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Country ownership and capacity building: the next buzzwords in health systems strengthening or a truly new approach to development?

Country ownership and capacity building: the next buzzwords in health systems strengthening or a... Background: During the last decade, donor governments and international agencies have increasingly emphasized the importance of building the capacity of indigenous health care organizations as part of strengthening health systems and ensuring sustainability. In 2009, the U.S. Global Health Initiative made country ownership and capacity building keystones of U.S. health development assistance, and yet there is still a lack of consensus on how to define either of these terms, or how to implement “country owned capacity building”. Discussion: Concepts around capacity building have been well developed in the for-profit business sector, but remain less well defined in the non-profit and social sectors in low and middle-income countries. Historically, capacity building in developing countries has been externally driven, related to project implementation, and often resulted in disempowerment of local organizations rather than local ownership. Despite the expenditure of millions of dollars, there is no consensus on how to conduct capacity building, nor have there been rigorous evaluations of capacity building efforts. To shift to a new paradigm of country owned capacity building, donor assistance needs to be inclusive in the planning process and create true partnerships to conduct organizational assessments, analyze challenges to organizational success, prioritize addressing challenges, and implement appropriate activities to build new capacity in overcoming challenges. Before further investments are made, a solid evidence base should be established concerning what works and what doesn’t work to build capacity. Summary: Country-owned capacity building is a relatively new concept that requires further theoretical exploration. Documents such as The Paris Declaration on Aid Effectiveness detail the principles of country ownership to which partner and donor countries should commit, but do not identify the specific mechanisms to carry out these principles. More evidence as to how country-owned capacity building plays out in practice is needed to guide future interventions. The Global Health Initiative funding that is currently underway is an opportunity to collect evaluative data and establish a centralized and comprehensive evidence base that could be made available to guide future country-owned capacity building efforts. Keywords: Country ownership, Capacity building, Organizational development, Global health initiative, Paris declaration on aid effectiveness * Correspondence: [email protected] Boston University Center for Global Health and Development, 801 Massachusetts Avenue, Boston, MA 02118, USA Full list of author information is available at the end of the article © 2012 Goldberg and Bryant; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Goldberg and Bryant BMC Public Health 2012, 12:531 Page 2 of 9 http://www.biomedcentral.com/1471-2458/12/531 Background efforts, and the donor organizations that play a variety of In 2009, the United States initiated a dramatic policy direct or indirect roles in capacity building initiatives shift regarding the provision of foreign assistance with (e.g. providing funding, engaging in implementation ac- the introduction of the Global Health Initiative (GHI). tivities, etc..). This working definition and framework will The initiative aims to invest up to $63 billion dollars enable these organizations to develop a clearer under- over six years to help partner countries improve health standing of the distinctive characteristics and goals of outcomes through the strengthening of health systems, country-owned capacity building. Emerging lessons and seeks to enable U.S. governmental agencies provid- learned in promoting successful country-owned capacity ing foreign assistance to become more efficient, ac- building will be identified and analyzed to provide a countable, and effective in their efforts to “help reference to organizations involved in similar efforts. countries lift themselves out of poverty” [1]. The under- lying principles of the GHI involve building country- Discussion level capacity to manage and operate health programs Defining capacity building and to encourage country-ownership of health efforts There is a general consensus in the literature that cap- through investing in country-led plans [2]. This effort acity building is a difficult concept to define [3-5]. by the United States is simply the latest in a series of Some explanations for this difficulty include the expan- efforts targeted on country ownership coming through siveness of the term, its increasing popularity since the documents such as the Paris Declaration on Aid Effect- 1990s, and the inconsistency with which it has been iveness of 2005, the Accra Agenda for Action of 2008, applied [3,6,7]. These factors work in concert to hinder and guidelines from the Global Fund to Fight AIDS, analytical understanding of the concept’s meaning. It is, Tuberculosis, and Malaria. however, possible to identify commonalities and differ- The intersection of capacity building and country ences among the various capacity building definitions ownership merits further theoretical consideration. Cap- in circulation. acity building is an approach to strengthening organiza- Capacity building is a common concept across health tions that is common to a variety of different sectors, and business sectors and is often described as either a including business and health program management. It process or an action aimed at the development of one or is a term that has been used with such frequency and more organizational components [4,8-11]. It is also variety of interpretation that its true meaning has be- defined as a means to improving an organization’s ability come obscured. Capacity building in foreign assistance to meet its stated goals [8,12], achieve its mission or en- efforts has in the past often entailed donor country hance its efficiency or effectiveness [10,13-15]. Other organizations driving the design and implementation of commonalities among capacity building definitions in- their technical assistance programs without equal par- clude that these efforts are generally linked in some way ticipation from partner country organizations. The GHI to improved performance of an organization and related approach to foreign assistance explicitly breaks with to the core tasks and functions of an organization past behavior and promotes local involvement by em- [8,16,17]. bracing the notion of “country-ownership”. This is a Despite the commonalities in definitions, capacity capacity building strategy that shifts the leadership of building is generally described more precisely within and responsibility for health promotion efforts onto the the business and management literature than in the partner country and its organizations on the ground. If health literature. Examples include terms such as the GHI’s emphasis on promoting country ownership organizational innovation, organizational development, in capacity building is carried out in practice, a huge absorptive capacity; strategic management and strategic influx of development funding will soon be allocated transformation are described as approaches to building to a new concept, “country-owned capacity building”, organizational competitiveness, effectiveness, growth, that is not clearly understood by practitioners or sustainability and responsiveness [18-21]. The differ- researchers alike. ences in terminology may be reflective of differences in This paper examines the relationship between organi- the organizational objectives in each sector [22]. In for- zational capacity building and the concept of country profit business, organizational expansion and increased ownership and proposes a working definition of country- profit margins are often the desired outcomes of cap- owned capacity building. A simple conceptual framework acity building efforts [23]. In the non-profit/non-gov- for implementing country-owned capacity building ernmental organization sector, organizations achieve efforts will also be described in order to support partner/ success by fulfilling their missions often through service donor organization collaboration in capacity building provision; capacity building in this context is directed efforts. The intended audiences of this paper are the part- toward enhancing programming and service delivery ner organizations that are the focus of capacity building [24]. Goldberg and Bryant BMC Public Health 2012, 12:531 Page 3 of 9 http://www.biomedcentral.com/1471-2458/12/531 Concepts informing the definition of country-owned constantly and actively aspiring to improved levels of capacity building functioning [12,31,35]. Finally, capacity building should In order to establish a working definition of capacity stress building an organization’s ability to adapt and re- building, it is necessary to examine and incorporate add- spond in changing environments [4]. itional