1. Capacity, Ownership
& the Quest for the Holy Grail
Spring Meeting
May 2, 2012
Sharon Arscott-Mills & Eric Sarriot
www.CedarsCenter.com

2. Agenda
• Introduction
• Word Game: “Pick your Theory!”
• Thinking about capacity and ownership
• Current Development Assistance Trends
• The Holy Grail
• Practical Conclusions
• Case Study – or - Q&A

3. Top Recent References
• Capacity, Change and Performance. Study report. Heather Baser and
Peter Morgan. With Joe Bolger, Derick Brinkerhoff, Anthony
Land, Suzanne Taschereau, David Watson and Julia Zinke. April 2008
• Capacity Development in Practice. Edited by Jan Ubels, Naa-Aku
Acquaye-Baddoo and Alan Fowler. Earthscan. 2010
Also:
• Capacity and capacity development: coping with complexity. Derick W.
Brinkerhoff, with Peter J. Morgan. Public Admin. Dev. 30, 2–10 (2010)
• Learning purposefully in capacity development: Why, what and when to
measure. By Alfredo Ortiz and Peter Taylor. International Institute for
Educational Planning
• Understanding pathways for scaling up health services through the lens of
complex adaptive systems. Ligia Paina and David H Peters. Health Policy
and Planning 2011;1–9

4. Context of our Concern?

5. “Pick your Theory”
A rapid word game on capacity-ownership and
sustainability concepts

6. THINKING ABOUT CAPACITY AND
OWNERSHIP

7. Overview Conceptual Framework
(Brown and Lafond, MEASURE Evaluation)
Capacity Levels Performance Sustainability
T
Health System
Health System Performance I
M Sustainable
Organization
Organizational E Health
Performance System
Health Personnel Performance
Program Performance
Personnel
Improved
Health
Status
Sustained
Client/Community Client/Community Client/Community
Capacity Behavior Change Behavior Change
External Environment
Cultural- Social- Economic- Political - Legal - Environmental

8. OCVAT Capacity Areas
Capacity (& Viability) Areas
Governance & Legal Structure
Program Management
Technical Capacity
Grants & Sub-grantee Management
Project Management
Monitoring & Evaluation (M&E)
Financial Management
Human Resources
Office Operations
Information Technology (IT)
Resource Mobilization
Networking
Communications

9. 5 dimensions of capacity
(Brinkerhoff – case studies’ review)
Brinkerhoff Comments
• Commit and engage Stewardship, leadership
• Technical Capacity Self explanatory
• Relate and attract support Linkages ++; Cf. SF/non-$ Viability
• Learn and Adapt 5th Discipline; resiliency; sustainability?
• Diversity and coherence “Fit”? Live with tensions in plans, adaptation,
multiple agendas, navigate environment…

10. • Capacity ‘that works’ is not just a matter of individual
skills or internal organizational arrangements. These
factors might be relevant building blocks – some would
call these competencies or capabilities – but they do
not constitute real capacity.
• Effective capacity is visible and exists when people
identify and act on issues of shared concern. And thus
real capacity lives between actors and in the ways that
they deal with each other to solve problems or to
realize their ambitions. In doing so, they build up
relational competencies and generate trust which, for
example, reduces transaction costs. If collaboration
works well – and it is not guaranteed and is seldom
conflict-free – stakeholders become less likely to treat
each other according to general stereotypes with
prejudices that cloud communication and reinforce
wrong interpretations of behaviour.
• Seeing capacity as a living property of relationships is
an important practitioners’ lens.
Source: Boesen, Chapter 11 in CD in Practice

11. 2 dimensions of organizations
(Boesen in: CD in Practice, Chapter 11)

12. Ownership
Latent variable or Oxymoron?
– “Excuse me. May I measure your ownership? Thank you.”
Current Thinking—specifics may matter more than the
conceptual packaging.
1. Political Will
2. Institutional and Community Ownership
3. Capabilities
4. Shared Accountability
Back to relationships, power, trust … properties in a
system (not in the program).
Discussion on McKinsey Initiative at iaen.org

13. CURRENT DEVELOPMENT ASSISTANCE
CULTURE – USAID FORWARD & PEPFAR

14. BUILDING
CAPACITY, OWNERSHIP, AND
FINDING THE HOLY GRAIL

15. Internal/External ; Functional/Political
Approaches to CD (Boesen)

16. 3 approaches to CD (Brinkerhoff)
What the RFP says, and our
1. Program / Project proposals promise…
– When: consensus, resources, executive
control, functional/technical/structural
objectives
What often happened over
2. Incrementalism / “Muddling through” the last 60 years…
– When: unstable context, uncertain
commitment, unpredictable
arrangements, confused strategy
How sustainability and
ownership largely happen
3. Emergence
– “when lack of state presence and resources
create space for other actors” (Brinkerhoff)
– When agents self-organize around new
attractors (vision, scenario, interests, habits)?

