Capacity Building Process Research Articles

Defining and assessing evidence for the effectiveness of technical assistance in furthering global health

In an era when health resources are increasingly constrained, international organisations are transitioning from directly managing health services to providing technical assistance (TA) to in-country owners of public health programmes. We define TA as: ‘A dynamic, capacity-building process for designing or improving the quality, effectiveness, and efficiency of specific programmes, research, services, products, or systems’. TA can build sustainable capacities, strengthen health systems and support country ownership. However, our assessment of published evaluations found limited evidence for its effectiveness. We summarise socio-behavioural theories relevant to TA, review published evaluations and describe skills required for TA providers. We explore challenges to providing TA including cost effectiveness, knowledge management and sustaining TA systems. Lastly, we outline recommendations for structuring global TA systems. Considering its important role in global health, more rigorous evaluations of TA efforts should be given high priority.

Information seeking for making evidence-informed decisions: a social network analysis on the staff of a public health department in Canada

BackgroundSocial network analysis is an approach to study the interactions and exchange of resources among people. It can help understanding the underlying structural and behavioral complexities that influence the process of capacity building towards evidence-informed decision making. A social network analysis was conducted to understand if and how the staff of a public health department in Ontario turn to peers to get help incorporating research evidence into practice.MethodsThe staff were invited to respond to an online questionnaire inquiring about information seeking behavior, identification of colleague expertise, and friendship status. Three networks were developed based on the 170 participants. Overall shape, key indices, the most central people and brokers, and their characteristics were identified.ResultsThe network analysis showed a low density and localized information-seeking network. Inter-personal connections were mainly clustered by organizational divisions; and people tended to limit information-seeking connections to a handful of peers in their division. However, recognition of expertise and friendship networks showed more cross-divisional connections. Members of the office of the Medical Officer of Health were located at the heart of the department, bridging across divisions. A small group of professional consultants and middle managers were the most-central staff in the network, also connecting their divisions to the center of the information-seeking network. In each division, there were some locally central staff, mainly practitioners, who connected their neighboring peers; but they were not necessarily connected to other experts or managers.ConclusionsThe methods of social network analysis were useful in providing a systems approach to understand how knowledge might flow in an organization. The findings of this study can be used to identify early adopters of knowledge translation interventions, forming Communities of Practice, and potential internal knowledge brokers.

Action Oriented Learning: A Tool for Effective Use of Forest Resources for Better Livelihood

Widespread poverty existed amongst the forest based tribal communities in the Aruku valley and the adjoining forest area of Andhra Pradesh state in southern India. In spite of dwelling in a forest range with rich biodiversity most of these tribal communities were unable to utilize the Non Timber Forest Products (NTFPs) to augment their livelihood base.Bereft of proper welfare services of the State since generations, because of the inaccessible terrain (ranges between 700 and 900 meters above mean sea level) the tribals languished with very low Human Development Indices. Quantitatively, NTFPs here have always been ample for the use of the communities but the State had never earnestly attempted to mobilize the people to utilize the same for improving their livelihood by accessing the market. Weak collectivization process of the communities stemmed from the apathy of the understaffed forest department. This had resulted in low knowledge and skill of the forest dependent community to utilize the surplus NTFPs for economic gains.A process (called the Action Oriented Learning) has been on since 2002 to mobilize the community in 3600 habitations to carry out microplanning exercises. This has been a tool for the communities to identify their priorities, the resources and look for means to address their short- and long-term needs. During this process apart from other issues, the community discusses issues of availability of specific NTFPs (of a season), the ongoing prices, the marketing avenues and gets to a common consensus to collectively trade in specific NTFPs. The accompanying social mobilization and capacity building processes have empowered them with information regarding the collection, value addition and the forward linkages.Currently tribals in 3600 habitations of this forested area trade in various NTFPs. The State run Co-operative is the primary buyer. There is least dependency on ‘external’ middlemen. The local NGOs and CBOs of the village form the vital link and there has been a sea change in the livelihood base of these forest-based communities. Not only has borrowing from moneylenders decreased, but out-migration to urban areas during the lean period has also fallen drastically.