concepts. Capacity building is essentially an in- ternal process that can be enhanced or accelerated by Capacity building and country-ownership outside groups [16,25]. In resource-poor settings, there Country ownership is an approach to development as- may be limited organizational energy (time, skills, ex- sistance that strives to empower partner countries to pertise, funds, facilities and equipment) to direct toward take, "effective leadership over their development pol- activities such as strategic planning and needs assess- icies, and strategies and co-ordinate development ments, which should ideally precede capacity building actions" [36]. The Paris Declaration for Aid Effectiveness activities [22]. Collaborations between donor/partner of 2005 and the Accra Agenda for Action of 2008 detail organizations can maximize the effectiveness of capacity the principles of country ownership, which involve the building ventures by focusing on key activities [26]. Un- partner country defining its own development priorities fortunately, capacity building efforts driven by outside and designing and leading programs that promote these organizations or funders are often ineffective in cultivat- priorities. The country ownership paradigm represents a ing a sense of ownership within the partner organization departure from past international development [27]. approaches, which were largely externally driven. The All organizations must already have some level of cap- capacity building theory and tools prior to the advent of acity as a pre-condition to effectively build more cap- country-ownership were generally targeted for use by ex- acity [28]. Organizational readiness for capacity building ternal organizations. Country-owned efforts involve is comprised of qualities such as the organization’s will- building-up in-country technical knowledge and pro- ingness to question itself, its understanding of its own moting organizational sustainability to minimize partner mission and goals, and the level of commitment from countries’ reliance on expensive, external expertise that key organizational stakeholders to participate in capacity is necessarily time-limited [36]. building efforts [7]. The development of new Country-ownership recognizes the need for endogen- organizational capacities is often reflected by an organi- ous drivers toward development in partner countries zation’s openness to change and the ability to adapt to [37]. It is rooted in ideological values, including self- shifts in its environment. Successful change efforts are determination, and advanced by evidence-based analysis largely predicated on the willingness of the organiza- of effective approaches [37]. Country-ownership requires tion’s leadership to support and facilitate that process partner countries to accept full responsibility for success [7,23,29,30]. At the same time, individuals are the build- of the development activities. The assumption states that ing blocks of organizational capacity and the willingness a partner country will be more likely to allot the neces- of individuals and groups within the organization to sary resources to ensure the full implementation of a change their behaviors can significantly affect the suc- program if it is accountable for its outcomes [38]. Critics cess of a capacity building intervention [29,31,32]. of the concept cite theoretical difficulties in achieving If capacity building is to become a process that is not country-ownership given the heterogeneity of interests externally driven, but is locally owned, it is important to among key stakeholders in the partner country, and reflect on some of the lessons learned over the last three challenges to designing a representative consultative decades. Firstly, technical assistance on the part of donor process in planning and implementing programs [39]. organizations is must be carefully tailored, given the The focus of country-owned capacity building should wide variety of needs and resources present among part- be to give organizations skills necessary to respond to ner organizations [33]. Secondly, it should not be challenges, solve problems and build capacity independ- assumed that past successful capacity building initiatives ently in the future. The Global Fund experience in build- could be replicated exactly under different conditions. ing country-ownership aims to encourage partner Thirdly, capacity building should be a participatory country organizations to generate technically sound pro- process, both as a collaborative venture between the posals for funding that are reflective of country needs, partner and donor organization and also in terms of en- and to ensure that nongovernmental organizations play gaging staff and stakeholders at all levels of the partner an instrumental role in designing, implementing and organization [27,34]. Fourthly, it is necessary to identify overseeing programs [40]. Successful country-owned relevant indicators to monitor and evaluate the success capacity building projects echo the importance of inclu- of a given capacity building effort. Fifthly, capacity build- siveness in the planning process and excellent working ing is a continuous process wherein the organizations relationships between partner/donor organizations that involved set and monitor time-limited goals but are produce true partnerships [41,42]. Donor organizations Goldberg and Bryant BMC Public Health 2012, 12:531 Page 4 of 9 http://www.biomedcentral.com/1471-2458/12/531 require expertise in building governance, management period of planning and implementing capacity building systems and organizational development in order to ef- initiatives generally follows the assessment stage and fectively build capacity in collaboration with partner monitoring and evaluating the initiative is often the final organizations [22,43]. stage. These stages are broad and general and can be deconstructed further into to their component parts in Introducing a working definition of capacity building in order to allow for greater understanding. Table 1 pro- the context of country ownership vides a description of the steps in a capacity building Having now explored the terms “capacity-building” and framework for county-owned projects. “country-ownership” in closer detail, it is possible to In the text that follows, partner refers to the local offer a working definition that combines the two con- organization (government, non governmental organi- cepts. This definition aims to clarify the interaction be- zation, faith based organization, civil society organiza- tween the terms and to account for specific tion, private company, etc), while donor refers to any considerations that must be addressed by organizations groups that provide funding to the partner organizations. engaging in country-owned capacity building efforts. Capacity building in the context of country ownership is Organizational assessment therefore, “a continuous and participatory process The need to conduct organizational assessment prior to undertaken independently or in collaboration with exter- engaging in capacity building projects presupposes that nal partners to empower the organization to systematic- any initiative to improve organizational functioning or ally identify and respond to its institutional needs and performance should be in response to an identified the needs of the population it serves in order to better organizational need or deficiency [34]. Organizational as- meet its stated mission and goals, solve problems, imple- sessment is the process by which organizations obtain sys- ment change and increase efficiency”. tematic information about their performance and the factors that affect it in order to diagnose competency areas The use of capacity building frameworks and areas in need of investment [50]. Organizational A theoretical framework is a tool that can help to assessments should be carried out under the partner orga- operationalize country-owned capacity building by pro- nization’s leadership in the country-ownership context, to viding a structured way in which to carry out the pro- ensure that these organizations can effectively self-assess cesses described in the definition above. There are many in the future without the support of external partners. examples of capacity building frameworks, both in the Organizational assessments can be facilitated by using peer reviewed and gray literature [22,44-47]. These fra- tools. These tools vary in terms of their focus and ap- meworks share a number of commonalities, including proach; some tools assess the organization as a whole the identification of organizational “core competencies” while others assess effectiveness one specific area (i.e. that each require a certain level of capacity in order for governance). Assessments use heterogeneous language an organization to be effective. Table 1 Steps in country-owned capacity building Organizational effectiveness is contingent upon the framework interplay of these core competencies, examples of which Step Action include governance, financial management, leadership, 1. Conduct an organizational self-assessment technical capacities, human resources and systems and in- to find areas of strength and weakness frastructure. Core competencies are also called ‘domains’ i) Define the impact of identified weaknesses or ‘elements’ of organizational efficiency, and can be on performance described by a variety of individual terms (i.e. ‘aspirations’ ii) Prioritize weaknesses for intervention versus ‘mission and goals’). Each core competency houses iii) Break down weaknesses into a number of smaller capacities, sub-domains, or “target manageable ‘challenges’ areas of intervention”, that are implicit within the larger 2. Identify challenge and define indicators to competency (i.e. financial management includes budget measure success in addressing that challenge preparation, internal auditing, etc.). The relative import- 3. Choose approach to address challenge ance of each core competency remains unclear, as does 4. Choose tools to address challenge their respective temporal ordering, which precludes agree- 5. Describe and carry out activities and ment among practitioners about which capacity building tasks to address challenge framework is superior [47]. 