Building Local Capacity for Health System Strengthening

1. Building Local Capacity for Health System Strengthening Fred Rosensweig Steve Yank December 3, 2009

2. Agenda • Health systems strengthening context for organizational capacity-building • Overview of Health Systems 20/20’s approach • Case example – Kinshasa School of Public Health • Takeaways

3. Definition of organizational capacity-building Organizational capacity-building is a systematic process that uses a range of interventions to improve the performance of an organization.

4. Health Systems 20/20 vision for capacity-building • Focus on country-level organizations that support the health system, e.g., central government agencies, research institutions, NGOs • Implement tangible, measurable, and sustainable improvements in the organizational performance of key HSS organizations • Address the full range of organizational competencies

5. Role of organizational capacity-building in health systems strengthening • Ensuring an enabling environment for health systems (i.e., institutional infrastructure needed to support the health system) • Identifying and strengthening key organizations that support the overall health system

6. Whose capacity needs to be strengthened?

7. Government National HIV/AIDS Control Program Office in MOH in DRC NAC Secretariat in Liberia NAC in Mozambique NMCP in MOH in Malawi HIS OD in Kenya NGOs/Consulting firms AFENET PROSALUD in Bolivia Local organizations in Zambia and Senegal Health System Action Network Research Institutions Kinshasa School of Public Health African Observatory Examples of organizations Health Systems 20/20 is strengthening

8. Approach to strengthening organizations • Address the full range of core competencies of these organizations (“whole of system” approach) • Use an approach that draws from the best practices of organizational development

9. What areas need strengthening?Core competencies

10. Organizational development approach • Expectation setting • Rapid organizational assessment to identify priority needs • Design of intervention plan • Implementation of intervention plan • Ongoing M&E • Planning to sustain progress

11. Promising practices • Process led by skilled OD consultant with overall responsibility for making sure the pieces fit together • Constant engagement with the leadership of the organization to build ownership and commitment to change • Actively build the capacity of the leadership team to guide the change process • Reliance on short-term local consultants • Proceed at a measured pace and don’t overwhelm the organization • Blend of practical short-term improvements to build confidence and momentum and still address key long-term issues

12. What does success look like?Indicators • Accepted and understood strategy to guide decision-making • Adequate number of qualified staff with clear roles and responsibilities to carry out key functions • Leadership that can provide direction and align actions with strategy • Management capacity to plan, budget, and implement • Keymanagement systems (financial, IT, and procurement) in place and functioning • Effective relationships with other organizations established • Governance structure that provides checks and balances • Ability to mobilize resources to carry out mandate

13. Kinshasa School of Public Health Case Example

14. Background • Founded in the mid 1980s with USAID support provided mostly through Tulane • Under the School of Medicine in UNIKIN but has high degree of autonomy • Masters programs in public health and health economics • Joint degree PhD programs • Aging core faculty (seven full professors) • Well respected and valued resource • Run by formally appointed five-person management committee

15. Background (cont.) • Anticipated US$ 6m in funding for projects in 2010 • Two assessments highlighted organizational weaknesses. USAID/Kinshasa asked Health Systems 20/20 to assist and try a different approach than in the past

19. Overall goal • Serve as the primary source of high level expertise in public health in the DRC • Train a cadre of officials to play leadership roles in the public health system throughout DRC Establish a sustainable organizational foundation to enable KSPH to:

20. Health Systems 20/20 program Three-year US$ 2.4m activity from FY 09-11: • Organizational strengthening component • Scholarship component

21. Scholarship program MPH • 25 MPH scholarships per year • Revised selection criteria increased number of female students this year Doctoral • Providing funds for four PhD students to complete their degrees • Possibility of additional support for PhD students

22. KSPH core competencies

23. Approach • Conducted a two-week rapid assessment to identify issues and develop three-year work plan. • Identified a local team. Careful attention to getting each consultant started. • Part-time local coordinator to follow up. • OD specialist visits once per quarter to monitor work of local team and conduct a 1-2 day event for leadership team. • Town meetings with KSPH staff to communicate.

24. Organizational strengthening component • Strengthening leadership team • Improving the financial management system • Upgrading IT capacity • Strengthening resource mobilization capacity • Reviewing the MPH program • Improving performance and productivity of administrative services • Procurement (IT, photocopier, generator, etc.)

25. Expected results after three years • Cohesive leadership team providing direction to KSPH and the institutional strengthening initiative • IT system that provides reliable internet access • Resource mobilization plan developed and implemented • Strengthened financial management system that accounts for expenditures and provides information for decision-making • Next generation of KSPH faculty completed PhDs and being prepared to assume leadership role • Increased number of women MPH students • Consensus reached on changes needed to enhance quality of MPH program • Administrative function is more effective and efficient

26. Summing Up

27. Takeaways • Mapping the organizations at the national level needed to support HSS. • Focusing on the whole organization is critical. • Size of the organization matters. • Type of organization matters (network, government organization, private, NGO, university, etc.). • Organizational capacity-building is not a quick fix. Trust builds over time and core issues begin to surface. • Autonomy is the key, not whether the organization is governmental or not.

28. Future challenges for organizational capacity-building • Building a body of knowledge about how to build capacity at the central and local government levels to support health systems strengthening • Lack of OD skills in most countries, especially in Africa, is a main constraint • Finding ways to measure success and developing meaningful indicators • Finding ways to scale up capacity-building efforts

29. Thank you Reports related to this presentation available at www.healthsystems2020.org