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.

Global Development - How Close to Home?

OK - hope everyone saw our latest newsletter -- The Bark! -- it will be posted on our resource page.

In the meantime, one of the things that catches my attention is how quickly the debates on "global development" are changing. [Spoiler alert: this is going to lead to a cool video about some of our ICF colleagues working in Community Development.] Our entire field was born out of a "us and them" vision: developed versus "third world" (remember?), former colonial powers versus former colonies, high growth high GDP versus low growth low GDP countries, industrialized versus non-industrialized.  I know it was a while back, but that's what we've inherited and built upon.

Now we're moving into a globalized, post-colonial and post-modern world. (Maybe colonization was the worst of the hubris of modernization -- but that's a philosophical discussion for another day.) And the us versus them doesn't really make sense anymore. (Thank God for small favors!) Development and sustainability in development are going to remain big questions for a little while, but it's just that we're going to have to look at it differently. If we're going to make good on the MDGs for example, I remember an excellent paper by Davidson Gwatkins back in 2002, basically saying that the poverty and "development" differentials within countries were to a large extent greater now than the between-country differences. And the case is clearly made when you look at the wealth and social protection differentials observed in today's United States. Horror stories about people losing their jobs, homes, and having no access to care in this country can quickly take on the seriousness and hopelessness of a"developing world" story.

I think personally that development has always been a global human and social issue, and it's just becoming more apparent now. Of course, we're still dealing with very substantial resources' differentials, even between Prince George County in the US (where I sit) and many towns and districts in Sub-Saharan Africa. I'm not saying there are no differences, just that they are shades of grey, rather than black and white.

In this context, it's been interesting to hear from and exchange with some of our colleagues in different corners of ICF, both the Public Health group (working on domestic/US health issues) and our Community Development division, which works primarily on domestic issues. The players change, but the variables at hand for building sustainable positive social change?... often not that different really.

So, read more and have a look at this marketing video about the good work of our colleagues (go to "View" on the right side), or click on 'go to video' link below:

Go to Video: Community Development Work of our ICF Colleagues

Cheers all,


Eric

EGPAF's Experience with Transitioning HIV Care and Treatment Programs to Local Partners, By Stephanie Cálves of EGPAF

For eight years, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) has supported HIV prevention, care, and treatment services to women, children, and families through the Centers for Disease Control and Prevention (CDC)-funded initiative Project HEART in Côte d’Ivoire, Mozambique, South Africa, Tanzania, and Zambia. Through its groundbreaking, lifesaving work in these five countries, Project HEART has enabled 1 million people to lead healthier lives. In addition to scaling up access to care and treatment services, two additional focuses of Project HEART were strengthening government health systems and the empowerment of local partners to provide quality health services. As part of this effort, in 2008, EGPAF began a process to transition Project HEART’s programmatic work to local, independent partners, including local NGOs and host country government agencies.

Through Project HEART, EGPAF has helped launch and strengthen three new independent NGOs in Côte d’Ivoire, Mozambique, and Tanzania:

• Fondation Ariel Glaser pour la Lutte Contre le SIDA Pediatrique – Côte d’Ivoire
• Fundação Ariel Glaser contra o SIDA Pediátrico – Mozambique
• Ariel Glaser Pediatric AIDS Healthcare Initiative – Tanzania

In the organizational development process, local staff and stakeholders identified a need for a long-term partnership between EGPAF and the new NGOs in order to promote accountability to international standards; provide access to technical resources and shared management systems; facilitate capacity building; and provide brand credibility to enhance organizational viability. To address these challenges, EGPAF and the new NGOs have developed a model for long-term affiliation, which has resulted in the emergence of a network of organizations that has a shared investment in supporting HIV programming in each country.

Given the nature of the transition process, effective organizational change management was a key factor for success. The establishment of the new NGOs meant that new communication structures, coordination mechanisms, and supervisory roles for staff would be developed. Some of the staff responsible for implementing Project HEART for EGPAF would be starting to work for the new local organizations, thus requiring that human resources systems be harmonized and staff be capacitated to take on new levels of leadership within the new organizations. The transition also meant that new finance, administrative, human resources, and program management systems needed to be established. To ease the impact of these types of changes on staff, at both the global and country levels, EGPAF established working groups at both levels to lead the transition process and established regular forums for communication across the organization.

With the transition also came risks. These risks included the potential for interruption of the continuity of programs, mismanagement of funding, and reputational risks if the process did not proceed smoothly. To address these risks, the transition process included a strong monitoring component. An accreditation structure was established for the new organizations, which facilitates ongoing organizational strengthening, allows for early detection of problems, and facilitates capacity building to address weaknesses.

As the eight-year Project HEART initiative came to a close in February 2012, EGPAF is excited that these organizations are able to move forward independently through new projects funded by the U.S. Centers for Disease Control and Prevention (CDC). Through these projects, they will be able to continue to support HIV care and treatment programs, strengthen their organizational capacity, and expand their impact. In addition, EGPAF and these new local partners will continue to partner with host country governments to strengthen health systems at the national, provincial, and district levels to assume greater ownership, leadership, and management of HIV/AIDS programs. The success of these future efforts will require both EGPAF and its local partners to maintain strong partnerships with host country governments, innovative mechanisms for measuring capacity building activities, and a strong focus on strengthening operations, leadership, and management systems.