6. Collect data throughout to monitor and Frameworks also highlight the steps in completing evaluate effectiveness of intervention capacity building projects. Often, these steps include an 7. Conduct an organizational reassessment and initial assessment phase wherein the organization identi- repeat cycle fies areas of needed development [22,44,46,48,49]. A Goldberg and Bryant BMC Public Health 2012, 12:531 Page 5 of 9 http://www.biomedcentral.com/1471-2458/12/531 to identify and describe the organizational core compe- Choose approaches and tools to address challenge tencies that are evaluated, similar to the capacity build- A capacity building approach is the general strategy by ing frameworks previously discussed. Assessments which an organization is able to address organizational diagnose organizational weaknesses by probing into the challenges [52]. In the country ownership context, organization’s current functioning or performance level approaches refer to the methods used by the donor/ and offering indicators that reflect the characteristics of partner organizations collaboratively to help partner an organization operating efficiently to serve as a organizations better achieve their mission and goals and comparison. solve problems that may arise in the future. Capacity There are collections of tools available via internet building approaches are often boiled down to training databases, many of which are free for use by the public. and technical assistance provided by the donor organiza- There is little information available concerning the valid- tions; however, there are a myriad of different forms that ity, quality or effectiveness of each tool, though some these approaches can assume. These include professional tools (like the McKinsey Capacity Assessment Grid) are training, peer assessments, process consulting, perform- often cited in the literature and have gained credibility. ance contracting, executive coaching, mentorship, inter- Existing tools only enable subjective assessments of national organizational collaboration, and a variety of organizational capacity, which makes objective measure- partnership types. ment of capacity which has been built, impossible. Each approach can be operationalized by means of a Donor and partner organizations should collaboratively variety of tools and activities. For example, a partner/ identify tools that address areas of relevance to the part- donor organization may decide to address an ner organization and work to ensure the partner organizational need for enhanced capacity in govern- organization becomes well versed in conducting ance, which was identified through a process of organizational assessments. organizational assessment. Within the arena of govern- The goal of the assessment phase is to identify areas of ance, this organization might have identified the need to organizational strength and weakness. Once weaknesses increase and diversify board membership as the chal- have been identified, it is necessary to define the impact lenge to be addressed. Specific indicators would then be that these weaknesses have on organizational perform- defined in order to track the capacity building effort’s ance. Partner organizations should lead the processes of progress in addressing that challenge (i.e. the number of both prioritizing the order in which the identified weak- different community sectors represented by board mem- nesses will be addressed and then deconstructing the bers). It is then necessary to identify the desired ap- highest priority weakness into small, manageable ‘chal- proach to addressing the challenge of building lenges’. Capacity building efforts should be designed to governance capacity. The chosen approach, (technical address one specific challenge at a time. assistance around board development for example), is operationalized through use of a specific set of activities Identify challenge and define indicators to measure and tasks such monthly consultations between the donor success in addressing that challenge and partner organizations regarding sound board mem- The assessment phase allows organizations to identify a ber recruitment and retention methods. This tool can be specific challenge(s) on which to focus their capacity further divided into its component parts, or activities, building efforts. The challenge will correspond to a tar- which could include the preparation of specific ques- get area of intervention, one of the many component tions to pose at the monthly consultation meetings and parts of the larger core organizational competencies. so on. The application of the defined tools and activities Once identified, the organization must design indica- represent the implementation phase of a capacity build- tors that will demonstrate the effectiveness of the cap- ing project [52,53]. acity building intervention to stakeholders (boards of directors, funders, beneficiaries etc.). Indicators can vary Evaluate the effectiveness of capacity building efforts by type, including process, output, outcome and impact Evaluation in capacity building projects is necessary to indicators [51]. Indicators provide clear metrics by which increase the accountability of both donor and partner the capacity building project can be monitored and eval- organizations, to allow donor organizations that sponsor uated throughout its life. Outcomes are often difficult to capacity building initiatives to engage in more evidence- link to efforts in practice, as there is rarely a financial based grant making, and to compare the effectiveness of bottom line to appraise [22]. Logic models are a com- different capacity building approaches [22]. Capacity monly used method to identify and define indicators for building in the context of country ownership has under- capacity building. Indicators should be reflective of the gone little formal evaluation and there are numerous specific findings gleaned from the organizational assess- explanations for this dearth of evidence. No standardized ment phase. approaches to monitoring and evaluating capacity Goldberg and Bryant BMC Public Health 2012, 12:531 Page 6 of 9 http://www.biomedcentral.com/1471-2458/12/531 building measures are currently defined due to the range any one indicator tells only part of a complex story. To of activities and circumstances that comprise capacity ensure ownership, attempts to capture changes in building interventions [31]. Monitoring and evaluation is capacity over time should be pursued through the use distinct from the initial assessment phase in that it aims of indicators that are defined by the partner organiza- to measure change over time whereas the initial assess- tion and relevant to locally determined concepts of ment is diagnostic and identifies organizational gaps change [31]. [53]. Difficulties inherent to defining ‘capacity’ and meas- uring an organization’s progress toward it are major Conduct an organizational reassessment and repeat the challenges to evaluating effectiveness, particularly when cycle evaluating ‘soft’ capacities, like leadership development Once the organizational challenge has been addressed or employee motivation, that are challenging to quantify and evaluated, the organization will have evolved in [54-56]. some manner. Addressing the original identified chal- Capacity building projects are often facilitated through lenge will ideally result in increased organizational cap- grant funding, part of which may or may not be allo- acity and efficiency; however, capacity building should cated for evaluation purposes by the funder organization be continuous process. Improved capacity in one area [57]. In the absence of designated resources, effective may expose other areas of organizational weakness that evaluation efforts may be difficult to conduct. Partner also require intervention, or the other pre-existing weak- and donor organizations may also have disparate under- nesses may still be present. The ‘new’ organization must standings of the capacity building initiative’s actual goals be re-assessed and another cycle of capacity building ac- and, by extension, how