Capacity Development Interventions Research Articles

One Health in Somalia: Present status, opportunities, and challenges

One Health (OH) is an integrated approach aiming at improving the health of people, animals, and ecosystems. It recognizes the interconnectedness of human health with the health of animals, plants, and the environment. Since Somali people's livelihoods are mainly based on livestock, agriculture, marine resources, and their shared environment, OH-oriented initiatives could significantly impact the country toward reducing complex problems affecting the health of humans, animals, and the environment. The term “One Health” was first introduced into the global scientific community in September 2004 and in 2013 in Somalia. After ten years, there is still a long road ahead for implementing the OH approach in the country. Herein, we present the status, opportunities, and challenges of OH in Somalia and recommend ways to promote and institutionalize it. The country has been involved in various OH initiatives solely driven by external funding, focusing on research, capacity development, and community interventions, apart from university-led initiatives such as Somali One Health Centre. In Somalia, OH initiatives face numerous challenges, ranging from limited infrastructure and resources to weak governance and institutional capacity. We urge the Somali government to address these challenges and prioritize OH as the main approach to tackling critical health issues. We suggest the Somali government institutionalize and implement OH actions at all administrative levels, including Federal, State, District, and community, through a mechanism to improve multisectoral coordination and collaboration to predict, prevent, detect, control, and respond to communicable and non-communicable diseases at the human-animal-ecosystem interface for improving health outcomes for all.

Blending Innovative Pedagogy and Technology for Capacity Development of Educators during the Pandemic

The increased use of digital learning environments augments the adoption of open practices in education which contributes to SDG4. The COVID-19 pandemic has compelled an accelerated move towards technology-enhanced learning, prompting educators to re-think and re-design learning environments grounded in innovative pedagogy and technology. In the current scenario it is imperative that educators are offered capacity development opportunities to meaningfully engage in digital and open practices. This paper presents a case study of an online capacity development intervention in OER-integrated technology-enhanced learning (TEL) material creation, implemented with a group of 15 educators selected using the purposive sampling method. It focused on the design, development, implementation, and evaluation of OER-integrated TEL materials by the educators. The intervention comprised a carefully designed learning experience with intensive hands-on activities in a Moodle online learning environment, supplemented with a series of ZOOM-based interactive workshops. The study explored the design strategies that enhanced the creation of OER-integrated TEL materials by the educators, challenges encountered by them and how those were managed, and the effects of the intervention on changing their thinking and practices. Multiple data gathering occurred via questionnaires, discussion forums, reflective journals, and focus group interviews. Primarily, an in-depth content analysis of the qualitative data gathered was conducted. The findings revealed that the systematic learning experience design, which adopted a ‘learning by designing’ approach harnessing the affordances of both technology and pedagogy, empowered educators to become active creators of OER-integrated TEL materials and to take leadership in integrating digital and open practices into teaching-learning processes.

Sustainable Targeted Intervention Models for Stepwise Capacity Development in Surgical Service Delivery in Low- and Middle-Income Countries: A Systematic Map of the Literature

INTRODUCTION: A variety of surgical, obstetric, and anesthetic (SOA) training intervention models have been implemented over the last 10 years to increase SOA service delivery in low- and middle-income countries (LMICs). This systematic map describes the literature on existing models to inform future intervention and evaluation design. METHODS: A comprehensive systematic map methodology was applied to identify studies published after 2010 describing scale-up of SOA in LMICs. Data were extracted and analyzed to assess the type, scale, scope, and impact of various models of surgical skill and capacity development, including tools used for evaluation. RESULTS: A total of 52 studies were identified for extraction; 37 (71%) described training models implemented in Africa. Only 5 used an experimental design with control. The models primarily focused on general surgical skills training (n = 11) and obstetrics and perinatal care (n = 11). Training components included a combination of didactics (45 of 52, 87%), simulation (21 of 52, 40%) and on-the-job instruction (33 of 52, 63%), with limited formal mentorship (8 of 52, 15%; Figure). Outcomes were evaluated on trainee, patient, and organizational levels. Only 2 studies report patient satisfaction scores.FigureCONCLUSION: A wide variety of capacity development interventions and evaluation methodologies are reported, but few describe their work in sufficient detail to allow reproducibility. Furthermore, few study methodologies support causal links between the intervention and recorded impact. Patients are infrequently included in study design and evaluation. This systematic map highlights the need for improved reporting and evaluation design that might inform continued efforts addressing the urgent need for patient-centered surgical care capacity building in LMICs.

