• “Access by the CSOs to sub grant funds is a key
factor, but does not in itself explain these dramatic
increases, as funding remained approximately the
same each year.” (FE Report)
• “This increase can most likely be attributed to
enhanced ability to deliver services due to:
– strengthened organizational and technical
capabilities;
– greater integration of services due to the
Comprehensive Family Care approach, resulting,
most likely, in greater efficiency.” (FE Report)

30. How were HIV/AIDS service delivery increases achieved?
• Community Mobilization activities also helped
identify new potential clients, who were then
provided with services by the CSOs and
government.
• Improved record keeping may have also allowed
the CSOs to report additional services they may
have been delivering before, but neglected to
report.

31. How were Technical Capacity gains achieved?
• Training based on best practices, technical assistance,
ongoing mentoring, access to tools/materials, peer
learning opportunities, continual encouragement
• Introduction of new service delivery strategies:
Comprehensive Family Care; Community
Mobilization; Food/Nutrition & Livelihoods
• Training and mentoring in key technical skills areas
for care & support (psychosocial support, palliative
care, ART adherence, etc.)
• Improved project design, planning & management
skills
• More stable organizational context due to capacity
building and stable funding over the life of project.

32. How were Resource Mobilization gains achieved ?
All of the organizational capacity domains have a direct impact on
organizational sustainability. However the ability to raise funds is one of the
most powerful indicators of an organization’s strength, and of its potential
sustainability.
Data for FY09 and FY10 show that the CSO partners are moving in the right
direction of diversifying their sources of support, from an average of 16% of their
funding coming from non-PEFPAR sources for FY09 to more than double, at 39% in
FY10 (data for FY11 is not yet available).

33. How were Resource Mobilization gains achieved ?
• Building Bridges served as an intermediary linking
CSOs and various funding sources and provided
technical assistance with proposals.
• In early 2010, PCI developed the skills series “Care like
an NGO, Act like a Business”. Delivered in three 4-day
workshops, the series teaches partners:
 how to approach fundraising from a position of
strength (“we are not beggars”)
 how to create a credible identity and package their
work for diverse audiences
 how to work with media
 how to form win-win partnerships with private sector
 how to obtain funds from a variety of government
grant programs
 how to use the internet for fundraising

34. Conclusions
• “Organizational development that was truly
sustainable proved more daunting than originally
imagined, with good governance and mobilization of
sufficient “non-PEPFAR” resources to maintain NGO
services harder to achieve than initially predicted.”
(FE Report)
• The program faced a number of challenges, such as
a more difficult and extended process than originally
envisioned necessary to achieve sustainable change,
with some inputs coming later than desired, and
targets, sometimes overly ambitious…were not
always met.” (FE Report)

35. Conclusions
• “PCI’s Building Bridges program has been an
innovative and successful project that was able to
strengthen both the programmatic and
organizational capacity of partner CSOs to deliver
integrated HIV/AIDS services…” (FE Report)
• The development and roll-out of innovative
strategies, including Comprehensive Family Care,
Community Mobilization...and the Food/Nutrition &
Livelihood strategy, coupled with an intensive
approach to organizational development, led to much
more cost efficient and effective services in the areas
of care and support for the families served…”
(FE Report)

36. Conclusions
• “PCI’s very personal and intense approach to
strengthening its partner CSOs was...key, with both
provision of a wide range of training opportunities…
and most important, intensive mentoring “on the
ground”, with quarterly visits to all CSOs and a
respectful but honest approach to problem-solving,
being essential components.” (FE Report)

37. With Gratitude
• USAID/PEPFAR
• Government of Botswana
– NACA
– Ministry of Local Government
– Ministry of Health
– Ministry of Agriculture
– District Government
• CSO Partners
• Collaborating Organizations
• PCI Staff
• Dr. Ann Brownlee