Scenario Planning for Development

CEDAR's Sustainability Framework has long talked about the importance of planning for various scenarios by taking the long view in project planning, management, and evaluation activities, reiterated again in a recent paper by Eric Sarriot et al., A causal loop analysis of the sustainability of integrated community case management in Rwanda which also studied scenarios.

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As Wilson Center's New Security Beat writes in its article Scenario Planning for Development: It's About Time, "scenario planning systematically looks at existing and emerging trends and their plausible - though sometimes unlikely - combinations in order to reduce risk. It's an exercise that does not produce single point predictions, but examines a range of possible situations to help prepare for the unexpected."

It's interesting, and heartening, to see USAID changing its approach to development over the last few years by incorporating longer term goals, "adaptive programming" to better respond to external influences such as natural disasters, disease outbreaks, or shifts in governance structures, and increasing focus on "exit pathways". New Security Beat writes of these adaptive approaches that are increasingly embraced, in line with and in response to the rise in uncertainty, preparedness/response shortfalls, and growing complexity. This indeed seems a direction to impact development work for years to come.

Read more about scenario planning and its increasing use by USAID here.

Learning from a post-project evaluation study, applying systems thinking and addressing complexity in community health

By Michelle Kouletio

It doesn't happen enough, but every once in a while a seed of a sustainable health intervention is planted in the ground.  In this case, the seed was planted at the doorstep of a mayor's office in northwestern Bangladesh, amid narrow, busy roads with open sewers of common of bustling secondary cities. Among the middle class families live the extreme poor.  Along with several other challenges, the poor are failed by the government health system whose facilities are overwhelmed by patient volume and whose outreach workers do not serve.   While national policy assigned elected municipal leaders with responsibility for ensuring coverage of equitable health services, these leaders were provided little guidance nor resources.

With support from the USAID Child Survival and Health Grants Program, Concern Worldwide worked in this and other municipalities in Bangladesh to empower municipal leaders to develop a replicable model for social mobilization in complex urban environments. What made this project unique from so many well intended and ambitious community health projects was the embedment of a systematic sustainability planning and monitoring system that established a shared vision and measurement framework across the Mayor’s office, elected representatives, service providers, social leaders and health volunteers along with the project team.

As the technical advisor for Concern Worldwide, I had the privilege of backstopping this initiative.  It took quite of bit of extra effort, particularly in developing practical capacity measuring tools from scratch and maintaining regular reviews at the neighborhood and municipality level. Sustainability planning also required tackling structural barriers and inter-ministerial relations which could have otherwise been ignored in a conventional project. However, the benefits of this deeper analysis and shared accountability approach resulted in real improvements in equitable health outcomes and an enduring political mobilization approach that allowed the population to continue reaping benefits years after the project closed.

Two recently published articles on this work further validate the importance of the hard work of the Concern Worldwide staff in Bangladesh and their contribution to the developing body of evidence on adaptive health systems and sustainability planning:

Advancing the application of systems thinking in health: sustainability evaluation as learning and sense-making in a complex urban health system in Northern Bangladesh

Community Health Systems as Complex Adaptive Systems: Ontology and Praxis Lessons from an Urban Health Experience with Demonstrated Sustainability

Post-script from Eric Sarriot:

These two papers coincide in their release to form a useful series on the Concern CSHGP Bangladesh experience. The first one is part of a larger and important Supplement of Health Research Policy and Systems on Systems Thinking in Health, coordinated by Taghreed Adam of WHO’s Alliance for Health Policy and Systems Research.

Link to the Supplement.

Link to Dr Taghreed Adam’s editorial.

Link to Dr David Peters’ introduction, The application of systems thinking in health: why use systems thinking?

