Publication in Globalization and Health -- Zambia HIV Sustainability Framework Application

A heads up about an interesting publication by a Dublin-Lusaka-London team, which uses the Sustainability Framework to look at CBO work in HIV/AIDS in Zambia.

Apart from stroking my fragile ego when I saw such an interesting use of our model, this paper achieves a number of things:

• substantially, anyone interested in HIV work at community level, will be interested in the case study it presents;
• methodologically, this is a great qualitative and systematic use of the Sustainability Framework. The qualitative emphasis is particularly interesting in that we often get caught in the production of spider diagrams, and the quantitative computations behind them. This is a good illustration of the fact that a framework is here to organize (systematize) our thinking. When numbers help, let's use them and organize them in a way which helps our intelligence. But here's a good illustration that qualitative analysis can be deep and meaningful, and that it is certainly not second-rate to good quantitative data;
• I personally really liked the way in which the authors used the definition of sustainability to structure some of their discussion. They also explicitly present the need for adaptation of the model for this specific study in the methodology.

Finally-- and this may betray my own bias as much as the authors' intent--the study findings are used to develop recommendations, which I see as scenarios (from a complex systems' methodological perspective) for sustaining CBO efforts for HIV in rural areas. [Some of our ICF colleagues in Atlanta have been doing work on this same issue with NACA and the Bank in Nigeria.]

Click here to access the provisional PDF of this paper. You can also find it in our Resources' page, with the authorization of the authors.

Have a great 2013!


Eric 

NEW RESOURCE: Family Planning Sustainability Checklist

The Family Planning Sustainability Checklist is a tool that has evolved over several years and was field tested in multiple countries during the process.  The goal of the Checklist is to provide a tool that enables family planning project designers, implementers and evaluators to think through all of the elements that need to be in place to sustain community-based family planning services over the long term.  The Checklist can be used at multiple points during a project cycle—from the initial design phase through regular staff meetings, annual reviews, to midterm and final evaluations. 

The Checklist does not provide a score but it does provide a method for consistently reviewing all essential program elements to ensure long term sustainability of services—and guides the user through  action planning to address identified weaknesses.  Although it is targeted toward NGO programs working with a national district management team, the “essential program elements” are common to most, if not all, community-based programs.  The essential program elements are: 1) Reliable supply of contraceptive methods, 2) Training, 3) Maintaining a network of quality service providers, 4) Supervision, 5) Demand creation, 6) Reporting and integration of data.  

The guide includes two versions of the Checklist which contain the same elements formatted in two ways to improve the usefulness of the tool.  It also includes guidance for 1) a facilitated one-day workshop for use with project partners and 2) a two hour meeting for when shorter timeframes are available.

We would love to hear feedback from those who use the tool.  Please post a blog or write us directly at sharon.arscott-mills@icfi.com  

In addition to being available on the CEDARS Resources page, the Checklist can be downloaded at the following locations:

1) Flex Fund website

2) K4Health

Best,

Sharon

CEDARS

Fellow in International Health

ICF International

Peak Oil and Global Health – Eric's reflection on an interesting paper by Winch and Stepnitz

There’s a lot of talk about systems and boundaries in our recent discussions about sustainability (mostly in health, but generally in social development).

We always emphasize that, no matter how compact, the social systems we work with in developing countries*are connected to a larger environment (“open systems” in Systems Thinking parlance).

Here’s a piece of thinking and analysis which looks at the rather Big System of Global Health work and the potential effects and scenarios following peak oil. Beyond Jesuitical hair splitting about “what do we really mean by sustainability?”, one part of sustainability thinking is to help actors consider the options in front of them to preserve progress for the future.

Peter Winch and Rebecca Stepnitz’s paper Peak Oil and Health in Low- and Middle-Income Countries: Impacts and Potential Responses offers an interesting analysis. As an interesting focus, they take the example of delays in receiving care for maternal emergencies (the three delays) and look at pathways for effects of peak oil and factors affecting utilization and outcome. The analysis is grounded in the contextual reality of poorer countries and looks at the links of energy and economy to people’s mobility, food security, and trade-offs with health (which we have documented for example for the 2008 food price crisis in the Middle East for example).

Winch and Stepnitz conclude with recommendations at a global level. I was particularly tickled by the fact that their conclusion takes them back to Alma-Ata, not out of nostalgia, but maybe because sound principles for local development and governance for now are also the sounder principles for preserving tomorrow’s options.

An interesting read  (access article on CEDARS website or through this link).

Eric

* I more and more think that this “developing country” distinction is making less and less sense. What we’re talking about are poor communities lacking essential resources—a situation which our “developed nations” are seeing more and more of as [pick your position] (1) the economy is slowing down, (2) safety nets are shrinking, or (3) all of the above. At the same time, the wealthy are getting wealthier, even in “developing countries.”

Food Systems Tools

Check out an educational page on Food Systems and tools that encourage systems thinking: http://www.nourishlife.org/teach/food-system-tools/

Update from the Summer Peace Institute (SPI) --the times for a changin'

This is update 4 from SPI. As this will be too long for a facebook update, the CEDARS blog is a good place for it. Visit our FB page and take a peek at the first short updates when you want.

