Hard-wiring and Soft-wiring in Sustainability via health program examples

by Jindra Cekan | Jul 10, 2022 | capacity strengthening, Community Driven Development, ex post evaluation, ex-post evaluation, Exit strategies, Feedback loops, Health programs, Humanitarian aid, Local Participants, Localization, OXFAM, Sustainability, sustainability planning, Sustainable development, UNICEF

Hard-wiring and Soft-wiring in Sustainability via health program examples: by Laurence Desvignes and Jindra Cekan/ova

Overview

We all want things to last. Most of us joined the ‘sustainable development’ industry hoping our foreign aid projects not only do good while we are there but long afterward. Following on last month’s blog on better learning about project design, implementation, and M&E, here are some things to do better.

Long-term sustainability rests on four pillars: the first rests on how the project is designed and implemented before exit and the second is to what degree conditions are needed for the continuation of results the project generated are put into place. While the first one embeds sustainability into its very results, the second invests in processes to foster the continuation of results. The other two of the four pillars, returning to see what lasts by evaluating the sustainability of results two or more years later and bringing those lessons back to funding, design, implementation, and building in shock-resilience, e.g., such as to climate change, are in other Valuing Voices blogs.

We focus on 1 and 2 in this blog, and use an analogy of hard-wiring and soft-wiring sustainability into the fabric of the project:

1. Hardwiring, ‘baking-in’ sustainability involves the design/ implementation which predisposes results lasting. This includes investing in Maternal Child Health and Nutrition’s first 1000 days from conception to age two that are vital for child development. The baby’s physical development and nutrition are so important as is maternal well-being. Investing in these early days leads to better health and nutrition throughout their lives. So too are buying local. Too often our projects rely on imported technology and inputs that are hard to replace if broken. A project on hand pumps used by UNICEF suggested local purchase of those “designed to optimize the chances of obtaining good quality hand pumps and an assured provision of spare parts” involves both the hardware of the pump and also the “capacity building plan and a communication strategy.” Also using local capacity/specialists when available vs external consultants can also be key to building the sustainability of a project.

Another example of baking-in sustainability is using participatory approaches to ensure that those implementing- such as the communities/ local authorities. In this example, it’s grassroots where participants are heard during design in terms of their priorities and how the project should be implemented. This includes targeting discussions and monitoring and evaluation being done with and by communities. The seminal research of 6,000 interviews with aid recipients, Time to Listen, found that they want to participate and when they do, things are more likely to be sustained, rather than being passive recipients…. there is ex-post proof such programming is more ‘owned’ and more sustained.

Conducting in-depth needs assessments at design is usually the way to collect information about what is needed and how projects should be implemented to last. Unfortunately, very often, the time is very limited for the proposal development and (I)NGOs are under pressure of short deadlines to submit the proposal, and needs assessments are either done quickly, collecting very basic information or not done at all. Yet time spent valuing the voices of participants can bring great richness. In 2022, the UN’s FAO did a monitoring and evaluation study in Malawi validating indicators for poverty by asking communities how they identify it from the start. “Researchers were impressed at how accurately the people they interviewed were able to gauge the relative wealth of their neighbors.” We were not surprised as the locals often know best.   Another example with Mines Advisory Group in Cambodia, we developed a community-based participatory approach for design whereby project staff would work with the mine-affected communities to draw local maps of their villages, highlighting the location of the dangerous places and the key areas/places used by the communities. Staff and communities discussed the constraints, risks, needs, etc. to make their community safer, which the project would follow up with risk education, clearance, victim assistance, and/or alternative economic /development solutions to make the community safer. Other mine action agencies, e.g. Danish Refugee Council (Danish Demining Group) are also now using safer community approaches, involving local residents to decide on how to make their village safer depending on the community priorities[1].

Hardwiring in participatory feedback-loop learning from locals during implementation is also key. Implementation of a community feedback strategy once the programme is running is also essential. The community feedback mechanism (CFM) is a formal system established to enable affected populations to communicate information on their views, concerns, and experiences of a humanitarian agency or of the wider humanitarian system. It systematically captures, records, tracks, and follows up on the feedback it receives to improve elements of a response. CFM is key to ensuring that people affected by crisis have access to avenues to hold humanitarian actors to account; to offer affected people a formalized structure for raising concerns if they feel their needs are not being met, or if the assistance provided is having any unintended and harmful consequences;  to understand and solicit information on their experience of a humanitarian agency or response; as part of a broader commitment to quality and accountability that enables organizations to recognize and respond to any failures in response; to promote the voices and influence of people affected so their perspectives, rights, and priorities remain at the forefront of humanitarian/development work[2].