EGPAF has developed a number of important tools through the process of launching Affiliates and transitioning programs to these new organizations. We view these as important resources for other organizations also engaged in HIV/AIDS programming. EGPAF has brought these tools and resources together in the toolkit Sustainability Focused Organizational Development: Tools and Resources for Foundation Affiliates. This toolkit includes an overview of the EGPAF’s affiliation model and accreditation system, a checklist organizational start-up, and the EGPAF’s accreditation review tool. It also includes the Organizational Capacity and Viability Assessment Tool, which is a product of EGPAF’s collaboration with ICF International.

For more information on Project HEART or EGPAF, contact Stephanie Cálves at scalves@pedaids.org.

Interesting Window into New Thinking at USAID

A lot of us work with, for, within, or around USAID. On good days we pledge eternal love, and on honest days we sometimes feel the burden of a bureaucracy, where good intentions and best thinking are at times at odds with new fads and the inherent challenges of a bureaucracy. I don't think I'm breaking any secrets here or making enemies of my USAID friends and colleagues. A bureaucracy is a bureaucracy; and you don't disburse billions in assistance dollars without one. (Well, not unless you want to repeat the first six months of Iraq.)

In this context, it was very invigorating to discover the blog Aid on the Edge of Chaos, and notably the report of an October 2011 meeting on USAID's Complexity Journey. Given our growing interest in Complex Adaptive Systems from both an approach to development and a methodological challenge, this gives a very refreshing and exciting report of 'thinking outside the box.'

I invite you to read for yourself, but small take-home snippet, for example, that when it comes to development:

the key is to build innovative platforms that unlock existing capacities, rather than deliver over-specified, top-down solutions.

 This doesn't sound revolutionary, but it's welcome thinking from a donor which can change the landscape.

Ben Ramalingan provides a rapid summary of other discussions -- Aid on the Edge of Chaos, a blog to follow.


Eric

ICF/CEDARS completes work with EGPAF

Over the past three years, ICF/CEDARS has been supporting various different aspects of the Elizabeth Pediatric AIDS Foundation’s (EGPAF) transition monitoring efforts for their CDC-supported PEPFAR program, Project HEART (Help Expand Antiretroviral Therapy to children and families). This month marks the successful completion of both Project HEART and the technical support from CEDARS (the end-of-project report and more information on Project HEART can be found at: http://www.pedaids.org/ProjectHEART).

As part of the PEPFAR Track 1.0 treatment initiative, this eight-year project was launched in Côte d’Ivoire, South Africa, Tanzania, and Mozambique in an effort to scale up ART through existing organizations implementing PMTCT (prevention of mother-to-child transmission). A core goal of Project HEART was to transition care and treatment activities to local partners in a sustainable way.

EGPAF contracted ICF/CEDARS to provide technical assistance in 1) the development of a plan for this transition, 2) the design and development of tailor-made data collection tools to measure progress in this transition process: the Organizational Capacity and Viability Assessment Tool (OCVAT), the Site Capacity Profile (SCP) for facility level assessments, CBO Capacity Profile for local organizations providing ARV treatment support, and a service delivery site mapping inventory, 3) the design and development of a training curriculum for country programs on program design for sustainable health outcomes, based on the Taking the Longview Sustainability Planning Manual.

The fruits of this productive collaboration between EGPAF and ICF/CEDARS will be posted on the CEDARS website over the course of the next few weeks—keep any eye for them!

Watch this video about the impact of Project HEART:

Living Proof: A Father and Son Love Story from EGPAF on Vimeo.

Progress toward sustainability - the Linear View

OK people - this is "for fun". You know me.
On our way to success?




Eric

Source: Downloaded from 'trending' of the word sustainable graph.

Emergence of Sustainability in a Complex System

On January 26, CEDARS was featured at a Microlinks Breakfast Seminar, which turned out to be a great success, as well as a unique learning experience for everyone.

Eric Sarriot, joined by Sudhir Wanmali, Sharon Arscott-Mills, and Owen Calvert, presented a simple definition of "Complex Adaptive Systems", described how the concept of Sustainability fits into this definition, and provided real-world examples of its use.

Following the presentation, a thought-provoking Q&A session took place amongst both the panel and the audience. One question, in particular, asked how complex systems in food security could be incorporated into Pastoral Systems, and the bulk of the discussion focused on data collection challenges, the need for accurate indicators, and stakeholder organization in these types of systems.

Watch Eric's follow-up interview:



For more information, view the full presentation with audio or visit the Microlinks website.

Read a detailed summary of the event on ICT 4 Agriculture's Blog: Sustainability Lessons from HSS: Implications for FS and ICTs Projects.


Cheers,

The CEDARS Team

People; Processes and Systems -- What Common Points between Sustainability Planning in Health and Food Security?

Hi all -- we hope to have an interesting discussion with Food Security colleagues at a Microlink Breakfast Seminar on January 26, 2012.

I've been asked to share some of our experience with the Sustainability Framework, and with the help of Sharon Arscott-Mills and two Food Security colleagues, Sudhir Wanmali and Owen Calvert, will try to lead a discussion about how some of the lessons learned can be applied to Food Security. We'll try to address some of the tensions between Value Chains as a strategy and the sustainability of Food Security outcomes in vulnerable populations as a larger goal.

Visit the Microlink page and register for this event here.

Maybe see some of you there.
Cheers,

Eric

Reminder-- the initial study, conducted for UNICEF with Thoric Cederstrom and Patricia Costa, which got CEDARS more concerned about the links between Food Security, Health, and Sustainable Social Development is available here.