Abstract
BackgroundDespite substantial investment in health capacity building in developing countries, evaluations of capacity building effectiveness are scarce. By analysing projects in Africa that had successfully built sustainable capacity, we aimed to identify evidence that could indicate that capacity building was likely to be sustainable.MethodsFour projects were selected as case studies using pre-determined criteria, including the achievement of sustainable capacity. By mapping the capacity building activities in each case study onto a framework previously used for evaluating health research capacity in Ghana, we were able to identify activities that were common to all projects. We used these activities to derive indicators which could be used in other projects to monitor progress towards building sustainable research capacity.ResultsIndicators of sustainable capacity building increased in complexity as projects matured and included- early engagement of stakeholders; explicit plans for scale up; strategies for influencing policies; quality assessments (awareness and experiential stages)- improved resources; institutionalisation of activities; innovation (expansion stage)- funding for core activities secured; management and decision-making led by southern partners (consolidation stage).Projects became sustainable after a median of 66 months. The main challenges to achieving sustainability were high turnover of staff and stakeholders, and difficulties in embedding new activities into existing systems, securing funding and influencing policy development.ConclusionsOur indicators of sustainable capacity building need to be tested prospectively in a variety of projects to assess their usefulness. For each project the evidence required to show that indicators have been achieved should evolve with the project and they should be determined prospectively in collaboration with stakeholders.
Highlights
Despite substantial investment in health capacity building in developing countries, evaluations of capacity building effectiveness are scarce
In CS3 a partnership was formed between the national TB programme and universities in Malawi and the UK to make sure that the research would address the national priorities for TB services
Generic indicators derived from activities Examples of sources of evidence for indicators used in case studies
Summary
Despite substantial investment in health capacity building in developing countries, evaluations of capacity building effectiveness are scarce. Capacity building is strengthening the ‘ability of individuals, organisations or systems to perform appropriate functions effectively, efficiently and sustainably’ [1] and it is an integral component of many health development projects. It has been difficult to devise generic indicators for monitoring and evaluating capacity building [4] because each project is unique. Strengthening the capacity of health systems is closely linked to building research capacity because high quality research is essential to identify and prioritise health needs, and to develop appropriate strategies to improve health outcomes. Capacity (for example strengthened systems or creation of public value) is distinct from capabilities [5] and indicators generally do not reflect complex capabilities such as the degree of autonomous leadership by southern institutions or the potential for sustainability
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