they should be evaluated. The tivities should commence in order to address the next existing evidence base of capacity building evaluations high-priority organizational challenge identified. generally describes either success in individual case stud- The above process of partnership between donor ies or among small samples of organizations, which organization and local partner should ultimately lead to hampers the generalizability of their findings [32]. local organizations capable of conducting the cycle of Partner and donor organizations should be prepared to capacity building activities internally without external test new strategies and approaches to monitor and evalu- guidance or leadership, as described in Figure 1. ate capacity building initiatives [53]. Currently utilized methods range from the traditional donor-driven app- Sustainability roaches to the participatory and ultimately self-directed Effective organizational capacity building will contribute activities of partner organizations; it is the participatory to an organization’s sustainability and, in the context of approach that should be embraced in country-owned country ownership, enhancing the sustainability of the capacity building [55]. Evaluation activities can serve partner organization and the health outcomes it aims to two integrated purposes; assessing the effectiveness/ produce is often a top priority [34]. Capacity is an orga- impact of a specific capacity building intervention and nization’s ability to perform its defined functions, set building the partner organization’s capacity to conduct and implement developmental objectives, and adapt and evaluations independently [32]. Because capacity is a respond to changing environments effectively, efficiently multi-faceted construct, it is necessary to remember that and on a sustainable basis [4,16]. Capacity building Figure 1 Visual schematic of country-owned capacity building framework. Goldberg and Bryant BMC Public Health 2012, 12:531 Page 7 of 9 http://www.biomedcentral.com/1471-2458/12/531 activities should be designed to endow partner organiza- building can and should be a two-way street, with donor tions with the skills and abilities to sustain current built organizations standing to gain knowledge from their capacity, to grow the skills necessary within the relationships with their partners [42]. Participation at all organization to continue to build its own capacity, as levels of the partner organization will ensure that the well as to respond to and proactively create changes in capacity building effort is truly owned by the orga- its environment into the future, absent of donor nization; it will build both the organization’s capacity organization and country support [36,55]. and that of individual employees to implement capacity Agreement on the importance of building capacity in a building processes without donor organization support sustainable way is necessary from the outset of the part- in the future. nership between donor and partner organizations [36]. Donor organizations have a responsibility to empower Leadership within the partner organization will ultim- partner organizations to build capacity independently by ately be responsible for directing and stewarding future teaching them to identify areas of needed intervention capacity building efforts; however, buy-in from all levels (through conducting organizational assessments), to of the organization and other relevant stakeholders and plan and implement a capacity building process (through the identification of internal and external champions of identifying a specific organizational challenge, setting the capacity building process will help ensure its future indicators, deciding on data collection methods, and sustainability [5,23,34]. To ensure that donor organiza- choosing approaches, tools and activities) and to evalu- tions impart all relevant expertise, opportunities for ate the effectiveness of their efforts. Donor organizations technical support and training should be demand-driven should anticipate any cultural considerations that could and informed by the partner organization’s knowledge hinder partnership efforts. Donor organizations may and understanding of local context and organizational need to simplify or reorganize their own internal pro- needs [34]. It should not be assumed that best practices cesses to facilitate collaboration. Aligning to the partner that are effective within the donor organization’s own organization’s priorities, systems and procedures is itself country or experience will translate seamlessly into the a capacity that donor organizations must develop [36]. partner organization’s context [21,36]. Partner organizations are expected to take the lead in Training-of-trainer approaches and coaching techni- country-owned capacity building. In this sense, leader- ques (that can augment traditional supervision or men- ship is an organizational capacity of primary importance, toring relationships by drawing upon the unique as future capacity building efforts cannot occur without knowledge and experiences of both the coach and coa- effective leadership. Leadership development, like moni- ched), could also be employed to build in-house expert- toring and evaluation, should be built into every capacity ise among the partner organization’s leadership in any building intervention as an integral part of the process necessary skill set. For example, training several partner and also as a desired outcome. Similarly, financial man- organization staff members to train others in skills relat- agement skills are another capacity that should receive ing to board development or to pursuing new and due attention in capacity building partnerships, particu- strengthening existing partnerships with other organiza- larly in light of the GHI funding that partner organiza- tions will ensure that this technical expertise remains tions will ultimately be accountable for managing. within the organization regardless of staff turnover. Country-owned capacity building is a relatively new Certain competencies, including those concerning concept that requires further theoretical exploration. organizational finances and strategic management, that The Paris Declaration on Aid Effectiveness is just that – contribute directly to an organization’s future sustain- a declaration. It details the principles of country owner- ability can be prioritized for training and technical sup- ship to which partner and donor countries should port [21]. Donor organizations can assist partner commit, but not the specific mechanisms to carry out organizations in creating sustainability plans that can these principles. More evidence as to how country- quantify the partner organization’s capacity building owned capacity building plays out in practice is needed goals prospectively and provide a framework for meas- to guide future interventions. Donor organizations must urement and evaluation in achieving those goals, in- build funding for evaluative purposes into their grants creasing the likelihood of successful and long-lasting and the results of effective interventions should not die organizational change [30]. unseen in internal reports. Evidence documenting suc- cesses and challenges should be made available to other Summary organizations as guide posts to prevent the duplication A common theme throughout this paper has been the of ineffective past efforts. It is the organizational actors importance of cultivating partner/donor organization on the ground that are poised to identify, evaluate and partnership as driving force for country-owned capacity disseminate the best practices that emerge in the prac- building projects. Partnership presupposes that capacity tice of country-owned capacity building. The Global Goldberg and Bryant BMC Public Health 2012, 12:531 Page 8 of 9 http://www.biomedcentral.com/1471-2458/12/531 Health Initiative funding that is currently underway is 10. Hudson M: Managing at the Leading Edge: new Challenges in Managing Nonprofit Organizations. San Francisco, CA: Jossey-Bass; 2005. an opportunity to collect evaluative data and establish a 11. 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Wing KT: Assessing the effectiveness of capacity-building initiatives: • No space constraints or color figure charges seven issues for the field. Nonprofit Volunt Sect Q 2004, 33:153–160. • Immediate publication on acceptance 55. Morgan P: An Update on the Performance Monitoring of Capacity Development Programs: What are we Learning? Paper Presented at the • Inclusion in PubMed, CAS, Scopus and Google Scholar Meeting of the DAC Informal Network on Institutional and Capacity • Research which is freely available for redistribution Development. Ottawa: CIDA Policy Branch; 1999. 56. Gariba: Participatory impact assessment as a tool for change: lessons Submit your manuscript at from poverty alleviation projects in Africa. In Knowledge Shared.In www.biomedcentral.com/submit http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png BMC Public Health Springer Journals

Country ownership and capacity building: the next buzzwords in health systems strengthening or a truly new approach to development?

