A Scalable New Model for Building Capacity of HIV/AIDS Implementing Organizations

Deloitte’s CYPRESS methodology

Authors:

Molly Loomis, Kimberly Switlick, Kate Donovan, Lohnan Singlah, Kingsley Frimpong

Deloitte Consulting, LLP

March 2013

2

1. Increased access and improved coverage of high quality comprehensive HIV/AIDS treatment, care and related services through improved efficiencies in service delivery.

2. Improved quality and integration of HIV/AIDS services.

3. Improved stewardship by Nigerian institutions for the provision of high quality comprehensive HIV/AIDS services.

Overview of the Strengthening Integrated Delivery of HIV/AIDS Services (SIDHAS) Project

• Leadership and stewardship • Coordination and communication • Change management • Human capital and workforce

development• financial management and analysis

• State Ministry of Health and other agencies

• Hospitals• Community-based Organizations

(CBOs)• Local Government Authorities (LGAs)

Build capacity of Nigerian counterparts… …in specific areas

Deloitte’s Scope of Work

SIDHAS Project’s 3 Key Results

• Goal theory

• Agency theory

• Informational asymmetry

• Change management

• Performance management

Deloitte’s CYPRESS methodology is the foundation for the capacity building approach in SIDHAS (Continuous Process Improvement)

CYPRESS is grounded in theory and strategic

concepts:

© copyright Deloitte 2013

CYPRESS is operationalized to shift the focus from capacity to performance

Counterparts set targets, shifting the power dynamic and aligning interests and goals

Analysis helps address information asymmetry between TA provider and counterpart regarding counterpart’s current and potential performance

Design phase helps promote alignment between activities and expected changes in performance

Counterparts begin to institutionalize change and performance management to catalyze greater action, motivation, accountability, and sustainability

Performance management helps maintain focus on what matters and facilitate evidence-based decisions and better return on investments

Oriented SIDHAS project staff to the CYPRESS methodology and tools.

Tailored CYPRESS process and tools for each counterpart group and vetted them with the counterparts.

Implementing the CYPRESS methodology in NigeriaP

rep

arat

ion

Helped counterparts create capacity development and performance improvement workplans.

Currently helping counterparts implement capacity building events to address prioritized capacity gaps and performance drivers.

Helped counterparts set new or review existing performance targets, and define benchmarks towards those targets.

Helped counterparts benchmark their current capacity and performance using the tailored maturity model and benchmarking tool.

6

• New attention to performance targets

• More defined vision of leading stage of maturity and how to get there

• Strong sense of ownership over the process

• More empowered to advocate, take control, and hold themselves accountable

Initial Results: output and emerging outcomes

• Initiated methodology for 160 counterparts entities in 18 states (85 state agencies, 15 CBOs, 60 LGAs)

• Assisted 160 partners to develop their capacity building plans

• Conducted workshop in 9 states to build counterparts’ workplanning skills and finalize performance targets, current state reports, and capacity building plans and current state reports

Outputs demonstrate methodology can be taken to scale

Emerging outcome-level themes suggest a paradigm shift

Copyright © 2012 Deloitte Development LLC. All rights reserved.7

In counterparts’ own words

We’re not used to looking at performance in this way. I am going to go back and make sure we have performance targets. We can even use those targets to advocate for more resources.

State Health Commissioner

This [M&E piece of the methodology] is not just numbers, but actually evaluating the change that has really happened, and knowing that it happened as a result of capacity building.

CBO representative

We will use this methodology with others in the state.

Bauchi State Ministry of Women Affairs and Child Development

[Before CYPRESS] it was like we were in a vehicle that was going to an unknown destination. Our eyes were closed. But now we know exactly where we need to go…we see what we can do for ourselves, even without waiting for the [state] government.

Local Government Authority

There is duplication in what we and other organizations are doing. We need to bring all implementing partners together so we can coordinate better.

State HIV/AIDS and STI Control Program representative

This is a wake-up call to take on our responsibility to ensure that our systems and processes are strong and sustainable.

National AIDS/STI Control Program representative

Copyright © 2012 Deloitte Development LLC. All rights reserved.8

CYPRESS is relevant across a wide range of settings, sectors, and organization types

Cyprus

Economic Growth

PartnershipsArmenia

Tax Reform

GovernmentAfghanistan

Health Economics

Ministry of Health

Bangladesh

Clean Energy

Government

Kyrgyzstan

Economic Policy

Central Level

Ukraine

Local Capacity Development Summit

South Sudan

Government &

NGOs

Thailand

Regional Development Mission Asia

Kenya

Eastern Africa Grain Council

Regional Organization

South Sudan

Eastern Africa Grain Council

Regional Organization

Kenya

Medical Supply Chain

Parastatal

Ghana

Neglected Tropical Disease

Ministry of Health

Mozambique

Health Systems Strengthening

Ministry of Health & Social Welfare

Nigeria

HIV/AIDS

State & Local Gov

Hospitals, NGOs

CYPRESS by the Numbers

12 countries 14 projects 6 sectors>200 counterparts 8 types of

counterparts

9

CYPRESS can be implemented at scale with a wide range of counterparts

• The methodology is flexible and can be tailored to diverse contexts

Deep change takes time• Counterpart learning increases are often incremental and

counterparts can reach a stage of change saturation

Counterpart leadership matters• A high level of leadership commitment appears to be one of the

pivotal factors for effective change

Technical Assistance providers’ perspective matters• The capacity to performance paradigm shift should occur in both

project staff and counterparts

Challenges and Lessons Learned: Nigeria and Globally

10

Multiple perspectives provide a richer view• Output and outcome level changes should be measured from an

internal (subjective) and external (objective) perspective

Interventions can yield rapid results• Even a short project (e.g. 1 yr.) can lead to outcome level changes in

capacity and performance

CYPRESS develops cultures of performance • formal and informal feedback indicate increases in counterparts’

stewardship in terms of commitment, engagement, and action.

Challenges and Lessons Learned (continued)

About DeloitteThis publication contains general information only and is based on the experiences and research of Deloitte practitioners. Deloitte is not, by means of this publication, rendering business, financial, investment, or other professional advice or services. This publication is not a substitute for such professional advice or services, nor should it be used as a basis for any decision or action that may affect your business. Before making any decision or taking any action that may affect your business, you should consult a qualified professional advisor. Deloitte, its affiliates, and related entities shall not be responsible for any loss sustained by any person who relies on this publication.

As used in this document, "Deloitte" means Deloitte Consulting LLP, a subsidiary of Deloitte LLP. Please see www.deloitte.com/us/about for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. Certain services may not be available to attest clients under the rules and regulations of public accounting.

Copyright © 2013 Deloitte Development LLC, All rights reserved.