Promoting and implementing community engagement, such as a community feedback strategy, provides a basis for dialogue with people affected on what is needed and on how what is needed might best be provided, especially as needs change during implementation. This will help identify priority needs and is a means to gauge beneficiaries’ understanding of activities being carried out, to assist in the identification of local partners and establishment and follow-up of partnerships, and in the organizational development and capacity building of local institutions and authorities. It can strengthen the quality of assistance by facilitating dialogue and meaningful exchange between aid agencies and affected people at all stages of humanitarian response and result in the empowerment of those involved. Targeted people are viewed as social actors that can play an active role in decisions affecting their lives.

OXFAM’s project in Haiti starting in 2012 came as a result of a cholera epidemic that began in 2010 (“Preventing the Cholera Epidemic by Improving WASH Services and Promoting Hygiene in the North and Northeast”), whose goal was to contribute to the cholera elimination, experimented with the community feedback strategy as a means of gauging the recipients’ understanding of the activities carried out and of further strengthening the links between OXFAM and the communities during implementation. The initial process of community feedback was intended to both receive recommendations from project participants for better management of the action and also to better understand the strengths and weaknesses of Oxfam interventions. Based on the information and recommendations applied, OXFAM served as a bridge between the community and the actors involved (e.g. private firm contracted to carry out some health centers/ water systems renovation work or other) in the implementation of the project. This is also part of Oxfam’s logic of placing more emphasis on the issue of accountability and community engagement.

The feedback-loop benefits of such a community process are manyfold, especially on Protection, human rights, risk management, and further below, adapting Implementation, M&E, and fostering organizational learning:

• CFMs assist in promoting the well-being, rights, and protection of people by offering them a platform to have a voice and be heard
• it fosters participation, transparency, and trust
• It uses Do No Harm and conflict-sensitive programming
• It helps identify staff misconduct
• It functions as a risk management and early warning system

Adapting Implementation and Improving M&E:

• This process makes it possible to adapt to the priorities of the beneficiaries, to better meet their needs hence ensuring the agency’s accountability to the affected population
• It facilitates and guarantees a better quality of the project.
• It represents a means of monitoring our approaches and our achievements.
• It makes it possible to construct a common vision shared between the various actors and the project participants/targeted communities.

Organizational Learning:

• Ensuring the programme quality and accountability through the establishment of an appropriate accountability strategy (including Transparency, Feedback, Participation, Monitoring, and Effectiveness) and relevant methodologies and tools (since the planning stage of the project) is a key exercise which allow to think and plan for the sustainability of the programme at an early stage.
• It allows us to gauge the strengths and weaknesses of the interventions while offering us the opportunity to learn from our experiences, hence allowing for programmatic learning and adaptative programming.
• It conveys the impact of the project and the change brought about in the lives of the beneficiaries.
• It is part of the logic of capitalizing on experiences to improve the quality of future projects.

2. Soft-wiring is creating conditions to make sustainability more likely for local communities and partners by thinking about how to replace what has been brought by the projects’ donors and implementers. This involves an analysis as well as actions that put conditions for sustainability into place before and during the time that foreign aid projects close. Valuing Voices’ checklists for exiting sustainably involves local ownership, sufficient capacities, and resources, viable partnerships, how well risks such as climate and economic shocks were identified and managed, and benchmarking for success 1-2 years before closure. Later it is important to return to check findings at ex-post project, comparing completion results to what was sustained 2-30 years later.

