Building Bridges Project 2008-2011

Building Bridges Between Civil Society and Government through

Capacity Building of the CSO Sector: Experience and Results

from Botswana

Carol B. Makoane, MPH

Technical Officer, HIV/AIDS Programs, PCI

This presentation is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of PCI and do not necessarily reflect the views of USAID or the United States Government.

Presentation Outline

I. Building Bridges Overview

II. The Good, The Bad and the Ugly• Highlights of HIV/AIDS Services

Achievements, Lessons Learned & Recommendations

• Highlights of Organizational Development Achievements, Lessons Learned & Recommendations

I. Conclusions

Building Bridges Overview

• In October 2008 PCI was funded by USAID to implement the 3-year Building Bridges Project.

• Aim: to strengthen the capacity of civil society organizations (CSOs) in Botswana to deliver integrated HIV/AIDS care & support services

• Approach: provided sub grant funding and technical assistance to the CSO partners

Why Civil Society Organizations?

• Government can’t do it alone – civil society has unique strengths that are needed to achieve national HIV/AIDS goals.

• CSOs have the passion and commitment to bring services to families in some of the poorest and hardest-to-reach places, often at low cost.

• They serve as a vital link between families in need, and government services, reaching into homes to help people with their daily struggles, and referring them back to government when needed.

• CSOs have a depth of relationship with their communities that they can use to motivate people to use services and change behaviors.

Building Bridges Partnerships

• Over the project life, PCI assisted 13 CSOs and two umbrella bodies for varying lengths of time.

• We also worked closely with MLG, MOH and district government in project design, implementation and monitoring.

Building Bridges CSO Partners :

• Bakgatla Bolokang Matshelo (BBM) - Mochudi

• Botswana Association for Psychosocial Rehabilitation (BAPR) - Lobatse

• BOCAIP Lesedi - Kanye

• BOCAIP Tumelong - Kumakwane

• Holy Cross Hospice - Gaborone

• House of Hope Trust - Palapye

• Humana Child Aid - Selebi-Phikwe

• Mothers Union Orphan Care Centre - Mahalapye

• Silence Kills Support Group - Selebi-Phikwe

• Tsholofelo Trust - Letlhakeng

• Positive Innovations for the Next Generation (PING)

• Botswana Network for People Living with HIV/AIDS (BONEPWA+)

• Botswana Network of AIDS Service Organizations (BONASO)

Building Bridges Strategies

The Building Bridges project used 4 main strategies to improve the effectiveness, reach and sustainability of CSO Partners’ HIV/AIDS services:

1. Comprehensive Family Care2. Community Mobilization3. Food/Nutrition & Livelihoods4. Organizational Development

Building Bridges ApproachesCOMPREHENSIVE FAMILY CARE• CSO staff and volunteers were trained to visit homes,

administer a family assessment tool and develop an intervention plan for the entire family.– provided ongoing services and referrals– family monitoring

COMMUNITY MOBILIZATION

• PCI trained and mentored 79 Journey of Life Facilitators and 14 Trainers in ten districts.

– These included government health workers and social workers, CSO partner staff, and staff from other CSOs in project districts.

– formed themselves into “District JoL Teams” to coordinate and follow up on district activities

Building Bridges ApproachesFOOD/NUTRITION & LIVELIHOODS

• PCI conducted a review of food/nutrition & livelihoods strategies, gaps and opportunities in Botswana

• 66 CSO staff and volunteers were trained and mentored in vegetable production and honey production, through partnership with Ministry of Agriculture.

– Two-tiered approach - NGO centre-based gardens or apiaries serve as demonstration sites, to teach community members how to establish their own backyard gardens or beekeeping projects.

– Food for Life model

– Honey for Life model

• 13 CSO staff were trained in entrepreneurship skills

Organizational Development: Description

• At the start of the program, and at stages throughout the project, partners’ service delivery and organizational capacity were assessed.

• Capacity building plans were developed with the partners, with some activities to be implemented by PCI and others by the partners themselves.

• The capacity building approach combined training, technical assistance, mentoring, provision of equipment/software, development of a variety of tools, as well as sub grant funding.

• PCI linked partners to local expertise from government, other civil society organizations, and private sector

Organizational Development: Description

• Technical capacity building was conducted alongside organizational capacity building to ensure that progress was made on both simultaneously, as they are interdependent.

• Priority was first given to HIV/AIDS Technical Capacity, Financial Management and Monitoring, Evaluation and Reporting.

– This was to ensure that partners could meet minimal requirements to deliver services, while effectively managing their sub grant funds and fulfilling data reporting requirements.

• While support for these areas continued, capacity building was then provided in areas of Governance and Leadership, Human Resource Management and Resource Mobilization.