There's something personally challenging, almost disturbing--in a good way--in sitting with the diversity of folks who are in class with me. We're talking of folks facing conflict at the micro-level, in households for example through gender-based violence, all the way to communities and tribes in Afghanistan or Kenya, in relations of minorities with a State, all the way to State Conflicts influenced by and influencing inter-community violence. (In French we use the word "communautarisme" for the emergence of a sense of community which demands separation from and potentially violence for "the others".)

As I mentioned before, the relatively recent field of Peace-building uses similar tools and methods to what we use in community development. Not only that, but if you look across another discipline--organizational development and specifically the evolution toward soft systems or post-modern system approaches to organizational change -- you realize that we are all playing with a limited set of "ingredients" and mixing them through different processes, emphases, and ultimate goals to essentially allow human systems to engage in constructive, equitable and sustainable ways. Now, along the way, labels change because it is helpful to identify the difference between a Quiche Lorraine and a Spinach Pie, without having to read the whole recipe. This is probably why the field of Social Sciences has so many Theories and Methodologies, which require high levels of expertise to distinguish one from the other. Whether these distinctions amount to much is a debate for another day. But here's one "ingredient" that gets a rough treatment from most of us, and for which the Peace-building field may provide some interesting insights. That ingredient is time.

In a short book, which I already mentioned, Lisa Schirch discusses different time frames and the opportunities they create or allow pre-, per- and post-conflict. [If you want a timely and pragmatic sense of this reality, read her Sept. 2011 proposal for Afghanistan.] In a nutshell, it seems to me that all serious activists/practitioners and scholars of Peace-making live not just with a sense of urgency, but with a sense of respect for time, a recognition of the importance of timing. People engage in lifelong, life-changing journeys, working from the micro-level (can individuals talk to other individuals?) to the macro-level (can a policy like land rights or water access be changed to allow defusing a conflict?). But almost nowhere do you read or hear of instant sustainable change, even if once in a while a landmark is crossed (such as a law or a resolution).

In our world of development, health projects, food security, sustainable development, community development, on the other hand, we live in a world of projects: short projects, long projects, big projects, huge projects, but always projects opening, starting up, hitting bumps, correcting trajectories, hurrying to make up for initial start up delays [what a surprise!] before we need to start getting the last deliverables out, do the final evaluation and get out of Dodge. While we do see some shifts in languages from our traditional donors, this reflects so far more of a change in intentions (as in "we're serious about ownership and sustainability, yes we are."), but limited change in the reality of a world of projects (as in "after achieving 'transformational change' and impact in the first 3 years, the project will scale up and ensure sustainability in the next 2.") To which we reply, "Amen. For sure we will."

Maybe once more funding goes to the field of Peace-building, the same cognitive dissonance about time will affect it, but right now at least from my limited perspective, I have the sense that practitioners of Peace-building build with time, while we build as if time were an accidental constraint which we are ultimately going to overcome. This delusion is perhaps fed by the illusion that time is fungible for money. After all, it works for infrastructure projects. If a road will take a year to build normally, triple the money, hire night crews, pay overtime and you can get it made in 6 months. Why shouldn't it work for community processes?

The easy answer is, because that is not how human complex adaptive systems behave -- never have never will.

In the pursuit of sustainable development, we have learned how to cheat. After all we will monitor how many stakeholder meetings took place, whether minutes were taken, and what decisions were made. We can also get drugs delivered, checklists checked, and training implemented. The funding carrot will not be mentioned as the main reasons why stakeholders agreed -- for now -- to play along. We will report success. A lone sociology master student will come later and question why "it was not sustainable", but who will read that?

The Spinach Quiche of CEDARS (sorry, the Sustainability Framework) still offers a way to start putting the the project-cart behind the horse of pursuing a public good defined by "the community", or at least some of its key stakeholders. This is what is behind the processes of consultation, system and stakeholder mapping, visioning and scenario development. It's interesting that this has remained one of the most self-evident steps to local actors, and one of the hardest to implement by projects. It's somewhat validating to me to see that, in another field, where social capital, mutual negotiation and understanding, and collaboration are essential (but aren't these things essential to sustaining health outcomes for the poor?) these steps are front and center.

I hope they remain so, even as resources accrue to carry out the work. And I hope the global health world rediscovers this.[*]

Over and out --


Eric
[*] ps -- the fact that we, in the health sector, have hard metrics of success does not change the fact that when we talk about sustainable success, these metrics are insufficient predictors and social processes are central. This unedited blog entry is about those.

Health - Development - Sustainability... Peace. Eric is back in school

We've been encouraged to get on with social media. So, as I'm away for 8 days of training at the Summer Peace Institute, I'm trying to post short updates on the new CEDARS Center Facebook Page. Come visit, like and follow us.
Cheers,
Eric

CEDARS Welcomes Sarah Jones

Join us in welcoming the newest member of CEDARS, Sarah Jones!
We are proud to welcome Sarah Jones as the newest member of the CEDARS team.Sarah comes to us from the field of Education Research and Evaluation, and currently works in Don Ellison’s Human Capital and Human Protection Group. Although she treks often from Nepal, to India, to Togo, she’s had a lot of US domestic experience. In other words, she brings new and welcome perspective to our little group at CEDARS.