Putting vulnerability first – the need to revise targeting and delivering aid to promote sustainability and resilience

By Debra Prosnitz, MPH

The Humanitarian Policy Research Group (HPG) recently released a policy brief on resilience: Political flag or conceptual umbrella? Why progress on resilience must be freed from the constraints of technical arguments (1). Reading this brief, I began to reflect on the relationship between resilience and sustainability. In the context of development, resilience should address ability to cope and recover from crisis, and the sustainability should address the process of strengthening social capital to sustain progress in health, social progress, etc. (2). If sustainability is a process, perhaps resilience is one of the outcomes. I decided that the importance of this topic deserved a CEDARS blog update.

In this short (4-page) brief, Simon Levine succinctly captures two approaches to addressing resilience, brings to light the stalemate and consequent inaction in which they are stuck, and suggests a new way forward in theory through action (3).

Levine discusses two “broad arguments” for addressing resilience, both of which, he argues, distract us from the underlying need to identify and understand vulnerabilities of individuals and communities, and find ways to address these vulnerabilities: The political argument convinces us that something needs to be done - “since the shocks and stresses that cause crises cannot be prevented, the task is to ensure that people are better able to cope when things do go wrong,” and the technical argument calls for a refined definition of resilience and new approaches for addressing it because what has previously been implemented has not adequately addressed the complexity and challenges of resilience, such as climate change. While we may not yet know the best way to define resilience or the best strategies and approaches to address it, we must not let this stop or delay efforts to do so.  We know that vulnerabilities exist and should be addressed, and should move forward by identifying and understanding vulnerabilities of individuals and communities, and findings ways to address these vulnerabilities.

Resilience then—even if imperfectly conceptualized--can already be enhanced by ensuring that “vulnerabilities are the center of development policy and investment,” and that marginalization be addressed and minimized through development; resilience should not become another sector of development. Thus, Levine suggests that the definition of and theoretical framework for resilience can be developed and refined through action (rather than delaying action pending conceptual clarity).

While Levine addresses the complexity of development and the “structural, institutional and bureaucratic obstacles” to making change to how development aid is targeted and delivered, I wish he had made a clearer link between resilience and sustainability. I’m envisioning resilience as a pillar of sustainability, because while we can’t predict which shock will occur, the occurrence of shocks and changes following even the best of our interventions is almost a certainty. Further, neither resilience nor sustainability can be achieved by external intervention and leadership alone. Community involvement should be a prerequisite for approaching both, with communities and individuals leading efforts to identify vulnerabilities and define resilience.

Levine’s brief is a glimpse into larger bodies of work he has published on this subject (4), which can also be found on the HPG website. Whatever your stance on resilience as a concept, this paper is an important reminder of the old adage not to let the perfect become the enemy of the good; we should not be complacent in our thinking about models of aid delivery, and should be actively thinking about and advocating for changes in the way in which aid is both targeted and delivered. Vulnerability should be the primary criteria, with aid targeted toward the most vulnerable first and delivered in a way that bolsters resilience.  

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(1) S. Levine, Political flag or conceptual umbrella? Why progress on resilience must be freed from the constraints of technical arguments. Policy Brief 60. Humanitarian Policy Research Group (London: ODI, 2014).
(2) Sarriot, et al. Taking the Long View: A Practical Guide to Sustainable Planning and Measurement in Community Oriented Health Programming. Macro International, Inc. (Calverton, MD, 2008) defined sustainability as “a process that advances conditions that enable individuals, communities, and local organizations to improve their functionality, develop mutual relationship of support and accountability, and decrease dependent on insecure resources…(and) enables local stakeholders to play their respective roles effectively, thus maintaining gains in health and development…”
(3) As our fearless CEDARS leader Eric Sarriot summed it up “praxis can improve without a perfect epistemology.” 
(4) S. Levine, Assessing resilience: why quantification misses the point. Humanitarian Policy Group Working Paper. (London: ODI, July 2014); and 

S. Levine and I. Mosel, Supporting Resilience in Difficult Places: A Critical Look at Applying the ‘Resilience’ Concept in Countries Where Crises Are the Norm, HPG Commissioned Paper for BMZ (London: ODI, 2014).