Enablers of sexual and reproductive health and rights interventions in low- and middle-income countries. Insights from capacity development projects implemented in 13 countries in Africa and Asia

ABSTRACT Background The global community has committed to achieving universal access to sexual and reproductive health and rights (SRHR) services, but how to do it remains a challenge in many low-income countries. Capacity development is listed as a means of implementation for Agenda 2030. Although it has been a major element in international development cooperation, including SRHR, its effectiveness and circumstances under which it succeeds or fails have limited evidence. Objective The study sought to examine whether improvement in team capacity of SRHR practitioners resulted in improved organisational effectiveness and/or improved SRHR outcomes in low-income countries. Methods The study involved 99 SRHR interventions implemented in 13 countries from Africa and Asia. Self-reported evaluation data from healthcare practitioners who participated in a capacity development international training programme in SRHR was used. The training was conducted by Lund University in Sweden between 2015 and 2019. Logistic regression models were used to examine the association between improved team capacity, improved organizational effectiveness and improved SRHR outcomes, for all the 99 interventions. Adoption of new SRHR approaches (guidelines and policies), media engagement, support from partner organisations and involvement of stakeholders were assessed as possible confounders. Results Improved team capacity, support from partner organisations and media engagement were positively associated with improved organisational effectiveness. Improved team capacity was the strongest predictor of organisational effectiveness even after controlling for other covariates at multivariate analysis. However, adopting new SRHR approaches significantly reduced organisational effectiveness. Furthermore, support from partner organisations was positively associated with increased awareness of and demand for SRHR services. Conclusions Successful implementation of capacity development interventions requires an enabling environment. In this study, an SRHR training programme aiming at improving team capacity resulted in an improvement in organisational effectiveness. Support from partner organisations and media engagement were key enablers of organisational effectiveness.

"I left my shyness behind": Sustainable community-led development and processes of motivation among rural Nicaraguan women.

This paper explores motivational changes of Nicaraguan women involved in sustainable community-led development. Sustainability is the goal of many organizations engaged with capacity development interventions. Research on what such sustainability entails point to a correlation between sustained action by communities, postintervention, and high levels of social capital, collective agency, and efficacy. But what factors motivate people to develop the social capital, self-efficacy, and agency that enable them to sustain their actions towards their communities' well-being? Using Self-Determination Theory as framework, and drawing from interview data, this qualitative paper explores the psychosocial processes rural Nicaraguan women undergo when initially engaging in, and eventually committing to community-led projects. Types of motivation in combination with shifts from initial to more sustained forms of motivation, we conclude, can inform current and future community development interventions on the role motivation plays toward establishing agency, efficacy, and relationships-that is, essential components of sustainable community development.

Exploring the relationship between context and effectiveness in impact assessment

Impact Assessment (IA) has been adopted worldwide typically to ensure the achievement of its goal(s), which might be one or more of sustainable development, environmental policy integration, and democratic governance. Researchers have developed and applied effectiveness frameworks in order to evaluate whether IA achieves its goal(s). The application of these frameworks often identifies some areas of ineffectiveness, and the frameworks are rarely transferable to other cases either within or across different jurisdictions, which makes national and international comparisons problematic. Context is frequently cited as a reason why ineffectiveness is identified in a case, and yet context is not clearly understood in relation to effectiveness. Our aim in this paper is to unpack the notion of context in order to better understand how IA can achieve its goal(s). Based on literature review and a subsequent conceptualisation of context drawing, for the first time, on Integral Theory, we propose that the notion of context can be understood as a range of mediators, which act either as enablers or barriers to the ability of IA to deliver its goal(s). It is these mediators which lead to very different IA system performance in terms of goals achievement, despite applying similar procedural steps. Our conceptualisation provides a significant contribution as it clarifies the validity of claims about contextual elements in the literature, explains the nature of different elements of context, provides a framework with which they can be meaningfully considered and makes an initial attempt at identifying strategies for ensuring mediators act as enablers rather than barriers. It also potentially serves to help unify literature on the meaning of context for IA effectiveness, effectiveness dimensions, and causation in IA, thus providing clarity over the challenges of goals achievement and the appropriateness of capacity development interventions.