The Yonmenkaigi System Method: An Implementation-Oriented Group Decision Support Approach

The Yonmenkaigi System Method (YSM) is presented as a participatory method to support group decision making. It is composed of four main steps: conducting a SWOT analysis, completing the Yonmenkaigi chart, debating, and presenting the group’s action plan. The YSM is an implementation and collaboration-oriented approach that incorporates the synergistic process of mutual learning, decision making and capacity building. It fosters small and modest breakthrough and/or innovative strategy development. The YSM addresses the issues of resource management and mobilization as well as effective involvement and commitment by participants and provides a strategic communication platform for participants. A case study for developing a disaster reduction action plan, carried out with a local community organization in the City of Kyoto, Japan, is used to demonstrate the characteristics of the YSM.

The role of information communication technology (ICT) towards universal health coverage: the first steps of a telemedicine project in Ethiopia

BackgroundEighty-five per cent of the Ethiopian population lives in remote areas, without access to modern health services. The limited health care budget, chronic shortage of health care workers and lack of incentives to retain those in remote areas further jeopardize the national health care delivery system. Recently, the application of information communication technology (ICT) to health care delivery and the use of telemedicine have raised hopes.ObjectiveThis paper analyzes the challenges, failures and successes encountered in setting-up and implementing a telemedicine program in Ethiopia and provides possible recommendations for developing telemedicine strategies in countries with limited resources.DesignTen sites in Ethiopia were selected to participate in this pilot between 2004 and 2006 and twenty physicians, two per site, were trained in the use of a store and forward telemedicine system, using a dial-up internet connection. Teledermatology, teleradiology and telepathology were the chosen disciplines for the electronic referrals, across the selected ten sites.ResultsTelemedicine implementation does not depend only on technological factors, rather on e-government readiness, enabling policies, multisectoral involvement and capacity building processes. There is no perfect ‘one size fits all’ technology and the use of combined interoperable applications, according to the local context, is highly recommended.ConclusionsTelemedicine is still in a premature phase of development in Ethiopia and other sub-Saharan African countries, and it remains difficult to talk objectively about measurable impact of its use, even though it has demonstrated practical applicability beyond reasonable doubts.

Borderwork: Finnish-Russian co-operation and civil society engagement in the social economy of transformation

This paper presents results from research projects that have investigated networks of civil society organizations (CSOs) between EU member states and neighbouring countries. The focus here is on Finnish-Russian civil society co-operation in the areas of social welfare provision as well as regional and economic development. One major objective in this conjunction is to assess the contribution of this cross-border co-operation to the development of Russia's social economy as well as to discuss the various obstacles that civil society actors face in developing co-operative projects. As such, organizational, social and technical issues are important areas to be addressed. However, civil society co-operation is not a mere technical issue; understanding of the social embeddedness of civil society are also necessary in order to promote social welfare agendas. The concluding section will reflect on experiences of CSO co-operation with regard to capacity-building processes of social learning and future prospects for social enterprise.

Challenges and opportunities in building health research capacity in Tanzania: a case of the National Institute for Medical Research.

