Austin Mtali, Health Project Manager

A Community Capacity Building Approach to Health and Nutrition

Concern Worldwide

Concern works in 25

countries around the world Community capacity

building occurs in most of

our projects (health,

education, livelihoods)

Drama event in Chiwaula village in Nkhotakota Picture by Davis Makhoza

Community Capacity Building at Concern

Concern developed the HeaIth Institution Capacity Assessment

Process (HICAP) Targets key community structures Strengthens linkages and communication between communities and

health services

First implemented in Bangladesh Child Survival Program in 2000 Adapted for rural Village Development Committees in Malawi in 2009 Will be used in Sierra Leone Child Survival Program, to build the

capacity of Health Management and Ward Development committees

The local health committee in Bangladesh has links with a wide range of community stakeholders

Organizational capacity building can be a valuable tool for

strengthening the capacity of communities

to engage with each other on health and

influence health services

Why target community structures?

Concern’s Approach to Organizational Capacity Building

Step 1

•What Capacity areas need to be built?

Step 2

•Self-assess current capacity levels

Step 3

•Prepare Capacity Building Plan

Step 4

•Implement Plan and Monitor Progress.•M

&E: Monthly, Annual, Mid-Term, End

Step 2

•Self-assess current capacity levels

The Health Institution Capacity Assessment Process (HICAP)

Facilitated self-assessment

approach Provides a quantifiable

capacity measure Clearly identifies capacity gaps Development of a capacity-

building plan Encourages regular monitoring

HICAP structure:• 5-6 general capacity areas

• Divided into subcategories

(indicators), which are the key

functions of the committee• For each indicator, five possible

stages of development• The committee discusses and

agrees on a score for each indicator• Indicator scores are averaged into a

composite score

Example of Capacity Scale

Capacity Results for Ward Health CommitteesBangladesh, 2006 - 2009

Capacity Area Baseline Endline

Human Resources 1.9 3.7

Leadership 2.8 3.8

Planning / implementation 2.3 3.4

Coordination / Resource Mobilization 2.8 3.4

Monitoring and Evaluation 1.9 3.5

Overall Score 2.35 3.55

Bangladesh - Results

From initial 2 pilot districts, approach

was scaled up to 7 more districts Significant improvements in health

behaviors and practices Increase in municipal funding for

health services from the committees Sustainability assessment in initial

districts, five years after the project,

found that committees still had

improved skills and capacity, and

improved self-awareness

Replicating

the HICAP in

a rural,

resource-

poor setting in

Malawi

Adapting the HICAP in Malawi

Makuta VDC in Nkhotakota discussing their stages during a HICAP training. Picture by Felix Katsoka.

Concern Malawi – Health and Nutrition Programme

April 2010 – March 2013, in two districts in Central

Malawi

Objectives: Increase availability, access, and utilization of quality child health and

nutrition services Improve the knowledge and adoption of household health behaviours

and care-seeking practices Strengthen local capacity to plan and manage health activities,

as well as improve linkages between the facility and community for

better accountability.

Some of the formal and informal community structures in place in Malawi to deal with development issues

District Council/District Executive Committee

Area Development Committee

Village Development

Committee (VDC)

Village Health Committee (VHC)

District Health Office

Health Facilities

Health Surveillance Assistants

Community Health Volunteers

Traditional Authority

Group Village Headman

Village Headman

Community structures are valuable resources that are often under-utilized in health

Village Development Committees

What is the VDC? The VDC is a representative

body from a group of villages. It provides an important link

between citizens and district

council (government). Develops local development

plans for community, but

usually no follow-up Health, education often

neglected in favor of

infrastructure or market support

A village clinic structure for CCM services built by the VDC in Nkhongo group village headman under Mpamantha Health Centre in Nkhotakota. Picture by Syphord Mwanza, January 2012.

Initial Changes in Capacity

Adapted HICAP tool for VDC Facilitate HICAP workshops

with 28 VDC Partnered with District

Community Development

Office and health extension

on training

HICAP process in Malawi Initial changes in the VDC

Developed workplans Filled vacancies Improved gender balance Became independent of the

chief structure Started communication with

community health workers Supporting CCM – e.g

building health posts

Preliminary Results: VDC capacity scores, Nkhotakota

Capacity Baseline 6 month follow-up

Participatory Planning 1.74 2.42

Leadership (Governance) 1.69 2.10

Resource Mobilization and Management 1.29 1.73

Collaboration and Coordination 1.14 1.85

Monitoring and Evaluation 1.00 1.38

Average capacity score: Total 1.37 1.90

Benefits of the HICAP tool

Empowering: Communities develop

their own plans and solutions Motivating: Committees encouraged

by seeing their improvement Easily adaptable, and not sector

specific: Capacity areas are universal Relatively sustainable: Committees

can continue the process on their

own Low-cost and easy to implement Can fit well within other trainings

A village clinic structure for CCM services built by the VDC in Nkhongo group village headman under Mpamantha Health Centre in Nkhotakota. Picture by Syphord Mwanza, January 2012.

Gaps

How to measure the impact of improvements in capacity How does this result in improvements for women and children in our area?

Not a one-off process – once committees identify their capacity

needs, they need continued support Facilitator needs to act as a continued catalyst

External influences on the organization may be out of the facilitator’s

control For example, VDCs no longer receiving funding, elections have not been

held

The whole system may need capacity building, not just one level

Feedback from partners

Local Government: The capacity building

trainings helps them to identify and address

the gaps in the whole local government system

Health facility staff: This has promoted

linkages and communication between the

community structure and health providers and

community health workers

Village headmen: The process has helped

them to understand their roles in relation to

other committees

Mrs Phiri (Nkhotakota DHO Staff)

during one of the community

trainings. Picture by Davis Makhoza.

THANK YOU

THANK YOU FOR YOUR ATTENTION

Young boy at Dwambazi health centre, Nkhotakota. Photo by Gwyneth Cotes