Transforming capacity-strengthening in an era of sustainable development
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EDITORIAL
Transforming capacity-strengthening in an era of sustainable development Anne Christine Stender Heerdegen1,2 Received: 17 April 2020 / Revised: 15 September 2020 / Accepted: 20 September 2020 Ó The Author(s) 2020
District health managers (DHMs) operate and manage most public health care facilities in the health systems of many low- and middle-income countries (LMICs). They must turn national health policies and human, material, and financial resources into accessible high-quality health services (Heerdegen et al. 2020a). To improve district health services in many LMICs, the capacity of DHMs must be strengthened (Dovlo 2016). Capacity-strengthening is multi-dimensional and includes ‘‘efforts towards strengthening the ability of individuals, organizations, or institutions to perform appropriate functions effectively, efficiently, and sustainably’’ (Bates et al. 2011). Many district management strengthening interventions focus on strengthening the DHMs’ individual competency through formal learning, e.g., classroom training (Martineau et al. 2018). Improving the skills, knowledge, and attitudes of DHMs increases their ability to carry out their job, but their performance also depends on the environment in which they operate (Heerdegen et al. 2020b). In Ghana, for example, DHMs face resource uncertainty (human, material and financial), have limited decision-making authority, and operate under budgetary restrictions in challenging working conditions (Heerdegen et al. 2020b). No matter how competent the DHMs are, these factors affect their ability to carry out responsibilities and limits their opportunity to be innovative and agile in responding to district health needs (Heerdegen et al. 2020b).
This Editorial is part of the series ‘‘Young Researcher Editorial’’, a training project of the Swiss School of Public Health. & Anne Christine Stender Heerdegen [email protected] 1
Swiss Tropical and Public Health Institute, Basel, Switzerland
2
University of Basel, Basel, Switzerland
Capacity should be viewed systemically because it is a product of a complex combination of factors (i.e., individual competencies, resources, policies) in a specific context (Arago´n and Giles Macedo 2010). Efforts to strengthen capacity must be based on a comprehensive understanding of the context in which DHMs are embedded. Gaining this understanding requires actively involving local stakeholders, including DHMs, who can identify bottlenecks and inefficiencies in organizational processes, policies, or individual competencies (de Savigny and Adam 2009). They can provide expert knowledge about management capacity gaps, and suggest ways to fill these sustainably, in ways appropriate to their culture and context. Actively involving local stakeholders in a participatory approach to capacity-strengthening is made easier by the use of tools that encourage users to think thematically, like social network analyses, causal loop diagrams, problem trees, and process mapping (de
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