Biodiversity conservation funding in Bhutan: Thematic, temporal, and spatial trends over four decades

AbstractAccess to sufficient financial resources is vital for effective biodiversity conservation. Although the importance of biodiversity conservation is widely recognized, lack of funding has been a significant impediment to achieving conservation goals. Yet, information on the allocation of conservation funding remains limited. This study addresses this gap by mapping conservation funding flows in Bhutan over the past four decades. We identified 249 projects totaling US$ 239.4 million allocated for biodiversity conservation in Bhutan from 1980 to 2019. Most of this funding derived from bilateral and multilateral aid agencies, with domestic trust fund and private foundations also contributing. Funding for projects with coupled conservation and development objectives and gender components was relatively high, particularly for funds allocated by multilateral and bilateral organizations. By contrast, domestic funding typically did not include development or gender components. Private foundations and domestic sources emphasized capacity development interventions. Despite relatively limited funding flows, the socio‐political context in Bhutan, which favors environmentally friendly practices, may have been key to the country's widely recognized conservation success. Evidence on trends and patterns in conservation finance, as presented here for Bhutan, can advance conservation science and practice by shedding new light on historical and current conservation priorities and helping inform future allocation.

Evaluating a capacity development intervention in health economics among producers and users of evidence in Nigeria: a case study in Getting Research Into Policy and Practice (GRIPP) in Anambra State

BackgroundThe use of research evidence to inform policy and practice cannot be overemphasized especially in low and middle-income countries (LMICs). To promote the use of research evidence in the provision of health services for enhanced effective control of communicable diseases in developing countries, the World Health Organization (WHO) in collaboration with the Health Policy Research Group (HPRG) commissioned a capacity development workshop in health economics among producers and users of research evidence in the healthcare system of Anambra state, south east Nigeria. This study was aimed to evaluate the impact of the workshop training on selected stakeholders on the use of health economics evidence to inform health policy and practice in the state.MethodsParticipants were purposively selected based either as producers and users of evidence at various levels of healthcare decision making in Anambra state, comprising mostly senior managers and executives from the ministry of health, the academic and health institutions in the state. A two-day capacity development workshop was conducted to train the participants on the use of economic evidence to inform health policy and practice. Pre-post test approach and group exercises were used to assess the knowledge and impact of the training exercises on the participants regarding the use of health economics evidence. Analysis was based on the framework of process-output-outcome-impact approach using the pre-post test and scores technique to assess the impact of the training programme.ResultsPretest average scores varied from 39.7% to 60.5% while posttest scores varied from 47.6% to 65.7%, showing big differences in individual scores among participants, between the producers and users of evidence both prior to and after the training. The significant differences between the test scores indicated success in increasing the knowledge of participants on the use of health economics evidence. Results corroborated participants’ perceptions that the workshop impacted positively on their ability to apply the knowledge of health economic evidence to inform decision making in their respective practices.ConclusionFindings underscored the need for regular upgrade of stakeholders in the health system for enhanced uptake and sustainability of the programme to achieve the desired goal of getting research into policy and practice in the state applicable to other settings.

The state of capacity development evaluation in biodiversity conservation and natural resource management

AbstractCapacity development is critical to long-term conservation success, yet we lack a robust and rigorous understanding of how well its effects are being evaluated. A comprehensive summary of who is monitoring and evaluating capacity development interventions, what is being evaluated and how, would help in the development of evidence-based guidance to inform design and implementation decisions for future capacity development interventions and evaluations of their effectiveness. We built an evidence map by reviewing peer-reviewed and grey literature published since 2000, to identify case studies evaluating capacity development interventions in biodiversity conservation and natural resource management. We used inductive and deductive approaches to develop a coding strategy for studies that met our criteria, extracting data on the type of capacity development intervention, evaluation methods, data and analysis types, categories of outputs and outcomes assessed, and whether the study had a clear causal model and/or used a systems approach. We found that almost all studies assessed multiple outcome types: most frequent was change in knowledge, followed by behaviour, then attitude. Few studies evaluated conservation outcomes. Less than half included an explicit causal model linking interventions to expected outcomes. Half of the studies considered external factors that could influence the efficacy of the capacity development intervention, and few used an explicit systems approach. We used framework synthesis to situate our evidence map within the broader literature on capacity development evaluation. Our evidence map (including a visual heat map) highlights areas of low and high representation in investment in research on the evaluation of capacity development.