Capacity building is considered a priority for health research institutions in developing countries to achieve the Millennium Development Goals by 2015. However, in many countries including Tanzania, much emphasis has been directed towards human resources for health with the total exclusion of human resources for health research. The objective of this study was to systematically investigate the capacity building process for the Tanzanian National Institute for Medical Research (NIMR) over a 30-year period and identify the challenges and opportunities in creating a critical mass of multi-disciplinary research scientists that is required for achieving the intended health benefits. A desk review of personnel database was conducted for information covering 1980-2009 on academic qualifications, training, research experience and research output. The current staff curriculum vitae (CV) were reviewed to gather information on researchers' employment record, training, training support, area of expertise and scientific output. Interviews were conducted with a cross section of researchers on capacity development aspects using a self-administered questionnaire. In-depth interviews were also conducted with the current and former NIMR Management to seek information on capacity development challenges. A review was also done on staff personal files, annual reports, strategic plans and other occasional documents. A total of 163 CV were assessed; of these, 76.7% (125) were for Research Scientists (RS), 20.9% (34) Laboratory Technologists (LT) and 2.4% (4) for System Analysts. The Institute had 13 research scientists upon its establishment. Since 1980, NIMR has recruited a total of 185 Research Scientists. By 2009, NIMR had a total scientific workforce of 170 staff (RS= 82.4%; LT= 17.6%). Of the 140 RSs, 37 (26.4%), were first degree; 77 (55.5%) second degree while 26 (18.6%) were PhD degree holders. Of the total of 78 researchers interviewed, 55 (70.5%) indicated to have accessed postgraduate training through their personal efforts and 23 through institutional arrangement. Sixty (77%) respondents were satisfied with their tenure at NIMR. Seventy (89%) indicated that they had not at any point considered leaving NIMR. Most (79%) research scientists were recruited while holding a first degree, a few (17%) with second degree while only one (0.7%) holding a PhD degree. NIMR has experienced a research scientist attrition rate of 17.5%. Staff retention factors included availability of training opportunities; passion for conducting research; and good career prospects. Despite having a training programme, the institute has never at any moment been able to hold its own training resources. Being a public research institution, NIMR receives its core funding from the government of the United Republic of Tanzania. The bulk of the funding appears to be spent on personnel emoluments that take up to 85% (mean = 66%) of the allocated budget. In conclusion, the current NIMR's research capacity building is dependent mainly on foreign funding and personal initiatives. There is an urgent need to increase local funding for capacity building and conduct of research. A programme should be put in place to ensure sustainability of the capacity building process.

Public-Private Partnership as a way to restore forest management. Some evidence from Liguria

Over the last ten years, Regione Liguria has been enacting a series of development policies with the purpose of restoring a supply chain for wooden products by promoting sustainable forestry. Public-Private Partnerships have been seen as a viable mean to connect economic exploitation of the forest resources to the sustainable development of rural areas. In this paper, the feasibility of this approach is tested by identifying and describing its effects on the uptake for forestry measures of the present rural development programming period. It is argued that publicprivate partnerships could be effective in revitalizing forest management whenever cooperation is set in a strategic framework and partners are actively involved in animation and capacity building processes.

Network Analysis as a Tool for Community Capacity Measurement and Assessing Partnerships Between Community-Based Organizations in Korea

The community partnership is a foundation laid by the local community that has been historically and geographically formed to develop itself. This article, an exploratory community network survey for capacity building, assessed collaborations among community-based organizations (CBOs) in the S-district, Republic of Korea, and evaluated methods for the reconstruction of a resident-governing healthy network. Using CBOs' evaluation questionnaire, the author surveyed 83 CBOs that were collected by snowball sampling. The CBOs in the S-district had formed community networks based on vocational associations established in the 1980s and the 1990s. The entire network evidenced a cooperative partnership, in which women's organizations and civic groups carried out essential functions. In the capacity-building process through CBOs, community collaboration can be naturally cultivated, and health promotion programs to improve the residents' health will tend to be more systematic than the current approach and yield higher compliance and practice rates. Thus, it will be necessary to construct an effective partnership of community networks by reorganizing existing exclusive relations.

The community capacity building for sustainable dengue problem solution (CCB-SDPS) model: The results from studies in community, southern region, Thailand

