Smarter Investments are Needed in Capacity Building to Meet the MDGs

Smarter Investments are Needed in Capacity Building to Meet the MDGs

Originally appeared in Global Health Magazine.

Over the last several decades, millions of dollars have been invested in capacity building interventions, and the chorus of capacity building enthusiasts continues to grow. Yet, both in description and practice, capacity building remains somewhat fuzzy. In many developing countries, one of the greatest obstacles to achieving the health MDGs - in particular those relating to child survival, maternal health, and combating major diseases such as HIV & AIDS - is the deep, persistent lack of organizational capacity among those responsible for attaining these goals.

Some of the essential capacity components that are often lacking include human capacity - adequate numbers of skilled, motivated and well distributed health providers who are supported by strong leadership; financial capacity - money management skills, financial accountability, and costing expertise; systems capacity - information and logistics, monitoring and evaluation, and governance structures and processes.

Yet, in many countries, progress in meeting capacity building needs has been fragmented, mainly supply-driven, and not evidence based. The overall level and quality of investment in organizational capacity building remains woefully inadequate compared to the need. Without more - and perhaps most importantly - smarter investments in organizational capacity building, the health MDGs will remain out of reach for many countries, and many more lives will continue to be needlessly - tragically - lost.

However, there are three fundamental principles for approaching organizational capacity building that we in the development community can follow to advance the discipline as follows:

First, we must remember that organizations are made up of individuals. If a health service delivery organization is to be effective, all individuals within the organization must have a shared view of what the mission and purpose of the organization is, and what their role in contributing to achieving that mission is. The reality is that, in large government (and other) organizations, it is often difficult to get this shared view.

Second, capacity building - in real life - happens in fits and starts. It's a bit like a river that meanders across the land through which it flows. In the same way, organizational capacity building may be a slow, unpredictable process, and move at a pace that begs ‘strategic patience' on the part of all involved, especially donors and their implementing contractors. As one Kenyan AIDS NGO worker once put it, "capacity building is hardly a clear and straightforward path....the fact of the matter is that it's a messy, up and down type business...but we just don't want to admit it."

Third, drawing on William Postman's oft quoted culinary analogy, to build and sustain the capacity of a health service organization is a bit like making a "curry meal." Making the meal requires skills, discipline, dedication, fresh ingredients and good timing. Obviously, there are a few "staple ingredients" that are absolutely essential - in the case of capacity building, they're effective leadership and governance, efficient management systems, participatory work approaches, and clinical, evidence based public health approaches - but there are also specific "spices" that can only be selected by the organization itself. And, in the end, it is only local capacity building recipients who will be able to mix all the ingredients correctly to form a recipe, assemble the right utensils, and prepare a curry that will truly reflect what they and their communities enjoy most.

As such, all of us in the development community need to fully appreciate and advocate for this contextual, locally-focused and results-driven approach to organizational capacity building. This appreciation calls for close scrutiny of the traditional assessment tools and approaches to organizational capacity building and moving towards more country-led, inductive process templates that allow for flexibility, creativity, ownership and learning.

We can no longer continue to talk about capacity building in vague terms. In the next five years, the global health community must recalibrate its approach to organizational capacity building for health service organizations. Every national government and international development partner should commit financial resources to develop, through a highly inclusive process, strategies for identifying capacity building interventions that are known to work and discard those that don't. This should be followed up with results driven, measurable investments for strengthening the organizational capacity and programmatic reach of public sector, community-based organizations and civil society groups that are working on health-related MDGs. Only those interventions which are both evidence based and able to be rigorously measured should be funded.

We just have to stop committing precious and scarce public health resources to interventions that don't meet these criteria. Such a commitment will ultimately not only restore health but also save millions of lives, and reduce waste and inefficiencies.

Ummuro Adano is a senior technical advisor for Capacity Building at the AIDSTAR-Two Project at MSH.