We Won't Go There: Barriers to Accessing Maternal and Newborn Care in District Thatta, Pakistan.

Accessibility and utilization of healthcare plays a significant role in preventing complications during pregnancy, labor, and the early postnatal period. However, multiple barriers can prevent women from accessing services. The aim of this study was to explore the multifaceted barriers that inhibit women from seeking maternal and newborn health care in Thatta, Sindh, Pakistan. This study employed an interpretive research design using a purposive sampling approach. Pre-tested, semi-structured interview guides were used for data collection. The data were collected through eight focus group discussions with men and women, and six in-depth interviews with lady health workers and analyzed through thematic analysis. The study identified individual, sociocultural, and structural-level barriers that inhibit women from seeking maternal and newborn care. Individual barriers included mistrust towards public health facilities and inadequate symptom recognition. The three identified sociocultural barriers were aversion to biomedical interventions, gendered imbalances in decision making, and women’s restricted mobility. The structural barriers included ineffective referral systems and prohibitively expensive transportation services. Increasing the coverage of healthcare service without addressing the multifaceted barriers that influence service utilization will not reduce the burden of maternal and neonatal mortality. As this study reveals, care seeking is influenced by a diverse array of barriers that are individual, sociocultural, and structural in nature. A combination of capacity development, health awareness, and structural interventions can address many if not all of these barriers.

Needs-driven talent and competency development for the next generation of regulatory scientists in Africa.

Capacity building programmes for African regulators should link education, training and research with career development in an approach that combines an academic base and experiential learning aligned within a competency framework. A regulatory ecosystem that engages with a broad range of stakeholders will mean that expertise in the ever‐expanding field of regulatory science filters into teaching and research in a symbiotic way. In this way capacity development interventions will be a collaborative approach between the learning context (academic and training institutions) and the performance context (regulatory agencies and industry), which will ultimately best serve the patients. Monitoring and evaluation of capacity development interventions will be essential to show value of investments and ultimately guide continued funding and sustainability.This paper reviews the skills and human capacity gaps, reports on regulatory assessment pathways used in Ghana, South Africa and Zimbabwe and outlines a staged tactical approach for Africa that builds on previous efforts to strengthen African regulatory ecosystems.

The Complex Relationship between Capacity and Infrastructure Project Delivery: The Case of the Indian National Urban Renewal Mission

Capacity development (CD) interventions are becoming a vital component of development projects. However, there is a lack of information about the relationships between capacity and project delivery. This paper presents the results of a study of how CD was applied to one of India’s largest urban infrastructure programs. While the Indian government considered a lack of capacity to be the main problem in project delivery, there is little evidence that explains the relationships between capacity and project delivery. This study analyzes the content of 58 interviews with project engineers, managers, and administrators about the hurdles they experienced at each stage of project delivery and seeks to understand these hurdles through the lens of CD. The study identifies the influence of capacity factors on project delivery and the converse influence of project performance and outcomes on CD. Ultimately, this study reveals the complex two-way interactions between capacity and project delivery.