BMC Public Health , Volume 12 (1) – Jul 20, 2012

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Springer Journals
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Copyright © 2012 by Goldberg and Bryant; licensee BioMed Central Ltd.
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Medicine & Public Health; Public Health; Medicine/Public Health, general; Epidemiology; Environmental Health; Biostatistics; Vaccine
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1471-2458
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10.1186/1471-2458-12-531
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22818046
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Abstract

Background: During the last decade, donor governments and international agencies have increasingly emphasized the importance of building the capacity of indigenous health care organizations as part of strengthening health systems and ensuring sustainability. In 2009, the U.S. Global Health Initiative made country ownership and capacity building keystones of U.S. health development assistance, and yet there is still a lack of consensus on how to define either of these terms, or how to implement “country owned capacity building”. Discussion: Concepts around capacity building have been well developed in the for-profit business sector, but remain less well defined in the non-profit and social sectors in low and middle-income countries. Historically, capacity building in developing countries has been externally driven, related to project implementation, and often resulted in disempowerment of local organizations rather than local ownership. Despite the expenditure of millions of dollars, there is no consensus on how to conduct capacity building, nor have there been rigorous evaluations of capacity building efforts. To shift to a new paradigm of country owned capacity building, donor assistance needs to be inclusive in the planning process and create true partnerships to conduct organizational assessments, analyze challenges to organizational success, prioritize addressing challenges, and implement appropriate activities to build new capacity in overcoming challenges. Before further investments are made, a solid evidence base should be established concerning what works and what doesn’t work to build capacity. Summary: Country-owned capacity building is a relatively new concept that requires further theoretical exploration. Documents such as The Paris Declaration on Aid Effectiveness detail the principles of country ownership to which partner and donor countries should commit, but do not identify the specific mechanisms to carry out these principles. More evidence as to how country-owned capacity building plays out in practice is needed to guide future interventions. The Global Health Initiative funding that is currently underway is an opportunity to collect evaluative data and establish a centralized and comprehensive evidence base that could be made available to guide future country-owned capacity building efforts. Keywords: Country ownership, Capacity building, Organizational development, Global health initiative, Paris declaration on aid effectiveness * Correspondence: [email protected] Boston University Center for Global Health and Development, 801 Massachusetts Avenue, Boston, MA 02118, USA Full list of author information is available at the end of the article © 2012 Goldberg and Bryant; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Goldberg and Bryant BMC Public Health 2012, 12:531 Page 2 of 9 http://www.biomedcentral.com/1471-2458/12/531 Background efforts, and the donor organizations that play a variety of In 2009, the United States initiated a dramatic policy direct or indirect roles in capacity building initiatives shift regarding the provision of foreign assistance with (e.g. providing funding, engaging in implementation ac- the introduction of the Global Health Initiative (GHI). tivities, etc..). This working definition and framework will The initiative aims to invest up to $63 billion dollars enable these organizations to develop a clearer under- over six years to help partner countries improve health standing of the distinctive characteristics and goals of outcomes through the strengthening of health systems, country-owned capacity building. Emerging lessons and seeks to enable U.S. governmental agencies provid- learned in promoting successful country-owned capacity ing foreign assistance to become more efficient, ac- building will be identified and analyzed to provide a countable, and effective in their efforts to “help reference to organizations involved in similar efforts. countries lift themselves out of poverty” [1]. The under- lying principles of the GHI involve building country- Discussion level capacity to manage and operate health programs Defining capacity building and to encourage country-ownership of health efforts There is a general consensus in the literature that cap- through investing in country-led plans [2]. This effort acity building is a difficult concept to define [3-5]. by the United States is simply the latest in a series of Some explanations for this difficulty include the expan- efforts targeted on country ownership coming through siveness of the term, its increasing popularity since the documents such as the Paris Declaration on Aid Effect- 1990s, and the inconsistency with which it has been iveness of 2005, the Accra Agenda for Action of 2008, applied [3,6,7]. These factors work in concert to hinder and guidelines from the Global Fund to Fight AIDS, analytical understanding of the concept’s meaning. It is, Tuberculosis, and Malaria. however, possible to identify commonalities and differ- The intersection of capacity building and country ences among the various capacity building definitions ownership merits further theoretical consideration. Cap- in circulation. acity building is an approach to strengthening organiza- Capacity building is a common concept across health tions that is common to a variety of different sectors, and business sectors and is often described as either a including business and health program management. It process or an action aimed at the development of one or is a term that has been used with such frequency and more organizational components [4,8-11]. It is also variety of interpretation that its true meaning has be- defined as a means to improving an organization’s ability come obscured. Capacity building in foreign assistance to meet its stated goals [8,12], achieve its mission or en- efforts has in the past often entailed donor country hance its efficiency or effectiveness [10,13-15]. Other organizations driving the design and implementation of commonalities among capacity building definitions in- their technical assistance programs without equal par- clude that these efforts are generally linked in some way ticipation from partner country organizations. The GHI to improved performance of an organization and related approach to foreign assistance explicitly breaks with to the core tasks and functions of an organization past behavior and promotes local involvement by em- [8,16,17]. bracing the notion of “country-ownership”. This is a Despite the commonalities in definitions, capacity capacity building strategy that shifts the leadership of building is generally described more precisely within and responsibility for health promotion efforts onto the the business and management literature than in the partner country and its organizations on the ground. If health literature. Examples include terms such as the GHI’s emphasis on promoting country ownership organizational innovation, organizational development, in capacity building is carried out in practice, a huge absorptive capacity; strategic management and strategic influx of development funding will soon be allocated transformation are described as approaches to building to a new concept, “country-owned capacity building”, organizational competitiveness, effectiveness, growth, that is not clearly understood by practitioners or sustainability and responsiveness [18-21]. The differ- researchers alike. ences in terminology may be reflective of differences in This paper examines the relationship between organi- the organizational objectives in each sector [22]. In for- zational capacity building and the concept of country profit business, organizational expansion and increased ownership and proposes a working definition of country- profit margins are often the desired outcomes of cap- owned capacity building. A simple conceptual framework acity building efforts [23]. In the non-profit/non-gov- for implementing country-owned capacity building ernmental organization sector, organizations achieve efforts will also be described in order to support partner/ success by fulfilling their missions often through service donor organization collaboration in capacity building provision; capacity building in this context is directed efforts. The intended audiences of this paper are the part- toward enhancing programming and service delivery ner