To help everyone learn a little more about our newest member, Sarah answered a couple of questions about her experience:

Which aspects of your educational and work experiences led you to become interested in sustainability?
The theme of sustainability has reappeared in my work over time as I’ve transitioned from conducting evaluation research on education reforms to evaluation research on other social and economic reform programs both domestically and abroad. It started with my dissertation and PhD work. I was the first researcher to systematically study the KIPP (Knowledge is Power Program) academies back in 1999-2002.

A lot of people at that time were writing about school effectiveness and the structural features of schooling with respect to the development of charter schools. The idea of effective schools research was to identify the structural features of schools that were leading to student success and then to reproduce those features in low performing schools. In a way, effective schools research was about sustainability, helping sustain high level student outcomes through school organizational development and reform.

While studying KIPP that was exactly what I expected to see: two schools, in two different regions of the country sustaining similar outcomes using a particular structural model. However, it became clear during my time at KIPP that it wasn’t just about school structure, it was about its organizational culture, and the cultural beliefs the participants (teachers, students, parents, school leaders) adopted. So I developed a hypothesis that sustainable school success isn’t just about a school’s structure, but also about it’s organizational culture, and the alignment between the two. Modern-day KIPP, I believe, is evidence of that.
When I started my research, there were two KIPP schools. Today there are 109 KIPP schools in 20 states and DC. Not to mention countless other charter schools that have attempted to replicate KIPP’s model. But some schools that replicated the features of KIPP turned out to be more successful than others. Why?

You emphasize a lot this concept of organizational culture. Our group has been more and more interested in recent publications about relational, political and cultural elements of organizational capacity. Do we need to go beyond structural and functional elements of organizational capacity?
For me, this is a big part of the sustainability question. Why do reform initiatives that are seemingly identical in one location not live up to the expectations that a model has set. I’m a culture person--I studied Sociology at UC-Santa Barbara and became interested in the notion of culture and the importance of organizational culture, in addition to the organizational structure and producing high quality programs. So this is an aspect I try to bring to understanding lack of sustainability in particular reforms. In the case of KIPP and KIPP-like schools, organizational culture seems to be a key component to reproducing and sustaining the success that the original KIPP schools have experienced.

My early work focused on education reform, much of which was funded by large scale NGOs. NGOs have had a vested interest in making sure that their investment continued beyond their funding. Therefore, the dilemma of replicability, scalability, and sustainability has always been something I’ve grappled with.

For example, I worked with the Gates Foundation, evaluating their small school reform initiative and did the same with the KnowledgeWorks Foundation. Both are doing small school reform initiatives, and one of the things they were interested in was the sustainability of their interventions. They were looking at distributed leadership and how that was related to sustainability, and also we discovered the level of buy-in. You can have distributed leadership, but if no one believes in it then it won’t have staying power.

The theme of sustainability has reappeared in my work over time as I’ve transitioned from conducting evaluation research on education reforms to evaluation research on other social and economic reform programs both domestically and abroad. This is what is so exciting to me about the CEDARS center. While I have looked at issues such as organizational culture, buy-in, socio-economic context of reforms, leadership, and organizational structure in relationship to sustainability, CEDARS has an active commitment to studying the topic systematically. 

What are the next steps for you and your work in sustainability?
About three to four years ago, I decided to transition to international development work, and it was a goal that I’ve had for a long time. I grew up internationally, studied abroad, lived abroad, travelled, but I wanted to hone my research expertise before applying to other contexts. My next career goals are to continue doing international development work, but most importantly, evaluation research that will help identify ways in which programs can improve reform initiatives and enhance their sustainability.

I also want to work with funding agencies on how they can create more sustainable social reform initiatives, and how they may think about sustainability as they construct calls for proposals for reforms.

The last piece, which is possibly the most important for me, is in-country capacity building. Let me give you an example. Currently I am working with the US Department of Labor which is evaluating its anti-child labor, anti-child trafficking programs around the world. I want to work with both the Department of Labor as well as their grantees to think about how they may design a sustainable initiative. And in addition to that, I want to build capacity in the countries where I am working so that local researchers may assess their programs and determine what changes may be made in order to encourage sustainability.

I like that you’re touching not just on the evaluation of sustainability, but on capacity building in research and evaluation—fundamentally, learning—as a necessary ingredient of sustainability.
As a researcher, evaluator, and methodologist, I’ve always been a teacher, to some degree. I aspire to encourage other people to learn how to do this kind of work, because I certainly don’t have all the answers. And if we begin to work together to try to answer some of them in a systematic manner, we will advance quicker.

And that is what I am confident I will be able to continue to do with the other Fellows at the CEDARS Center. It really is exciting to know that I will be able to participate in this important work,and collaborate with a group of scholars connected to professionals who practice and work on the ground.