Measuring Local Capacity Strengthening

The Bad? The Ugly?

Building Bridges Final Evaluation

• Aim of the Final Evaluation: to identify achievements & lessons learned that can help show ways forward for future programs

• External consultant Dr. Ann Brownlee worked as a team with PCI staff.

• Over a 5-week period starting in April 2011, Dr. Brownlee & the evaluation team conducted key informant interviews and focus group discussions with CSO partners and beneficiaries in project sites, as well as with district and national government.

• The team also conducted further analyses of data gathered on PEPFAR indicators over the project life.

Final Evaluation Key Challenge• There was limited availability of quantitative data on

the CSO partners’ capacity and service quality at the start of the project. This made it difficult to quantify life-of-project changes.

– The capacity assessment methodology used at the start of the project featured self-assessment, and aimed to build ownership of capacity gaps, and consensus on ways forward.

• While powerful as an organizational change tool, it is not as effective for quantifying change over time.

– This is a weakness of many organizational capacity assessment tools: although they produce numerical scores, the reliance on self-assessment without sufficient objective verification of capacity, makes a tool less useful for measuring change over time.

Rapid Organizational Capacity Assessment (ROCA)

• Tool developed by PCI to provide a rapid participatory technical and organizational capacity assessment for Civil Society Organizations (CSOs)– Used 10 selected domains rated on a scale of 1 to 4– Used focus group discussions with key stakeholders of

partner organizations– Scoring completed by partner stakeholders facilitated

by a consultant; scoring based on consensus– Identification of capacity needs in the process– Did not give a clear picture of the partner’s level of

capacity due to self-reporting; and partners overstated how well they were doing

How was this challenge addressed?

• The Final Evaluation team developed a rapid assessment tool featuring externally verifiable measures of change*

• Using this tool, CSO partners were assessed on baseline capacity retrospectively, and on present capacity.

• Data from the assessment was supplemented by review of existing project data and through other types of information gathering conducted for the Final Evaluation.

*adapted in part from the organizational capacity assessment tool developed by AED through the USAID-funded Capable Partners project

The Good

Measuring Local Capacity Strengthening

IV. Highlights of Organizational Development Achievements, Lessons Learned & Recommendations

Organizational Development: Successes

The graph above presents the overall organizational capacity scores by partner, for both 2008 (in retrospect) and for June 2011, the final month for partner support under Building Bridges. Each of the Building Bridges CSO partners achieved substantial gains in overall organizational capacity over the project period.

The graph above presents the organizational capacity scores by domain for all the partners combined, for both 2008 (in retrospect) and for June 2011, the final month for partner support under Building Bridges.

Gov: GovernanceP.Mgt: Program ManagementHR: Human ResourceTC: Technical Capacity

FM: Financial Management NC: Networking /CollaborationPMER: Project M&E/ReportingRM: Resource Mobilization

Building Bridges capacity building resulted in substantial improvement in all domains for the CSO partners, with the greatest changes in HIV/AIDS Technical Capacity, Monitoring, Evaluation & Reporting, and Project Management.

+42+49+32

Organizational Development: Successes

Organizational Development: Lessons Learned & Recommendations

• Organizational capacity assessment should come at the very beginning of future projects and should:

– use “new generation” capacity assessment tools that incorporate objective verification, thus enabling quantitative comparisons over time

– incorporate quantifiable measures of program service quality

• Measurement frameworks for future projects with a strong OD component should incorporate impact indicators that link improved organizational capacity, service quality and beneficiary outcomes

Organizational Development: Lessons Learned & Recommendations

• “Since the OD process must be intensive to achieve full impact, future programs with a strong OD focus should include one or two full-time staff members, sufficient cross-training of technical staff in OD and, if feasible, a long-term relationship with a highly skilled OD consultant firm, for full impact.”

(FE Report)

• “Future programs should build in “achievement of sustainability” as a clear program objective, require cost-sharing, and provide capacity building on resource mobilization and governance early on.”

(FE Report)

Organizational Development: Lessons Learned & Recommendations

• Increasing financial sustainability of local NGO partners is a slow and costly process

• Challenges to strengthening NGO financial sustainability unique to Botswana include:

– the presence of few donors given Botswana’s “middle income” status,

– absence of Global Fund, and

– lack of tax incentives for private companies to make charitable donations.

Organizational Development: Lessons Learned & Recommendations

• “Three years is short for this type of process…Future capacity building projects should be funded for five years, at minimum.” (FE Report)

• “Future programs should work closely with the GOB, key donors, and other HIV/AIDS stakeholders to develop mechanisms for closer coordination to help insure rational distribution of available resources and continue to explore possibilities for major partnerships with the private sector.” (FE Report)

• Governance has proven to be a key driver of organizational effectiveness and sustainability, yet it has also proven one of the most difficult areas to change. Training and mentoring have not been as

effective as in other capacity areas.

