Assessing local capacity for health intervention

Because of their location within the practice realm, participatory, community-based public health coalitions offer many lessons about implementing and sustaining local interventions. This paper presents a case study of capacity assessment at the local level. Capacity evaluation methods are presented, with emphasis on the theoretical framework used to guide the evaluation. The capacity evaluation framework presented herein was theoretically based and designed to generate practical information to facilitate the adoption of a locally tailored youth obesity prevention program, VERB Summer Scorecard (VSS). Using multiple methods, four aspects of community capacity were assessed, including community, knowledge and skills, resources, and power. Within each category, factors that facilitated or impeded program implementation were distinguished. The evaluation protocol was designed to generate information increasing community capacity to sustain a community-based obesity prevention program. Capacity tables were used as a program-planning tool and as a system for sharing implementation and sustainability requirements with potential adopters. This case study also explores how to use capacity assessment results to empower coalitions to serve as catalysts for development of local programs in other communities.     

MERGE

Computer simulations of social welfare policy processes allow us to exploit the power of learning by doing and, at the same time, avoid the ethical and practical limitations of applying the theoretical "experiments" in the field. This paper describes the application of a package of simulations, called MERGE, which simulates four different theoretical explanations of process in a scenario at the local level. MERGE is based upon a general simulation system, called EXPER SIM, available from CONDUIT, a non-profit organization dedicated to the distribution of computer-assisted instructional materials.     

Using a NIATx based local learning collaborative for performance improvement

Local governments play an important role in improving substance abuse and mental health services. The structure of the local learning collaborative requires careful attention to old relationships and challenges local governmental leaders to help move participants from a competitive to collaborative environment. This study describes one county's experience applying the NIATx process improvement model via a local learning collaborative. Local substance abuse and mental health agencies participated in two local learning collaboratives designed to improve client retention in substance abuse treatment and client access to mental health services. Results of changes implemented at the provider level on access and retention are outlined. The process of implementing evidence-based practices by using the Plan-Do-Study-Act rapid-cycle change is a powerful combination for change at the local level. Key lessons include: creating a clear plan and shared vision, recognizing that one size does not fit all, using data can help fuel participant engagement, a long collaborative may benefit from breaking it into smaller segments, and paying providers to offset costs of participation enhances their engagement. The experience gained in Onondaga County, New York, offers insights that serve as a foundation for using the local learning collaborative in other community-based organizations.     

New roles for families in child welfare: Strategies for expanding family involvement beyond the case level

This paper examines the strategies and approaches child welfare agencies used to integrate meaningful family involvement into their service delivery systems, under the Children's Bureau Improving Child Welfare Outcomes Through Systems of Care demonstration initiative. Through a series of retrospective interviews with child welfare agency staff, systems of care project staff, family members actively involved in implementing the systems of care initiative, and local program evaluators, researchers investigated the family involvement planning and capacity building activities of child welfare agencies during the initiative's implementation. Findings indicate that child welfare agencies' capacity building efforts primarily centered on human resource development, focusing on three areas: program staffing, family engagement, and agency buy-in. These findings illustrate the importance of developing the capacity of child welfare agency staff and family members before fully implementing family involvement programs and activities. Although more research is needed to document the impact of family involvement, the lessons learned from these grant communities' experiences provide critical information and can inform development of policies and practices to help child welfare and other child- and family-serving systems promote and implement meaningful and sustainable family involvement.     

Lessons from a project to create performance measures for public health

This paper uses a specific example to illustrate complications that arise in formulating and implementing performance measures. The context of this demonstration is a Centers for Disease Control and Prevention (CDC)-funded project to explore the feasibility of performance measures developed at the national level for local sexually transmitted disease (STD) prevention and control programs. Grantees provided local data and reported on their experience in eliciting the data and using the results for program development. The experience of this project suggests that measures can be made operationally feasible and programmatically useful only if terminologies are subjected to extensive definition and clarification activities. These activities must include development of common language, mapping of workflows, and clarification of spheres of influence. Finally, performance measures must be used with some caution, as they often unintentionally capture extraneous program elements.     