17. Sustainability
WHICH LEADS US TO THE

18. Do we need a system perspective in Health?
E.g. Sustainability Assessment in an Urban Health System, Bangladesh (Concern / CEDARS)
ADB, DfID, USAI
MOLGRD D, etc.
MOHFW
Chairman
City Government
Health Platform MOHFW District & Sub-
Health Inspector (MESPCC) District
(in absence of Med Off.)
NGO Health
Health Department Providers
Govt & Private Health
Social & religious Facilities
leaders
Commissioner Private
Community pharmacists
organizations
Ward Health Committee
Teachers
Youth volunteers
Traditional health providers

19. Behavior of Agents & Behavior of a System

20. Sustainability in Health System
Strengthening is…
• A (emerging) property of a system, embedded in
a larger environment
– in which interdependent actors,
– through negotiated and coordinated social
interactions,
– which allow the expression of their respective and
collective capabilities,
– maintain and improve the health of a vulnerable
population.

21. Toward Sustainability:
Coaching Progress Toward a New Equilibrium
(vision, ownership, capacity, relations, resources)
Social
Capital
Expression of collective capacity
to sustain outcomes

22. Please…
PRACTICAL CONCLUSIONS?

23. Practical Guidance on Capacity
Development:
• CD is about altering the access of people to
authority, resources and opportunities
• Sustainability, capacity, ownership are:
– Latent
– Heavily Endogenous
• CD is often a combination of all three approaches
– Planned CD works best under certain conditions
– Incrementalism works best in unstable contexts and where
choice of strategy is difficult to clarify.
– Emergence is usually evident where donor funding was
not involved.

24. Practical Guidance cont’d
• Primum non nocere: projects create two shocks
(coming in, coming out)
• Recognize the contribution of intangibles--
values, vision, management style and
organizational culture on CD.
• Recognize the fallacy of “one best way”
approaches
• Incorporate flexibility and learning; role of
“accompaniment” / coaching
• Pay attention to the people-in-context

25. REMEMBER!
• Ability of “outsiders” to influence CD is very
circumscribed.
• Maintain a “system perspective”
“How sustainable the system is depends on its
proficiency in keeping its stakeholders
happy, both at specific points in time and
over an extended period.” (Brinkerhoff)

26. An Existential Dilemma:
Projects vs.Real Life
• Progress in GHI language and USAID Forward
thinking
– But… the {time*project*ownership*sustainability}
equation still often unsolvable in RFA/RFP language.
• We know this is not how it’s going to happen
– But… that’s what the RFA asks for.
– … and that’s how our marketing colleagues told the story.

27. There is no escape from our Existential
Dilemma!
• Project commitment and institutional (NGO) commitment
• Can’t ensure Ownership? How about Honesty?
• Best practices are exemplified every day
– Maximize the best aspirations of RFAs/RFPs
– Minimize the worst perverse effects of project-driven development
– Involve stake-owners early in facing your unintended effects
– Choose approaches and tools which strengthen system processes and learning
• Evaluation is a powerful and undervalued education tools
– Project Grantees, sure.
– Are we taking the time to make it useful to capacity, ownership and
sustainability?
– Are we doing enough to make it educative to our donors?

28. Before heading for the development of capacity, ownership and…. The
Holy Grail… a
CASE STUDY DISCUSSION

29. THANK YOU.

30. Sustainability: A High Concern for the Global
Health Initiative
• GHI— [Implementation of the Global Health Initiative: Consultation Document]
– “The challenge of the next decade and beyond is to take these impressive
accomplishments to the next level by helping countries achieve long-term
sustainability in their health services.”
– “Building on a long tradition of U.S. government global health leadership
and the unprecedented level of commitment manifested in recent years,
the Obama Administration’s Global Health Initiative has the opportunity to
move global health to a new level of effectiveness, with a vision of long-
term sustainability led by partner countries.”

31. 1 slide only on measurement!
• OCAT, OCVAT, MOST, ISA, ETC. – Useful, but when?
• Validity of a “Latent Variable”*: Do measures guide
right action?
• Measuring ownership and capacity vs. capacity to own
questions and measures?
* Brinkerhoff

32. Know Thyself (or what Thy Project Can Do)
Emergence of
Planned CD
Sustainability
More complex More orderly
Sustaining Appropriate and Promoting Proper and safe
population health sustainable utilization of administration of
through political staffing of NGO / services immunizations in
and institutional Clinic / District facilities
changes Office
Sustainably District capacity in Municipal Financial Building individual
promoting an producing and allocation of tax accountability of technical skills
essential nutrition utilizing revenue to health committees
package at information support Health
household level Department
with livelihood
interventions
Developing and Diversifying and Strengthening Building essential Meeting
managing new scaling up NGO leadership in NGOs management registration
partnerships Mission structures and criteria for small
while keeping functions in local CBO/NGO
focus on accepted NGO
public good
Complexity Matrix: Geyer and Rihani