organizations that are the focus of capacity building [24]. Goldberg and Bryant BMC Public Health 2012, 12:531 Page 3 of 9 http://www.biomedcentral.com/1471-2458/12/531 Concepts informing the definition of country-owned constantly and actively aspiring to improved levels of capacity building functioning [12,31,35]. Finally, capacity building should In order to establish a working definition of capacity stress building an organization’s ability to adapt and re- building, it is necessary to examine and incorporate add- spond in changing environments [4]. itional concepts. Capacity building is essentially an in- ternal process that can be enhanced or accelerated by Capacity building and country-ownership outside groups [16,25]. In resource-poor settings, there Country ownership is an approach to development as- may be limited organizational energy (time, skills, ex- sistance that strives to empower partner countries to pertise, funds, facilities and equipment) to direct toward take, "effective leadership over their development pol- activities such as strategic planning and needs assess- icies, and strategies and co-ordinate development ments, which should ideally precede capacity building actions" [36]. The Paris Declaration for Aid Effectiveness activities [22]. Collaborations between donor/partner of 2005 and the Accra Agenda for Action of 2008 detail organizations can maximize the effectiveness of capacity the principles of country ownership, which involve the building ventures by focusing on key activities [26]. Un- partner country defining its own development priorities fortunately, capacity building efforts driven by outside and designing and leading programs that promote these organizations or funders are often ineffective in cultivat- priorities. The country ownership paradigm represents a ing a sense of ownership within the partner organization departure from past international development [27]. approaches, which were largely externally driven. The All organizations must already have some level of cap- capacity building theory and tools prior to the advent of acity as a pre-condition to effectively build more cap- country-ownership were generally targeted for use by ex- acity [28]. Organizational readiness for capacity building ternal organizations. Country-owned efforts involve is comprised of qualities such as the organization’s will- building-up in-country technical knowledge and pro- ingness to question itself, its understanding of its own moting organizational sustainability to minimize partner mission and goals, and the level of commitment from countries’ reliance on expensive, external expertise that key organizational stakeholders to participate in capacity is necessarily time-limited [36]. building efforts [7]. The development of new Country-ownership recognizes the need for endogen- organizational capacities is often reflected by an organi- ous drivers toward development in partner countries zation’s openness to change and the ability to adapt to [37]. It is rooted in ideological values, including self- shifts in its environment. Successful change efforts are determination, and advanced by evidence-based analysis largely predicated on the willingness of the organiza- of effective approaches [37]. Country-ownership requires tion’s leadership to support and facilitate that process partner countries to accept full responsibility for success [7,23,29,30]. At the same time, individuals are the build- of the development activities. The assumption states that ing blocks of organizational capacity and the willingness a partner country will be more likely to allot the neces- of individuals and groups within the organization to sary resources to ensure the full implementation of a change their behaviors can significantly affect the suc- program if it is accountable for its outcomes [38]. Critics cess of a capacity building intervention [29,31,32]. of the concept cite theoretical difficulties in achieving If capacity building is to become a process that is not country-ownership given the heterogeneity of interests externally driven, but is locally owned, it is important to among key stakeholders in the partner country, and reflect on some of the lessons learned over the last three challenges to designing a representative consultative decades. Firstly, technical assistance on the part of donor process in planning and implementing programs [39]. organizations is must be carefully tailored, given the The focus of country-owned capacity building should wide variety of needs and resources present among part- be to give organizations skills necessary to respond to ner organizations [33]. Secondly, it should not be challenges, solve problems and build capacity independ- assumed that past successful capacity building initiatives ently in the future. The Global Fund experience in build- could be replicated exactly under different conditions. ing country-ownership aims to encourage partner Thirdly, capacity building should be a participatory country organizations to generate technically sound pro- process, both as a collaborative venture between the posals for funding that are reflective of country needs, partner and donor organization and also in terms of en- and to ensure that nongovernmental organizations play gaging staff and stakeholders at all levels of the partner an instrumental role in designing, implementing and organization [27,34]. Fourthly, it is necessary to identify overseeing programs [40]. Successful country-owned relevant indicators to monitor and evaluate the success capacity building projects echo the importance of inclu- of a given capacity building effort. Fifthly, capacity build- siveness in the planning process and excellent working ing is a continuous process wherein the organizations relationships between partner/donor organizations that involved set and monitor time-limited goals but are produce true partnerships [41,42]. Donor organizations Goldberg and Bryant BMC Public Health 2012, 12:531 Page 4 of 9 http://www.biomedcentral.com/1471-2458/12/531 require expertise in building governance, management period of planning and implementing capacity building systems and organizational development in order to ef- initiatives generally follows the assessment stage and fectively build capacity in collaboration with partner monitoring and evaluating the initiative is often the final organizations [22,43]. stage. These stages are broad and general and can be deconstructed further into to their component parts in Introducing a working definition of capacity building in order to allow for greater understanding. Table 1 pro- the context of country ownership vides a description of the steps in a capacity building Having now explored the terms “capacity-building” and framework for county-owned projects. “country-ownership” in closer detail, it is possible to In the text that follows, partner refers to the local offer a working definition that combines the two con- organization (government, non governmental organi- cepts. This definition aims to clarify the interaction be- zation, faith based organization, civil society organiza- tween the terms and to account for specific tion, private company, etc), while donor refers to any considerations that must be addressed by organizations groups that provide funding to the partner organizations. engaging in country-owned capacity building efforts. Capacity building in the context of country ownership is Organizational assessment therefore, “a continuous and participatory process The need to conduct organizational assessment prior to undertaken independently or in collaboration with exter- engaging in capacity building projects presupposes that nal partners to empower the organization to systematic- any initiative to improve organizational functioning or ally identify and respond to its institutional needs and performance should be in response to an identified the needs of the population it serves in order to better organizational need or deficiency [34]. Organizational as- meet its stated mission and goals, solve problems, imple- sessment is the process by which organizations obtain sys- ment change and increase efficiency”. tematic information about their performance and the factors that affect it in order to diagnose competency areas The use of capacity building frameworks and areas in need of investment [50]. Organizational A theoretical framework is a tool that can help to assessments should be carried out under the partner orga- operationalize country-owned capacity building by pro- nization’s leadership in the country-ownership context, to viding a structured way in which to carry out the pro- ensure that these organizations can effectively self-assess cesses described in the definition above. There are many in the future without the support of external partners. examples of capacity building frameworks, both in the Organizational assessments can be facilitated by using peer reviewed and gray literature [22,44-47]. These fra- tools. These tools vary in terms of their focus and