This paper provides an approach for sustainable dengue problem solution by the community capacity building model and the results of two studies from implementation the model in Southern region, Thailand. The conceptual framework of the CCB-SDPS model consisted of three dimensions; 1) community-based (leader and non-leader in community), 2) community capacity building process, and 3) sustainable dengue problem solution (outcomes). The outcomes of studies focused on the capacity level by the DCCAT (14 domains of leader group, and 11 domains of non-leader group), dengue entomology (Larval) index, and epidemiological (morbidity and mortality) rate. The two studies were pilot study in high risk dengue areas. These studies were application of CCB-SDPS model. First study was the process of using the tool for testing the DCCAT in two communities. The results showed only three steps of using assessment tool; community preparation, assessment, and community hearing. The second study was the fully testing model in three communities. Participatory action research and mix methods; quantitative and qualitative collecting data were preparation community-based, building capacity process (assessment, plan, implement, and reassessment), and outcomes monitoring. The results of second study showed three models of the CCB-SDPS. The two studies confirmed the sustainable in after intervention of community capacity building such as increased capacity level of leader and non-leader group, deceased entomological indices (HI, BI, and CI), and non presentation of morbidity and mortality rate in during study period. These results showed the model conducing on contexts of each community such the three dimensions of the conceptual framework of the model, community-based, building capacity process, and measurement of outcomes of sustainable dengue problem solution. These experiences in Southern Thailand demonstrated the main keys to the approach of CCB-SDPS were in the use of strategies planning to initiate community capacity building towards sustained dengue problem solution.

A study on the extent of environmental awareness among rural people in coastal area of Kerala

The present study intends to analyse the extent of environmental awareness among the rural community of coastal area of Kerala. The objective of the study is to analyse the existing pattern of living and the creation and implementation of a renewed environmental education programme, designed to set off a capacity-building process for environmental management to be developed within a regional approach. The population of this study consisted of the rural people of the Anchuthengu Panchayath, the coastal area of the capital district of Kerala. A representative sample of 310 families in Ward VI of Anchuthengu Panchayath was selected. Data was collected using an environmental awareness scale and the results indicate that only technocratic solutions will not be sufficient to tackle such complex problems. One must admit that peoples’ participation as an institutional structure is a stronger alternative than mere governmental poverty alleviation and environmental preservation programmes, as it not only empowers the beneficiary groups but also makes people (groups) responsive to the cost of preservation of the environment and entitles them to the benefits emerging there from.

Measuring capacity building in communities: a review of the literature

BackgroundAlthough communities have long been exhorted to make efforts to enhance their own health, such approaches have often floundered and resulted in little or no health benefits when the capacity of the community has not been adequately strengthened. Thus being able to assess the capacity building process is paramount in facilitating action in communities for social and health improvement. The current review aims to i) identify all domains used in systematically documented frameworks developed by other authors to assess community capacity building; and ii) to identify the dimensions and attributes of each of the domains as ascribed by these authors and reassemble them into a comprehensive compilation.MethodsRelevant published articles were identified through systematic electronic searches of selected databases and the examination of the bibliographies of retrieved articles. Studies assessing capacity building or community development or community participation were selected and assessed for methodological quality, and quality in relation to the development and application of domains which were identified as constituents of community capacity building. Data extraction and analysis were undertaken using a realist synthesis approach.ResultsEighteen articles met the criteria for this review. The various domains to assess community capacity building were identified and reassembled into nine comprehensive domains: "learning opportunities and skills development", "resource mobilization", "partnership/linkages/networking", "leadership", "participatory decision-making", "assets-based approach", "sense of community", "communication", and "development pathway". Six sub-domains were also identified: "shared vision and clear goals", "community needs assessment", "process and outcome monitoring", "sustainability", "commitment to action" and "dissemination".ConclusionsThe set of domains compiled in this review serve as a foundation for community-based work by those in the field seeking to support and nurture the development of competent communities. Further research is required to examine the robustness of capacity domains over time and to examine capacity development in association with health or other social outcomes.

The state of capacity building in Africa

How can we account for the actual state of capacity building in Africa? This paper attempts to respond to this question, building on the existing literature and statistical data available both within and outside the continent. Using the arguments put forward by different national and international institutions around the world, it is possible to trace the path followed by the capacity building process in Africa around change and human capital theories. Following the creation of ACBF in 1991 and thanks to the intervention of a number of development partners, capacity building practices have significantly influenced the functioning of African States, the implementation of educational systems, the expansion of microfinance, and the impact of multilateral trade negotiations. This paper suggests that capacity building in Africa still requires urgent and vigorous actions towards a qualitative and quantitative of scientists, for the coordination of the dispersed efforts made by various regional and sub‐regional institutions, and for the strengthening of individual and collaborative programmes aimed at developing African human resources in Africa.