There are four categories of sustainability-fostering actions to do pre-exit which were identified by Rogers and Coates of Tufts for USAID for sustained exit:

1. RESOURCES:

Several blogs on Valuing Voices deal with resources, including assumptions donors make. Donor resource investments cannot be assumed to be sustained.  The checklists outline a wide array of questions to ask during design and latest a year pre-exit, including what assumptions do aid projects make?  USAID water/ sanitation/ hygiene investments have mostly not been sustained, due to a combination of lack of resources to maintain them and low ownership of the resources invested.   Some key questions are:

• Did the project consider how those taking over the project would get sufficient resources, e.g., grant funding or other income generation available or renting out their facility or infrastructure that they own or shift some of their activities to for-profit production, sold to cover part of project costs?
• Does the project or partner have a facility or infrastructure that they own and is rentable to increase resources outside donor funding or can the project shift to for-profit, including institutional and individual in-kind products or technical knowledge skills that can be sold to cover part of project costs?
• What new equipment is needed, e.g. computers, vehicles, technical (e.g. weighing scales) for activities to continue, and which stakeholder will retain them?
• Or even no resources are needed because some project activities will scale down, move elsewhere, focus on a smaller number of activities that are locally sustainable, or the whole project will naturally phase-out)

2. PARTNERSHIPS:

The objective of that Oxfam project was to reduce the risks of communities placed in a situation of acute vulnerability to the cholera epidemic in two departments in Haiti (where about 1.5 million inhabitants reside). It focused on sustainability by effectively supporting and accompanying governmental WASH and health structures in the rapid response to alerts and outbreaks recorded in the targeted communities. How? Through awareness-raising activities among the populations concerned, by strengthening the epidemiological surveillance system and coordination between concerned stakeholders. The project also aimed to improve drinking water structures such as drinking water distribution points, drinking water networks or systems, catchments, and boreholes.  As part of this intervention, Oxfam worked in close collaboration and in support of the Departmental Directorates of Health (DH), DINEPA (government services responsible for water and sanitation), and local authorities at the level of cities, towns and neighborhoods, and community structures including civil protection teams.   Oxfam and DINEPA staff intervened through mixed mobile response teams that included technical and managerial staff from the health department to whom Oxfam provided ongoing technical support in terms of WASH analysis and actions, WASH training, finance training, and monitoring, as well as logistical support for the deployment of teams in the field (provision of vehicles and drivers). Oxfam was therefore working to ensure that cholera surveillance and mitigation actions were led by state and community actors, and by supporting state structures to build their capacities and allow ownership of the various aspects of the fight against cholera.   Concretely, this was done as follows:

• Preliminary meetings and discussions were held with concerned governmental authorities to agree on a plan of action based on needs, implementation means, priorities, and budget for the health and wash governmental services/teams to be able to function. This was followed by the signature of an MoU between Oxfam and the Departmental Directorates of Health (DH).
• An action plan was set up with the DH and DINEPA (governmental water and sanitation agency) at the very beginning of the project.
• Outbreak response teams were managed directly by the DH and the staff was recruited, managed, and paid by the DH. The DH and DINEPA implemented the activities, managed the staff of the mobile teams, and provide technical monitoring in coordination with Oxfam.
• The epidemiological monitoring activities carried out by the DH were also monitored by the Oxfam epidemiologist who, in close coordination with the DH, built the capacities of epidemiologists and staff at the departmental level and at the level of the treatment centers to ensure adequate monitoring and communication.
• An Oxfam social engineering officer worked with DINEPA to ensure that the various water committees at the sources/infrastructure rehabilitated by Oxfam were functional. Sources/infrastructures were rehabilitated in concert with DINEPA to ensure the proper ownership.
• Oxfam provided funding, and technical supervision and wrote and submitted the final report to the donor. Based on DH’s regular reports on activities which were then consolidated by Oxfam for the donor.
• Teams were paid directly by the DH from funds received by Oxfam, based on the budget agreed by both Oxfam and the DH, and were based on government salary scales.
• The Oxfam WASH team, which systematically accompanies case investigations in the field, further encouraged the participation of DINEPA and its community technicians, through regular meetings with the DINEPA departmental directors.
• Overall, Oxfam ensured to provide support and capacity building of the DH, DINEPA, and community actors involved in the fight against cholera, to ensure proper ownership and to avoid substitution of the health/wash authorities.