III. Highlights of HIV/AIDS Service Achievements, Lessons Learned & Recommendations

Data on PEPFAR indicators gathered through the project’s M&E system showed that the number of HIV infected or affected adults and children who were provided with at least one care service by the 11 CSO partners almost doubled, increasing from 5,759 to 10,273.

The majority of these clients were “registered” with a CSO and received comprehensive, ongoing care and support services over the project life.

Data on this PEPFAR indicator showed that the number of HIV positive clients provided with a minimum of one clinical service increased almost 3-fold, from 1,285 to 3,815 comparing 2009 with the first 3 quarters of 2011.

The majority of these clients were “enrolled” with a CSO and received comprehensive, ongoing services over the life of project.

From 2010-2011, 36% more vulnerable children, and 29% more adults received psychosocial support.

From 2010-2011, 131% more vulnerable children and 41% more adults received protection and legal aid services

How were HIV/AIDS service delivery increases achieved?

• “Access by the CSOs to sub grant funds is a key factor, but does not in itself explain these dramatic increases, as funding remained approximately the same each year.” (FE Report)

• “This increase can most likely be attributed to enhanced ability to deliver services due to:

– strengthened organizational and technical capabilities;

– greater integration of services due to the Comprehensive Family Care approach, resulting, most likely, in greater efficiency.” (FE Report)

How were HIV/AIDS service delivery increases achieved?

• Community Mobilization activities also helped identify new potential clients, who were then provided with services by the CSOs and government.

• Improved record keeping may have also allowed the CSOs to report additional services they may have been delivering before, but neglected to report.

How were Technical Capacity gains achieved?

• Training based on best practices, technical assistance, ongoing mentoring, access to tools/materials, peer learning opportunities, continual encouragement

• Introduction of new service delivery strategies: Comprehensive Family Care; Community Mobilization; Food/Nutrition & Livelihoods

• Training and mentoring in key technical skills areas for care & support (psychosocial support, palliative care, ART adherence, etc.)

• Improved project design, planning & management skills

• More stable organizational context due to capacity building and stable funding over the life of project.

How were Resource Mobilization gains achieved ?

All of the organizational capacity domains have a direct impact on organizational sustainability. However the ability to raise funds is one of the most powerful indicators of an organization’s strength, and of its potential sustainability.

Data for FY09 and FY10 show that the CSO partners are moving in the right direction of diversifying their sources of support, from an average of 16% of their funding coming from non-PEFPAR sources for FY09 to more than double, at 39% in FY10 (data for FY11 is not yet available).

How were Resource Mobilization gains achieved ?

• Building Bridges served as an intermediary linking CSOs and various funding sources and provided technical assistance with proposals.

• In early 2010, PCI developed the skills series “Care like an NGO, Act like a Business”. Delivered in three 4-day workshops, the series teaches partners:

how to approach fundraising from a position of strength (“we are not beggars”)

how to create a credible identity and package their work for diverse audiences

how to work with media how to form win-win partnerships with private sector how to obtain funds from a variety of government

grant programs how to use the internet for fundraising

Conclusions

• “Organizational development that was truly sustainable proved more daunting than originally imagined, with good governance and mobilization of sufficient “non-PEPFAR” resources to maintain NGO services harder to achieve than initially predicted.” (FE Report)

• The program faced a number of challenges, such as a more difficult and extended process than originally envisioned necessary to achieve sustainable change, with some inputs coming later than desired, and targets, sometimes overly ambitious…were not always met.” (FE Report)

Conclusions

• “PCI’s Building Bridges program has been an innovative and successful project that was able to strengthen both the programmatic and organizational capacity of partner CSOs to deliver integrated HIV/AIDS services…” (FE Report)

• The development and roll-out of innovative strategies, including Comprehensive Family Care, Community Mobilization...and the Food/Nutrition & Livelihood strategy, coupled with an intensive approach to organizational development, led to much more cost efficient and effective services in the areas of care and support for the families served…”

(FE Report)

Conclusions

• “PCI’s very personal and intense approach to strengthening its partner CSOs was...key, with both provision of a wide range of training opportunities…and most important, intensive mentoring “on the ground”, with quarterly visits to all CSOs and a respectful but honest approach to problem-solving, being essential components.” (FE Report)

With Gratitude

• USAID/PEPFAR

• Government of Botswana

– NACA

– Ministry of Local Government

– Ministry of Health

– Ministry of Agriculture

– District Government

• CSO Partners

• Collaborating Organizations

• PCI Staff

• Dr. Ann Brownlee