Social dilemmas and individual/group coordination strategies in a complex rural land-use game

Strengthening ongoing bottom-up capacity building processes for local and sustainable landscape-level governance is a multi-dimensional social endeavor. One of the tasks involved – participatory rural land use planning – requires more understanding and more awareness among all stakeholders regarding the social dilemmas local people confront when responding to each other’s land-use decisions. In this paper we will analyze and discuss a version of our game SIERRA SPRINGS that is simple to play for any stakeholder that can count to 24, yet entails a complex-coordination land use game – with an extensive and yet finite set of solutions – which can mimic in a stylized form some of the dilemmas landowners could confront in a landscape planning process where there livelihoods are at stake. The game has helped researchers and players observe and reflect on the individual coordination strategies that emerge within a group in response to these stylized dilemmas. This paper (1) develops a game-theoretical approach to cooperation, competition and coordination of land uses in small rural watersheds, (2) describe the goal, rules and mechanics of the game, (3) analyzes the structure of each farms’ solution set vs. the whole watershed’s solution set, (4) derives from them the coordination dilemmas and the risk of coordination failure, (5) describes four individual coordination strategies consistently displayed by players; mapping them in a plane we have called Group-Level Coordination Space, and (6) discusses the strengths, limitations and actual and potential uses of the game both for research and as an introductory tool for stakeholders involved in participatory land use planning.

Social dilemmas and individual/group coordination strategies in a complex rural land-use game

Strengthening ongoing bottom-up capacity building processes for local and sustainable landscape-level governance is a multi-dimensional social endeavor. One of the tasks involved – participatory rural land use planning – requires more understanding and more awareness among all stakeholders regarding the social dilemmas local people confront when responding to each other’s land-use decisions. In this paper we will analyze and discuss a version of our game SIERRA SPRINGS that is simple to play for any stakeholder that can count to 24, yet entails a complex-coordination land use game – with an extensive and yet finite set of solutions – which can mimic in a stylized form some of the dilemmas landowners could confront in a landscape planning process where there livelihoods are at stake. The game has helped researchers and players observe and reflect on the individual coordination strategies that emerge within a group in response to these stylized dilemmas. This paper (1) develops a game-theoretical approach to cooperation, competition and coordination of land uses in small rural watersheds, (2) describe the goal, rules and mechanics of the game, (3) analyzes the structure of each farms’ solution set vs. the whole watershed’s solution set, (4) derives from them the coordination dilemmas and the risk of coordination failure, (5) describes four individual coordination strategies consistently displayed by players; mapping them in a plane we have called Group-Level Coordination Space, and (6) discusses the strengths, limitations and actual and potential uses of the game both for research and as an introductory tool for stakeholders involved in participatory land use planning.

“Capacity‐building” in global Internet governance: The long‐term outcomes of “multistakeholderism”

Abstract“Capacity building” is a catch phrase from the UN development discourse. In recent years, it has entered the global Internet governance (IG) arena. At World Summit of the Information Society (WSIS 2003), “capacity building” was identified as a key public policy issue. It is proposed in this study that ‘capacity building’ be defined in a different manner – as the principal outcome of the experimental multistakeholder (MSH) process in global IG. The open and inclusive process of stakeholder deliberation leads to accumulation of intellectual capital, development of relational infrastructure for the domain (epistemic community), and emergence of common global consciousness. When cast as a capacity‐building process, MSH collaboration at global Internet governance arenas exhibits long‐term and large‐scale intangible outcomes. This study contributes to the understanding of the capacity‐building potential of MSH collaboration in IG. By employing concepts from International Relations and Organizational Learning, the author develops a model of tangible and intangible outcomes of MSH collaboration. This unique model can be used for studying the effects in other stakeholder venues of governing global resources and processes.