Striking a Balance between Program-Specific and Portfolio-Level Evaluation: Lessons Learned from a Multi-Site Evaluation on the Texas-Mexico Border

Funders are increasingly making strategic investments across multiple grantees, aiming for their portfolio to improve targeted outcomes in a specific issue area. To this end, funders might use multi-site evaluation (MSE) approaches to examine the impact of their collective investments. However, it is important to recognize that each program—and its own program evaluation—must be tailored to its setting, population, and local context to best meet the needs of its target population. Therefore, multi-site evaluations need to account for this complexity. This paper describes the Sí Texas project, a large initiative of eight grantees implementing different integrated behavioral health models to improve physical and mental health outcomes along the Texas-Mexico border. With over 4,200 MSE study participants, the evaluation for Sí Texas used a partnership-centered approach to both enhance the evidence base and build local organizational capacity. This paper describes this approach, the process of tailoring evaluation practices to the grantees’ context, and the challenge of balancing consistency at the grantee-level for the portfolio multi-site evaluation. Successes, challenges, and lessons learned related to study design, data collection, grantee partnership, and capacity building are discussed.     

The Americans with Disabilities Act in Federal Court: litigating against public entities

This study represents the first systematic inquiry into the outcome of litigation against state and local public entities under Title II of the Americans with Disabilities Act (ADA) of 1990. Because Congress instituted a system of judicial review that established the courts as the final authority of rights and responsibilities under the Act, Title II litigation has a potentially significant impact on the disability policymaking of state and local governments in the United States. The analysis is based on all reported federal court rulings through June 2000 in which the court adjudicated a Title II claim against a public entity. The results show that plaintiffs are moderately successful in their suits against public entities, especially when compared to their record in litigating against private employers. However, the courts, particularly at the appellate level, still exercise restraint about interfering in the disability policies of subnational governments when implementing the ADA.     

Community Wildfire Events as a Source of Social Conflict*

Abstract The literature notes that natural disasters, including wildfires, that damage human settlements often have the short‐term effect of “bringing people together.” Less recognized is the fact that such events can also generate social conflict at the local level. This study examines the specific sources of such social conflict during and after community wildfire events. Examining qualitative data generated from six case studies of wildfires in the American West, we suggest that integrating the theories of Weber, Giddens, and Habermas with community interaction theory provides a context for understanding such conflict. Rationalized forms of interaction and problem solving imposed by extra‐local organizations during and after wildfire events are often resisted by local actors who are also inhibited from acting due to local capacity limitations. Thus, conflict occurs when social relations are disembedded by non‐local entities, and there is a perceived loss of local agency.     

The Capacity of Community‐Based Organizations to Lead Local Innovations in Welfare Reform: Early Findings from Texas

Community‐based organizations (CBOs) are now cast among the lead actors in welfare reform. But do they have adequate capacity to perform this critical leadership function? Early findings from fifteen state‐funded projects in Texas show that state planners must carefully assess the capacity of a CBO to initiate and sustain an innovation at the local level. The authors examine six organizational variables that predict success or failure: goals, management, technology, funding, community involvement, and performance.     

Designing for equality: Conceptualising a tool for strategic territorial planning

The struggle for equality is fundamental to the reduction of poverty in Central America. Besides, one of the foremost goals of urban spatial planning, when implementing social policies, is to contribute to the reduction of poverty. This is done by producing a list of territorially-based actions and selecting those suitable for the implementation of social policies developed at national level. However, urban planners working with local authorities in the Region face political, managerial, financial and technical limitations for adequately conducting this task. Of particular interest to this paper are the limited options they have for technically assessing the impact that territorially-based actions have on reducing inequality, and therefore poverty.An operational methodology is proposed in this paper, as a step forward to enable planners to simulate, assess and monitor the impact of territorially-based actions on inequality, and to promote the use of evidence from statistical data when proposing, implementing and monitoring those actions. The methodology is introduced by inscribing it in the context of urban spatial planning, presenting the concepts that underpin it, describing how it is intended to work, and illustrating its use through the presentation of an empirical study.     

Interaction dynamics: The case of the water sector skills plan in South Africa

Despite extensive and continuous efforts to strengthen the capacity of people, organizations and institutions, there is evidence of an increasing gap between the existing and required capacities within the water sector. Consensus seems to be emerging regarding the need for national strategies to improve water sector capacity development. This paper analyses the dynamics of actors’ interactions and their characteristics (motivation, cognition and power) during the formulation and implementation of a specific capacity development strategy, namely the Water Sector Skills Plan (SSP) in South Africa. Based on the Contextual Interactive Theory and empirical findings, our analysis indicates slow progression and challenges with implementing the SSP, mainly due to the lack of consultation with key stakeholders during the formulation stage, a lack of data sharing among the target group (the Sector Education Training Authorities), and a lack of capacities within the key implementing organizations. These policy dynamics need to be taken into account when advocating for national capacity development strategies as a solution for challenges with water sector capacity development. The paper proposes the recommendations that are of relevance for the SSP as well as similar initiatives in other countries.     

