Strengthening and Measuring Community Capacity for Sustained Health Impact_Mtali_5.4.12
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Transcript of Strengthening and Measuring Community Capacity for Sustained Health Impact_Mtali_5.4.12
Austin Mtali, Health Project Manager
A Community Capacity Building Approach to Health and Nutrition
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
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
The local health committee in Bangladesh has links with a wide range of community stakeholders
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
Why target community structures?
Concern’s Approach to Organizational Capacity Building
Step 1
•What Capacity areas need to be built?
Step 2
•Self-assess current capacity levels
Step 3
•Prepare Capacity Building Plan
Step 4
•Implement Plan and Monitor Progress.•M
&E: Monthly, Annual, Mid-Term, End
Step 2
•Self-assess current capacity levels
The Health Institution Capacity Assessment Process (HICAP)
Facilitated self-assessment
approach Provides a quantifiable
capacity measure Clearly identifies capacity gaps Development of a capacity-
building plan Encourages regular monitoring
HICAP structure:• 5-6 general capacity areas
• Divided into subcategories
(indicators), which are the key
functions of the committee• For each indicator, five possible
stages of development• The committee discusses and
agrees on a score for each indicator• Indicator scores are averaged into a
composite score
Example of Capacity Scale
Capacity Results for Ward Health CommitteesBangladesh, 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 Mobilization 2.8 3.4
Monitoring and Evaluation 1.9 3.5
Overall Score 2.35 3.55
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
Replicating
the HICAP in
a rural,
resource-
poor setting in
Malawi
Adapting the HICAP in Malawi
Makuta VDC in Nkhotakota discussing their stages during a HICAP training. Picture by Felix Katsoka.
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.
Some of the formal and informal community structures in place in Malawi to deal with development issues
District Council/District Executive Committee
Area Development Committee
Village Development
Committee (VDC)
Village Health Committee (VHC)
District Health Office
Health Facilities
Health Surveillance Assistants
Community Health Volunteers
Traditional Authority
Group Village Headman
Village Headman
Community structures are valuable resources that are often under-utilized in health
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
neglected in favor of
infrastructure or market support
A village clinic structure for CCM services built by the VDC in Nkhongo group village headman under Mpamantha Health Centre in Nkhotakota. Picture by Syphord Mwanza, January 2012.
Initial Changes in Capacity
Adapted HICAP tool for VDC Facilitate HICAP workshops
with 28 VDC Partnered with District
Community Development
Office and health extension
on training
HICAP process in Malawi Initial changes in the VDC
Developed workplans Filled vacancies Improved gender balance Became independent of the
chief structure Started communication with
community health workers Supporting CCM – e.g
building health posts
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 Management 1.29 1.73
Collaboration and Coordination 1.14 1.85
Monitoring and Evaluation 1.00 1.38
Average capacity score: Total 1.37 1.90
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 Low-cost and easy to implement Can fit well within other trainings
A village clinic structure for CCM services built by the VDC in Nkhongo group village headman under Mpamantha Health Centre in Nkhotakota. Picture by Syphord Mwanza, January 2012.
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
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
other committees
Mrs Phiri (Nkhotakota DHO Staff)
during one of the community
trainings. Picture by Davis Makhoza.
THANK YOU
THANK YOU FOR YOUR ATTENTION
Young boy at Dwambazi health centre, Nkhotakota. Photo by Gwyneth Cotes