A capacity assessment framework for the fit-for-purpose land administration systems: The use of unmanned aerial vehicle (UAV) in Rwanda and Kenya

This article presents a novel capacity assessment framework, coined as Fit-For-Purpose capacity assessment framework (FCAF), to measure the capacity of the land administration system compliant with the Fit-For-Purpose approach. The framework incorporates legal, political, operational, social, technical, and technological capacity conditions and provides a holistic view of the capacity development pathways. The FCAF is designed by merging six capacity dimensions, namely regulations, political system, operational unit, social norms, land recording techniques, and software. FCAF systematically identifies context-specific, enabling and impeding capacity components and thus provides a basis to develop the necessary capacity development strategies and interventions. Specifically, FCAF can serve as a useful heuristic for the development of the capacity development strategies for the adaptation and sustainability of the geospatial technologies in land administration systems. In the article, by assessing the capacity needs for the adaptation of unmanned aerial vehicle (UAV) technology in Rwandese and Kenyan land administration systems, the efficacy of the FCAF is tested. The findings suggest that in Rwanda, capacity conditions are more supportive of an easier uptake of UAV. Nonetheless, weak market conditions and strict regulations concerning UAV call for attention. In Kenya, existing institutional and political challenges in the land administration system raise concerns about the reliability and attainability of UAV under the current framework conditions. Despite that, there are more supportive market conditions in Kenya in comparison to Rwanda and multiple non-governmental and private actors that can bolster the adaptation process into a more sustainable and scalable land administration system.

A health care professionals training needs assessment for oncology in Uganda

BackgroundCancer incidence and mortality in sub-Saharan Africa are increasing and do account for significant premature death. The expertise of health care providers is critical to downstaging cancer at diagnosis and improving survival in low- and middle-income countries. We set out to determine the training needs of health care providers for a comprehensive oncology services package in selected hospitals in Uganda, in order to inform capacity development intervention to improve cancer outcomes in the East African region.MethodsThis was a cross-sectional survey using the WHO Hennessey-Hicks questionnaire to identify the training needs of health workers involved in cancer care, across 22 hospitals in Uganda. Data were captured in real time using the Open Data Kit platform from which the data was exported to Stata version 15 for analysis using the Wilcoxon signed-rank test and Somers-Delta.ResultsThere were 199 respondent health professionals who were predominately female (146/199, 73.37%), with an average age of 38.97 years. There were 158/199 (79.40%) nurses, 24/199 (12.06%) medical doctors and 17/199 (8.54%) allied health professionals. Overall, the research and audit domain had the highest ranking for all the health workers (Somers-D = 0.60). The respondent’s level of education had a significant effect on the observed ranking (P value = 0.03). Most of the continuing medical education (CME) topics suggested by the participants were in the clinical task-related category.ConclusionThe “research and audit” domain was identified as the priority area for training interventions to improve oncology services in Uganda. There are opportunities for addressing the identified training needs with an expanded cancer CME programme content, peer support networks and tailored training for the individual health care provider.

Does Capacity Development Increase Demand for Health Services and Rights Among Key Populations Affected by HIV? A Systematic Review of Evidence from Low and Middle-Income Countries.

Capacity development is a process by which individuals, organizations and societies develop abilities to perform functions, solve problems and achieve objectives. This systematic review sought to document capacity development interventions, the associated outcomes and its effectiveness in increasing demand for rights and health services among key populations (KP) in low and middle-income countries. Twenty papers met our review's selection criteria. Significant improvements in health service utilization were achieved in most community mobilization and peer-led interventions. Whilst we found ample evidence linking capacity development to uptake of services, there was a striking dearth of research examining the impact of capacity development on demand for rights among KP. There was inadequate contextual data to explain variations in intervention effectiveness across different projects. More evidence is needed on the impact of capacity development on demand for health services and rights among KP. Consensus on parameters of capacity development and priority outcomes is required.

The impacts of agroforestry on agricultural productivity, ecosystem services, and human well-being in low-and middle-income countries: An evidence and gap map.

The impacts of agroforestry on agricultural productivity, ecosystem services, and human well-being in low-and middle-income countries: An evidence and gap map.

The 2030 Agenda and coherent national development policy: In dialogue with South African policymakers on Policy Coherence for Sustainable Development

AbstractThe Policy Coherence for Sustainable Development (PCSD) agenda is regarded as the principal instrument to ensure the coherent alignment of the Sustainable Development Goals (SDGs) with domestic policies. Due to PCSD's genesis in the foreign aid donor–recipient relationship, there is a shortage of research on policymakers in developing countries' perspective on PCSD. In this article, interviews with South African policymakers are used to evaluate the applicability of PCSD beyond the donor–recipient relationship critically. Emphasis is placed on vertical coherence. Policymakers are found to emphasise (a) the need to prioritise the SDGs' targets in terms of national priorities, (b) the importance of attending to institutional issues such as a lack of accountability and efficiency, (c) addressing the skills mismatch of capacity development interventions, and (d) engaging party politics.