ap- meworks share a number of commonalities, including proach; some tools assess the organization as a whole the identification of organizational “core competencies” while others assess effectiveness one specific area (i.e. that each require a certain level of capacity in order for governance). Assessments use heterogeneous language an organization to be effective. Table 1 Steps in country-owned capacity building Organizational effectiveness is contingent upon the framework interplay of these core competencies, examples of which Step Action include governance, financial management, leadership, 1. Conduct an organizational self-assessment technical capacities, human resources and systems and in- to find areas of strength and weakness frastructure. Core competencies are also called ‘domains’ i) Define the impact of identified weaknesses or ‘elements’ of organizational efficiency, and can be on performance described by a variety of individual terms (i.e. ‘aspirations’ ii) Prioritize weaknesses for intervention versus ‘mission and goals’). Each core competency houses iii) Break down weaknesses into a number of smaller capacities, sub-domains, or “target manageable ‘challenges’ areas of intervention”, that are implicit within the larger 2. Identify challenge and define indicators to competency (i.e. financial management includes budget measure success in addressing that challenge preparation, internal auditing, etc.). The relative import- 3. Choose approach to address challenge ance of each core competency remains unclear, as does 4. Choose tools to address challenge their respective temporal ordering, which precludes agree- 5. Describe and carry out activities and ment among practitioners about which capacity building tasks to address challenge framework is superior [47]. 6. Collect data throughout to monitor and Frameworks also highlight the steps in completing evaluate effectiveness of intervention capacity building projects. Often, these steps include an 7. Conduct an organizational reassessment and initial assessment phase wherein the organization identi- repeat cycle fies areas of needed development [22,44,46,48,49]. A Goldberg and Bryant BMC Public Health 2012, 12:531 Page 5 of 9 http://www.biomedcentral.com/1471-2458/12/531 to identify and describe the organizational core compe- Choose approaches and tools to address challenge tencies that are evaluated, similar to the capacity build- A capacity building approach is the general strategy by ing frameworks previously discussed. Assessments which an organization is able to address organizational diagnose organizational weaknesses by probing into the challenges [52]. In the country ownership context, organization’s current functioning or performance level approaches refer to the methods used by the donor/ and offering indicators that reflect the characteristics of partner organizations collaboratively to help partner an organization operating efficiently to serve as a organizations better achieve their mission and goals and comparison. solve problems that may arise in the future. Capacity There are collections of tools available via internet building approaches are often boiled down to training databases, many of which are free for use by the public. and technical assistance provided by the donor organiza- There is little information available concerning the valid- tions; however, there are a myriad of different forms that ity, quality or effectiveness of each tool, though some these approaches can assume. These include professional tools (like the McKinsey Capacity Assessment Grid) are training, peer assessments, process consulting, perform- often cited in the literature and have gained credibility. ance contracting, executive coaching, mentorship, inter- Existing tools only enable subjective assessments of national organizational collaboration, and a variety of organizational capacity, which makes objective measure- partnership types. ment of capacity which has been built, impossible. Each approach can be operationalized by means of a Donor and partner organizations should collaboratively variety of tools and activities. For example, a partner/ identify tools that address areas of relevance to the part- donor organization may decide to address an ner organization and work to ensure the partner organizational need for enhanced capacity in govern- organization becomes well versed in conducting ance, which was identified through a process of organizational assessments. organizational assessment. Within the arena of govern- The goal of the assessment phase is to identify areas of ance, this organization might have identified the need to organizational strength and weakness. Once weaknesses increase and diversify board membership as the chal- have been identified, it is necessary to define the impact lenge to be addressed. Specific indicators would then be that these weaknesses have on organizational perform- defined in order to track the capacity building effort’s ance. Partner organizations should lead the processes of progress in addressing that challenge (i.e. the number of both prioritizing the order in which the identified weak- different community sectors represented by board mem- nesses will be addressed and then deconstructing the bers). It is then necessary to identify the desired ap- highest priority weakness into small, manageable ‘chal- proach to addressing the challenge of building lenges’. Capacity building efforts should be designed to governance capacity. The chosen approach, (technical address one specific challenge at a time. assistance around board development for example), is operationalized through use of a specific set of activities Identify challenge and define indicators to measure and tasks such monthly consultations between the donor success in addressing that challenge and partner organizations regarding sound board mem- The assessment phase allows organizations to identify a ber recruitment and retention methods. This tool can be specific challenge(s) on which to focus their capacity further divided into its component parts, or activities, building efforts. The challenge will correspond to a tar- which could include the preparation of specific ques- get area of intervention, one of the many component tions to pose at the monthly consultation meetings and parts of the larger core organizational competencies. so on. The application of the defined tools and activities Once identified, the organization must design indica- represent the implementation phase of a capacity build- tors that will demonstrate the effectiveness of the cap- ing project [52,53]. acity building intervention to stakeholders (boards of directors, funders, beneficiaries etc.). Indicators can vary Evaluate the effectiveness of capacity building efforts by type, including process, output, outcome and impact Evaluation in capacity building projects is necessary to indicators [51]. Indicators provide clear metrics by which increase the accountability of both donor and partner the capacity building project can be monitored and eval- organizations, to allow donor organizations that sponsor uated throughout its life. Outcomes are often difficult to capacity building initiatives to engage in more evidence- link to efforts in practice, as there is rarely a financial based grant making, and to compare the effectiveness of bottom line to appraise [22]. Logic models are a com- different capacity building approaches [22]. Capacity monly used method to identify and define indicators for building in the context of country ownership has under- capacity building. Indicators should be reflective of the gone little formal evaluation and there are numerous specific findings gleaned from the organizational assess- explanations for this dearth of evidence. No standardized ment phase. approaches to monitoring and evaluating capacity Goldberg and Bryant BMC Public Health 2012, 12:531 Page 6 of 9 http://www.biomedcentral.com/1471-2458/12/531 building measures are currently defined due to the range any one indicator tells only part of a complex story. To of activities and circumstances that comprise capacity ensure ownership, attempts to capture changes in building interventions [31]. Monitoring and evaluation is capacity over time should be pursued through the use distinct from the initial assessment phase in that it aims of indicators that are defined by the partner organiza- to measure change over time whereas the initial assess- tion and relevant to locally determined concepts of ment is diagnostic and identifies organizational gaps change [31]. [53]. Difficulties inherent to defining ‘capacity’ and meas- uring an organization’s progress toward it are major Conduct an organizational reassessment and repeat the challenges to evaluating effectiveness, particularly when cycle evaluating ‘soft’ capacities, like leadership development Once the organizational challenge has been addressed or employee motivation, that are challenging to quantify and evaluated, the organization will have evolved in [54-56]. some