What you don't know can hurt your community: Lessons from a local United Way

This paper describes how a controversial executive compensation package approved by a local United Way agency eclipsed the agency's long‐standing record and reputation of being a top fundraiser and pillar of the community. Using the framework developed by P. Connelly and York (2003), this case study illustrates how the lack of leadership and adaptive capacity within the board of directors, coupled with questions and speculation about managerial capacity, contributed to a highly visible scandal that resulted in the loss of the agency's chief executive officer, the resignation of the chairman of the board of directors, an internal investigation, and ultimately, a federal investigation. Not only did these events hurt the agency, which was forced to eliminate programs and cut staff, but these events hurt the annual campaign, which declined by more than 30 percent, resulting in substantial cuts in funding to dozens of nonprofit organizations. The findings from this study illustrate the importance of building strong governing boards that focus on both organizational processes and performance outcomes. They also highlight how important it is for the flagship charitable institutions to model best practices and invest in their own capacity.     

Engaging decentralization in an uncertain political context: Lessons from Liberia

This study uses a Diagnostic Framework for Local Governance to evaluate the current capacity for administrative decentralization at the county level in Liberia, as well as to identify political economy challenges and opportunities surrounding decentralization. Applying the Problem‐Driven Iterative Adaptation (PDIA) framework to our findings, we offer recommendations for moving decentralization reform forward. We find strong demand for administrative decentralization among local officials, and propose that decentralization reform can be enhanced through incremental implementation that focuses on strengthening the existing structures and capacity of local administration, and through the creation of stronger accountability and participatory mechanisms. The triangulated research design includes focus group and interview data in eight Liberian counties, analyzed using NVivo Qualitative Data Analysis Software.     

Evaluating school capacity to implement new programs

An eight-factor survey-based Bayesian model (Bridge-It) for assessing school capacity to implement health and education programs was tested in secondary analyses of data from 47 schools in the Texas Tobacco Prevention Initiative (TTPI). Bridge-It was used during the pre-implementation phase and again at mid-course of the TTPI 2 years later. Achieved implementation status was evaluated in follow-up almost 4 years after the start of the TTPI. The Bridge-It score aggregated across all eight of the capacity factors predicted both quality of adherence to the Guidelines for School Programs to Prevent Tobacco Use and Addiction and quantity of implementing activity. The school-based leadership factor was an independent predictor of quality of adherence whereas the facilitation processes factor predicted quantity of implementing activity. Integration of Bridge-It, or comparable multi-attribute tools, into the planning and evaluation of school-centered programs can increase understanding of factors that influence implementation and provide guidance for capacity building.     

Urban infrastructure: Trends,needs and the role of aid

The benefits of urban services have to be made accessible to increasing numbers of low income families in less developed countries. High levels of service are unlikely to be sustainable, and success depends upon addressing the key issues of Affordability and Maintenance. The complex interactions between technical, financial and social factors must be considered. The provision of high standards of service by implementing agencies is expensive and reflects neither the priorities of the beneficiaries nor their ability to pay. It is more effective to provide only the most basic level of service (primary level infrastructure) at the outset, which can subsequently be upgraded. The community should be able to take individual and collective responsibility for their priorities in improving the services based upon what they can afford. Primary level infrastructure is provided without cost recovery, with subsequent improvements being funded through loans to individuals and the community. It is easier both to recover costs from and to maintain individual plot service connections; however, the installation costs and tariffs must be affordable. Efficient operation and maintenance is essential. This is frequently the responsibility of an urban local authority who should be fully involved throughout; design and implementation should take account of their technical and financial capabilities.The factors which should be considered in the implementation of urban infrastructure can be summarised by the “Five I's”: Incremental improvement; Involving people; Individual services; Income related; Institutional.Possible implications for external aid are: (1) funding of primary level infrastructure for identifiable communities, including support for continued community development; (2) funding loans for infrastructure upgrading, with loan repayments forming a revolving fund; (3) strengthening the financial and managerial performance of urban local authorities; (4) technical training for housing authorities, urban local authorities, and public utilities.     

Improvement of financial management by local government: Computer model implementation

Abstract

We develop a computerized optimization model and present its implementation for improvement of financial management at the local government (LG) level. An example of the real-life long-term budget planning and analysis, helped by the model, is presented. The analysis exemplifies good governance practice and observation of standards of efficient management in the area of long-term financial, investment and safe debt planning. These analyses also demonstrate ways of accessing maximum, feasible level of investment expenditure and maximum capacity of a municipality to borrow with all safety measures provided. The model supports informed decision-making process by LG managers, decreases the level of risk and enhances quality and transparency of governance.     