Capacity building to achieve sustainable fisheries management in Mexico

Achieving sustainable fisheries management is an enormous challenge and involves the enhancement of scientific and technological management capacities worldwide. The improvement of this capacity building (CB) is particularly crucial to developing countries with massive fisheries such as Mexico. To understand the current status of CB in Mexico, the contemporary development of its academic research system was examined by undertaking a bibliographic review of specialized literature, including research institutions and postgraduate programs. The resulting information was considered as Mexican CB indicators and its theoretical and spatio-temporal analysis revealed capabilities are increasingly supporting research topics related to advancing sustainable fisheries development. However, because the recent and tumultuous development of the Mexican academic research system, much of the knowledge accumulated centers on commercial resources, and the renovation of the system itself is geographically inconsistent. In this paper, some key insights on how to improve Mexican CB process are highlighted.

Planning for knowledge infrastructure and capacity building in a distinct insular regional context (Cyclades-Southern Aegean): the role of higher education institutions’ research actions

This paper is based on the study of a distinct insular region in Greece: Cyclades Prefecture with reference to also to the broader Periphery of the Southern Aegean. It elaborates on the issue of island innovation systems and the role of actions driven by higher education institutions (HEIs) in knowledge infrastructure (KI) and capacity building (CB). The paper argues that an exceedingly high number of HEI research actions tend to develop with “relative autonomy” from local expertise, networks and knowledge patterns embedded in the insular setting. In addition, these actions are conditioned by the EU policy doctrine, the dominant central state perception of innovation policies and the adverse pattern of HEI development in the national territory. Its geographically scattered composition and scarcities in scientific specializations and research fields make the sole regional HEI feeble in its ability to assume a leading role in fostering KI and CB processes. From this context, a number of factors and obstacles militate against a knowledge area-wide integrated strategy, deriving from: (a) the local socio-economic setting; (b) the proliferation of HEI actions; and (c) the institutional-governance system. In parallel to such obstacles, however, there are indications of potential conditions of change emanating from the positive role of some HEIs actions, the relatively active presence of regional HEIs, the growth trends of the insular economy, the making of new niches and networks, the presence of international institutions and, above all, the building of an atmosphere of trust between local communities and HEIs.

Evaluation-Capacity Building: The Three Sides of the Coin

Abstract: I share my experience as a Canadian evaluator who is starting out in the field and new to the process of evaluation capacity building. I draw on three metaphors to describe what I believe are abilities of an effective evaluator. The first is an ability to be like playdough—to mould to external requirements. The second is an ability to be like a spider—to build webs or networks based on an understanding of the global context of the intervention. The third is an ability to be like Buddha—to cultivate a Zen-like attitude during stormy times. I illustrate each metaphor with some of my own evaluation experiences. I also discuss the possible disadvantages of each of these abilities.

An action research approach for developing research and innovation in nursing and midwifery practice: Building research capacity in one NHS foundation trust

The National Health Service in the United Kingdom is committed to a process of reform centred on quality care and innovative practice. Central to this process is the need for research capacity building within the workforce. The aim of this study was to develop an infrastructure for research capacity building within one National Health Service Foundation Trust. Using an Action Research methodology, sixteen individuals were purposefully selected from a population of nurses and midwives to participate in the study. This nonprobability sampling method enabled the researchers to select participants on the basis of who would be most informative about existing research capacity building structures and processes within the Trust. Data were collected in the form of semi-structured individual interviews with each participant. The main findings were that research activity was not embedded in the culture of the organisation, and initiating and undertaking change was a complex process. As a result, a range of structures and processes which were considered necessary to enable the Trust move forward in developing capacity and capability for research were developed and implemented. This paper reports the first two stages of this process, namely: the findings from the pre-step and an outline of how these findings were used to create an infrastructure to support research capacity building within one NHS Foundation Trust Hospital in the United Kingdom.