manner. Addressing the original identified chal- Capacity building projects are often facilitated through lenge will ideally result in increased organizational cap- grant funding, part of which may or may not be allo- acity and efficiency; however, capacity building should cated for evaluation purposes by the funder organization be continuous process. Improved capacity in one area [57]. In the absence of designated resources, effective may expose other areas of organizational weakness that evaluation efforts may be difficult to conduct. Partner also require intervention, or the other pre-existing weak- and donor organizations may also have disparate under- nesses may still be present. The ‘new’ organization must standings of the capacity building initiative’s actual goals be re-assessed and another cycle of capacity building ac- and, by extension, how they should be evaluated. The tivities should commence in order to address the next existing evidence base of capacity building evaluations high-priority organizational challenge identified. generally describes either success in individual case stud- The above process of partnership between donor ies or among small samples of organizations, which organization and local partner should ultimately lead to hampers the generalizability of their findings [32]. local organizations capable of conducting the cycle of Partner and donor organizations should be prepared to capacity building activities internally without external test new strategies and approaches to monitor and evalu- guidance or leadership, as described in Figure 1. ate capacity building initiatives [53]. Currently utilized methods range from the traditional donor-driven app- Sustainability roaches to the participatory and ultimately self-directed Effective organizational capacity building will contribute activities of partner organizations; it is the participatory to an organization’s sustainability and, in the context of approach that should be embraced in country-owned country ownership, enhancing the sustainability of the capacity building [55]. Evaluation activities can serve partner organization and the health outcomes it aims to two integrated purposes; assessing the effectiveness/ produce is often a top priority [34]. Capacity is an orga- impact of a specific capacity building intervention and nization’s ability to perform its defined functions, set building the partner organization’s capacity to conduct and implement developmental objectives, and adapt and evaluations independently [32]. Because capacity is a respond to changing environments effectively, efficiently multi-faceted construct, it is necessary to remember that and on a sustainable basis [4,16]. Capacity building Figure 1 Visual schematic of country-owned capacity building framework. Goldberg and Bryant BMC Public Health 2012, 12:531 Page 7 of 9 http://www.biomedcentral.com/1471-2458/12/531 activities should be designed to endow partner organiza- building can and should be a two-way street, with donor tions with the skills and abilities to sustain current built organizations standing to gain knowledge from their capacity, to grow the skills necessary within the relationships with their partners [42]. Participation at all organization to continue to build its own capacity, as levels of the partner organization will ensure that the well as to respond to and proactively create changes in capacity building effort is truly owned by the orga- its environment into the future, absent of donor nization; it will build both the organization’s capacity organization and country support [36,55]. and that of individual employees to implement capacity Agreement on the importance of building capacity in a building processes without donor organization support sustainable way is necessary from the outset of the part- in the future. nership between donor and partner organizations [36]. Donor organizations have a responsibility to empower Leadership within the partner organization will ultim- partner organizations to build capacity independently by ately be responsible for directing and stewarding future teaching them to identify areas of needed intervention capacity building efforts; however, buy-in from all levels (through conducting organizational assessments), to of the organization and other relevant stakeholders and plan and implement a capacity building process (through the identification of internal and external champions of identifying a specific organizational challenge, setting the capacity building process will help ensure its future indicators, deciding on data collection methods, and sustainability [5,23,34]. To ensure that donor organiza- choosing approaches, tools and activities) and to evalu- tions impart all relevant expertise, opportunities for ate the effectiveness of their efforts. Donor organizations technical support and training should be demand-driven should anticipate any cultural considerations that could and informed by the partner organization’s knowledge hinder partnership efforts. Donor organizations may and understanding of local context and organizational need to simplify or reorganize their own internal pro- needs [34]. It should not be assumed that best practices cesses to facilitate collaboration. Aligning to the partner that are effective within the donor organization’s own organization’s priorities, systems and procedures is itself country or experience will translate seamlessly into the a capacity that donor organizations must develop [36]. partner organization’s context [21,36]. Partner organizations are expected to take the lead in Training-of-trainer approaches and coaching techni- country-owned capacity building. In this sense, leader- ques (that can augment traditional supervision or men- ship is an organizational capacity of primary importance, toring relationships by drawing upon the unique as future capacity building efforts cannot occur without knowledge and experiences of both the coach and coa- effective leadership. Leadership development, like moni- ched), could also be employed to build in-house expert- toring and evaluation, should be built into every capacity ise among the partner organization’s leadership in any building intervention as an integral part of the process necessary skill set. For example, training several partner and also as a desired outcome. Similarly, financial man- organization staff members to train others in skills relat- agement skills are another capacity that should receive ing to board development or to pursuing new and due attention in capacity building partnerships, particu- strengthening existing partnerships with other organiza- larly in light of the GHI funding that partner organiza- tions will ensure that this technical expertise remains tions will ultimately be accountable for managing. within the organization regardless of staff turnover. Country-owned capacity building is a relatively new Certain competencies, including those concerning concept that requires further theoretical exploration. organizational finances and strategic management, that The Paris Declaration on Aid Effectiveness is just that – contribute directly to an organization’s future sustain- a declaration. It details the principles of country owner- ability can be prioritized for training and technical sup- ship to which partner and donor countries should port [21]. Donor organizations can assist partner commit, but not the specific mechanisms to carry out organizations in creating sustainability plans that can these principles. More evidence as to how country- quantify the partner organization’s capacity building owned capacity building plays out in practice is needed goals prospectively and provide a framework for meas- to guide future interventions. Donor organizations must urement and evaluation in achieving those goals, in- build funding for evaluative purposes into their grants creasing the likelihood of successful and long-lasting and the results of effective interventions should not die organizational change [30]. unseen in internal reports. Evidence documenting suc- cesses and challenges should be made available to other Summary organizations as guide posts to prevent the duplication A common theme throughout this paper has been the of ineffective past efforts. It is the organizational actors importance of cultivating partner/donor organization on the ground that are poised to identify, evaluate and partnership as driving force for country-owned capacity disseminate the best practices that emerge in the prac- building projects. Partnership presupposes that capacity tice of country-owned capacity building. The Global Goldberg and Bryant BMC Public Health 2012, 12:531 Page 8 of 9 http://www.biomedcentral.com/1471-2458/12/531 Health Initiative funding that is currently underway is 10. Hudson M: Managing at the Leading Edge: new Challenges in Managing Nonprofit Organizations. San Francisco, CA: Jossey-Bass; 2005. an opportunity to collect evaluative data and establish a 11. 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