Transformative State Capacity in Post-Collective China: The Introduction of the New Rural Cooperative Medical System in Two Counties of Western China, 2006-2008

In 2002, the Chinese leadership announced a turnaround in national welfare policy: Local insurance at county level, called the New Rural Cooperative Medical System (NRCMS), was to cover all counties by 2010. This paper addresses the main characteristics of NRCMS as an example of 'transformative state capacity' in decentralised policy fields and its feature 'responsiveness' as a market-based means of its introduction.Reviewing the modes of governance and comparing the introduction of local schemes based on two case studies of western China since 2006, this paper argues that the flexibility shown by local administrators in considering structural and procedural adjustments is the result not only of central directives but also of local initiatives. Forms of locally embedded responsiveness to the needs and perceptions of health care recipients are crucial in enhancing the accountability and responsiveness of local cadres. These new modes of 'responsiveness' or responsive regulation are important in understanding and conceptualising the transformative state capacity. Responsive settings using centrally defined local feedback loops are different from hierarchical control and the formal institutionalised representation of the interests of the local population, and are a rough but effective means of enhancing both flexibility and the efficiency of control and financing by the central state. These feedback loops, which are based on voluntary enrolment and on central state subsidies made dependent on contributions received from participants and local government, are complementary forms of governance at grassroots level.     

Making urban sector lending work; lessons from a capacity building programme in Karnataka, India

This article presents experiences with human resource development and ‘capacity building programmes’ in urban sector lending by multilateral agencies. The article first reviews the history of ‘capacity building’ and provides a view on its meaning. The experiences with a capacity building programme, part of an infrastructure loan to the state of Karnataka in India, are subsequently elaborated as an illustration. The article seeks to identify the factors determining the success of capacity building programmes which are part of urban lending. It concludes first that Terms of Reference, drafted in a bottom–up and demand-driven fashion are a better guarantee for ownership, commitment and positive results. Secondly, capacity building activities need to be tailored to the ability of the towns to make changes in their operation. Finally, capacity building at local government level can only be effective if reciprocated by supportive measures of state governments. The paper also argues that Technical Assistance (TA) as a component of capacity building should be more strongly integrated in the loan component activities and continue throughout the project period.     

Understanding knowledge transfer in an ergonomics intervention at a poultry processing plant

This case study reviews the knowledge transfer (KT) process of implementing a knife sharpening and steeling program into a poultry processing plant via a participatory ergonomics intervention. This ergonomics intervention required stakeholder participation at the company level to move a 'train-the-trainer' program, developed in Québec, Canada, into action on the plant's deboning line. Communications and exchanges with key stakeholders, as well as changes in steeling and production behaviours were recorded. The intervention was assumed to be at least partially successful because positive changes in work operations occurred. Ergonomic-related changes such as those documented have been cited in the academic literature as beneficial to worker health. However, several components cited in literature that are associated with a successful participatory ergonomics intervention were not attained during the project. A Dynamic Knowledge Transfer Model was used to identify KT issues that impacted on the success of train-the-trainer program. A debriefing analysis reveals that a failure to consider key participatory ergonomics factors necessary for success were related to capacity deficits in the knowledge dissemination strategy.     

Evaluating the engagement of universities in capacity building for sustainable development in local communities

Universities have the potential to play a leading role in enabling communities to develop more sustainable ways of living and working however, sustainable communities may only emerge with facilitation, community learning and continual efforts to build their capacities. Elements of programme planning and evaluation on the one hand, and capacity building on the other, are needed. The latter entails approaches and processes that may contribute to community empowerment; universities may either lead such approaches, or be key partners in an endeavour to empower communities to address the challenges posed by the need for sustainable development. Although capacity building and the promotion of sustainable development locally, are on the agenda for universities who take seriously regional engagement, very little is published that illustrates or describes the various forms of activities that take place. Further, there is a paucity of studies that have evaluated the work performed by universities in building capacity for sustainable development at the local level. This paper is an attempt to address this need, and entails an empirical study based on a sample of universities in the United Kingdom, Germany, Portugal and Brazil. The paper examines the extent to which capacity building for sustainable development is being undertaken, suggests the forms that this might take and evaluates some of the benefits for local communities. The paper concludes by reinforcing that universities have a critical role to play in community development; that role has to prioritise the sustainability agenda.