Because coconuts do not grow in Canberra: Complexity theory and capacity development in Solomon Islands Police Force

SummaryStatebuilding has been informed and captured by reductionist, linear change models. Defined by technocratic approaches to public sector (re)building and reform—it has been monitored, measured and evaluated by New Public Management artefacts such as log‐frames and Results‐Based Management. Through a case study on the capacity development of the Royal Solomon Islands Police Force, I explore the possibilities for using complexity theory to better understand, manage, and monitor capacity development interventions. The analysis of interview data with police practitioners from both sides of the intervention—advisors and local counterparts—reveals the explanatory power of complexity concepts (such as interconnectedness, emergence, initial conditions, and non‐linear change) in ways that could inform a rethink of how we frame public sector capacity building interventions.

How climate awareness influences farmers’ adaptation decisions in Central America?

Central America is one of the regions with the highest vulnerability to climate change, with negative effects projected to affect its economy and food security. To address this issue, an integrative farm management approach such as Climate-Smart Agriculture can help reorient agricultural practices towards climate adaptation and food security. Past studies have shown that several factors can either hinder or encourage the adoptions of Climate-Smart practices, including subjective expectations and perceptions. Building on this literature, we analyze farmers' climate awareness and their perceptions regarding the change in climate patterns as well as their choices of farming practices to adapt to these changes. We show that reforestation was the preferred adaptation strategy among interviewed farmers and that educational profiles and the size of landholdings drive the adoption of this and other practices. Soil management and introduction of new crops are preferred by literate farms with large farmlands, whereas illiterate farmers with smaller farmland tend to move towards farm intensification with an increase in the utilization of external inputs. Our findings provide evidence to support the design of capacity development interventions targeting specific groups of farmers according to their main crop and education profile.

Individual capacity-building approaches in a global pharmaceutical systems strengthening program: a selected review

BackgroundMedicines use related challenges such as inadequate adherence, high levels of antimicrobial resistance and preventable adverse drug reactions have underscored the need to incorporate pharmaceutical services to help achieve desired treatment outcomes, and protect patients from inappropriate use of medicines. This situation is further constrained by insufficient numbers of pharmaceutical personnel and inappropriate skill mix. Studies have addressed individual capacity building approaches of logistics, supply chain or disease specific interventions but few have documented those involving such pharmacy assistants/professionals, or health workers/professionals charged with improving access and provision of pharmaceutical services. We examined how different training modalities have been employed and adapted to meet country-specific context and needs by a global pharmaceutical systems strengthening program in collaboration with a country’s Ministry of Health and local stakeholders.MethodsStructured, content analysis of training approaches from twelve selected countries and a survey among conveniently selected trainees in Bangladesh and Ethiopia.ResultsCase-based learning, practice and feedback, and repetitive interventions such as post-training action plan, supportive supervision and mentoring approaches are effective, evidence-based training techniques. In Ethiopia and Bangladesh, over 94% of respondents indicated that they have improved or developed skills or competencies as a result of the program’s training activities. Supportive supervision structures and mentorship have been institutionalized with appropriate management structures. National authorities have been sensitized to secure funding from domestic resources or from the global fund grants for post-training follow-up initiatives. The Pharmaceutical Leadership Development Program is an effective, case-based training modality that motivates staff to develop quality-improvement interventions and solve specific challenges. Peer-to-peer learning mechanisms than traditional didactic methods was a preferred intervention among high level government officials both within country and between countries.ConclusionInterventions must involve local institutions in the design and delivery of content for both pre-service and in-service training as well as web-based methods where feasible. Such efforts would meet the changing demand in the pharmaceutical system, and promote the ownership of the human capacity development interventions. The cost-effective partnership with universities demonstrate that competency based pre-service training will prepare the future pharmaceutical workforce with a critical foundation of knowledge and skills required to meet the growing demand for patient-centered pharmaceutical services in resource-constrained countries.