3. OWNERSHIP:

The type of peer-partnering at design and during implementation described above is vital for ownership and sustainability. Unless we consider people’s ownership of the project and capacities to sustain results, they won’t be sustained. See Cekan’s exiting for sustainability checklists on phasing over before phasing out and exit, strengthening ownership, which brings us full circle to the participatory hard-wiring described above in Haiti.

4. CAPACITIES-STRENGTHENING

We have to strengthen capacities at the most sustainable level. Taking an example from IRC’s Sierra Leone Gender-based Violence project involves looking at what happens when capacities training done for local participants and partners to take over are not done right. In this case, there were two-year consultancies to the Ministry (MSWGCA) on strategic planning and gender training, but “it is not clear if this type of support has had a sustainable impact. The institutional memory often disappears with the departure of the consultant, leaving behind sophisticated and extensive plans and strategies that there is simply no capacity to implement.” The report found that community-based initiatives that are the “primary sources of support for GBV victims living in rural areas in a more innovative and sustainable way that promotes local ownership. They also may yield more results,” most donor agencies find it hard to partner with community-based organizations so they recommended a focus on training and capacity-building of mainstream health workers to respond to GBV and aim for the government will assume control of service provision in approximately five years. The excellent manual by Sarriot et al on Sustainability Planning, “Taking the Long View: A Practical Guide to Sustainability Planning and Measurement in Community-Oriented Health Programming puts local capacity strengthening at the core. We have to consult and collaborate throughout and create an ‘enabling environment’ so that the activities and results are theirs.

Source: Sarriot et al 2008

Obviously, we should check on the sustainability we hope for. As ITAD/CRS note, we should do and learn from more ex-post evaluations which is much of what Valuing Voices advocates for.

Recommendations for fostering sustainability:

Few donors require information on how hard-wired or how soft-wired programming pre-exit is at closure which would make sustainability likely. Even fewer demand actual post-closure sustainability data to confirm assumptions at exit, sadly we believe most of our foreign aid has had limited sustained impacts. But this can change.   Donors need to be educated that the “localization” agenda is the new trend (just as gender, resilience, and climate change have been at one point). It is beyond the “nationalization” of staff members (e.g. replacing expatriates with national staff), which is only one of the elements relating to locallization. True localization is to promote the local leadership of communities in their own ‘sustainable development’. While this is easier to say than to do, sustainability depends on it. We foster it through the hard-wiring and soft-wiring we discussed above and more steps, below.   Here are specific steps from Laurence’s and Jindra’s experiences with the Global South:

• Funds & additional time for local partnership and ownership need to be embedded in the design and planned for, which requires a different approach on which the donors also need to be sensitized/ educated/ advocated to;
• In-depth needs assessment must be carried out just before or when an NGO sets up an operation – it usually takes time and should be integrated into any operation. Advocating this approach to donors is key so that it can be included in the budget or the NGO needs to find its own funds to do so) and the NGO country and sector strategy can then be updated yearly to embed such activities into the (I)NGO DNA;
• Conduct a capacity strengthening assessment of the local authorities or partners with whom we are going to conduct the project. This can take between 3 to 6 months, depending on the number and type of actors involved but this is an essential element to build self-sustaining local capacities and ensure that comprehensive capacity building is going to take place. This transparent step is also an essential step to ensure ownership by national/governmental stakeholders;
• It is vital to allow time to plan for an exit strategy at an early stage, even as early as design. This requires time and needs to be included in the budget for the implementation of the plan at least one year before the end, for phasing over to local implementing partners to take over before the donors/ Global North implementers exit, and for possibly strengthening capacities or extending programming to deliver on their timeline rather than ours before exiting out. More on this from CRS’ Participation by All ex-post and of course the oft-cited “Stopping As Success: Locally-led Transitions in Development” by Peace Direct, Search for Common Ground, and CDA. Also do not forget shared leadership noted by UK’s INTRAC’s “Investing in Exit”;
• Finally, don’t forget about evaluating ex-posts and embedding those lessons into future design/ implementation/ monitoring and evaluation.

  Investing in sustainability by hard-wiring or soft-wiring works! Let us know what you do…      

[1] https://drc.ngo/our-work/what-we-do/core-sectors/humanitarian-disarmament-and-peacebuilding/

[2] https://www.drc.ngo/media/vzlhxkea/drc_global-cfm-guidance_web_low-res.pdf