MEASURING CAPACITY BUILDING IN THE

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MEASURING CAPACITY BUILDING IN THE HEALTH
SECTOR Lisanne Brown Based on work done
through MEASURE Evaluation Project Capacity
Building Measurement Initiative
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Capacity building in the health sector

• Definition
• Is a process that improves the ability of the
  health system, organizations within the system,
  individuals working within the system and clients
  of the system to meet their objectives or to
  improve performance.

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Characteristics of capacity building

• Dynamic and continual process of improvement
• Internal process possibly enhanced by external
  intervention
• Can occur at 4 mutually dependent levels
• Health System, Organization, Health Program
  personnel and client/community
• Linked to performance
• Influenced by the external environment
• Contributes to sustainability

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Assumptions About Capacity

• Adequate Investment Capacity
• Lasting Improvement in Health Status

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What role does capacity play?

• Capacity is linked to Performance
• But we dont know
• What level of capacity is needed for performance?
  
• What are the critical elements of capacity needed
  to achieve performance ?

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Mapping Capacity

• M E of capacity building aims to measure
  changes in capacity
• Start with a map/conceptual framework

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Figure 1. Overview
Conceptual Framework
Capacity Levels
Performance
Sustainability
Health System Performance (access, quality,
equity, efficiency)
T I M E
Sustainable Health System Performance
Health System
Organizational Performance
Organization
Health Program Personnel
Personnel Performance
Improved Health Status
Sustained Client/Community Behavior Change
Client/Community Behavior Change
Client/Community Capacity
External Environment Cultural- Social- Economic-
Political - Legal - Environmental
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Figure 2 Health System Capacity
IntermediateOutcomes
Inputs
Process
Outputs
Published health policies and regulations Formal
and informal coalitions Sector-wide strategy
developed Increased local financing recurrent
costs Improved human resource availability in
rural areas Coordinated donor interventions Time
ly analysis and dissemination of national health
information
Health policy making Enforcement of health
related laws and regulations Health sector
strategic planning Resource allocation Resource
generation Financial and human resource
management Donor coordination Multi-sectoral col
laboration Information coordination
dissemination
Effective h. policies Accountability (financial
and program transparency) Capacity to assess and
cope with external environmental Financial
self-reliance Effective quality
control Responsiveness to client Efficient/appro
priate resource allocation Exchange of lessons
learned
Public/private composition and
infrastructure Organizational structure of the
public sector Existing health-related laws,
regulations, and policies Information/
communication systems Human resources Financial
resources (public/ private, internal/ external)
External Environmental Factors Cultural- Social-
Economic- Political - Legal - Environmental
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Figure 3 Health Service and Civil Society
Organizations
Inputs
Process
Outputs
Intermediate Outcomes/ Performance
Mission Leadership Organizational
structure Finances Supplies Infrastructure Hum
an resources - technical - managerial
Strategic and operational planning Human
resource management and development Financial
management Logistics/supplies management
Quality assurance Research and
evaluation Coordination with other
units Resource mobilization IEC Advocacy Commu
nity mobilization
Staff trained Strategic and operation plans
developed Management system established Financia
l management system established Health
information and communication system
established Service delivery systems established
Capacity to cope with environmental
change Responsiveness to client Financial
self-reliance/ability to generate
resources Community involvement Service access,
quality, and demand Service cost
effectiveness Efficiency
Health System Environmental Factors
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Figure 4 Health Program Personnel
Intermediate Outcomes/ Performance
Process
Outputs
Inputs

• Financial resources (i.e salaries, incentives)
• Physical resources
• venues
• materials
• supplies
• equipment
• National/organizational training plan
• Up-to-date information on appropriate clinical
  and managerial practices
• Curricula
• Human resources

Pre-service and in-service training events
(training of trainers and trainees) Training
events for managers (including supervisors) Staff
performance evaluations Experiential learning
opportunities Professional networking
Trainees apply acquired knowledge and skills in
appropriate job according to health system needs
Trainers train according to health system
needs Trainers and trainees competent in job
over time
Staff trained Trainers trained Managers trained
Health System and Organization Environmental
Factors
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Figure 5 Client/Community Capacity
Intermediate Determinants
Intermediate Outcomes
Inputs
Outputs
Individual/family Education Income Family
history Gender
Perceptions of need/risk Past experiences with
health services and prevention practices Willingn
ess to seek care Ability to pay Severity of
illness Sense of community Understanding of
community history Community power Community
values Critical reflection
Utilization of health services Self
treatment Compliance Prevention behavior
Community mobilization and empowerment
Recognition of need for services Intention to
use services Participation in community health
committees Advocacy
Exposure to program Utilization-enhancing
activities (e.g., IEC, accessible services)

• Community dimensions
• Citizen participation
• Community Leadership
• Resources (internal and external to community)
• Social and interorganizational networks

External Environmental Factors Cultural- Social-
Economic- Political - Legal - Environmental
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Measurement approaches

• To date most measurement at organizational and
  personnel levels
• Functioning of management system
• Skills acquisition of staff
• Self assessment common approach for organization
• Monitoring of training events and people trained

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Measurement approaches Examples

• Management and Organizational Sustainability Tool
  (MOST) - developed by MSH
• framework for organization to conduct its own
  management assessment and develop concrete action
  plan to make improvements by
• Assessing the current status of organizations
  management capabilities and practices
• Identifying changes that can be made to manage
  the organization more effectively
• Making specific plans to implement these changes
• Monitoring the resulting improvements.
• The Health Managers Electronic Resource Center
  (ERC) http//erc.msh.org.

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Measurement challenges

• Dynamic - capacity develops in stages
• Multidimensional - Relationships between levels
  often ignored
• The role of context is not well-documented
• Lack of evidence - which elements of capacity are
  critical to performance?

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Measurement challenges

• Performance standards may be context specific
• The value of self-assessment versus objective
  measurement
• Little experience measuring capacity over time

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Measurement - Future Needs

• Field research to test indicators and tools
• Repeated measures to capture stages of capacity
  and link to performance
• Improved understanding of health sector and
  community capacity
• Improved understanding of linkages between levels
  - indicator development for linkages