Building Capacity

When requested by the countries, END in Africa provides technical assistance, training and other capacity building support to help countries build their capacity in areas such as:

  • Forecasting and procuring drugs for mass drug administration (MDA) activities.
  • Adapting and rolling out standard operating procedures for effectively managing NTD medicines, which encompass logistics, storage, inventory control, waste management, inspections, distribution, usage and documentation of severe adverse effects.
  • Providing technical assistance and training for health and education staff at the national, regional, district, sub-district and community levels, including teachers and community volunteers, as appropriate, in areas including:
    • Coordination of the NTD drug supply chain
    • NTD diagnosis
    • MDA delivery and reporting
    • Financial management performance
    • Implementation of the Tool for Integrated Planning and Costing (TIPAC)
    • Fixed obligation grant (FOG) management and related topics such as milestone-based budgeting and activity-based costing
    • Use of NTD program and disease-specific workbooks
    • Development of high-quality monitoring & evaluation systems

Standardization for better drug management

Standardization is an important ingredient for efficiency in program management because it takes the guess-work out of important processes. Rather than having to figure out how to do their jobs, giving staff access to pre-tested standardized procedures lets them get right to work, so they can do more in less time and get the job done correctly the first time.

As national NTDCPs identify areas that may benefit from efficiency improvements, the END in Africa project is continuously working to support them by finding ways to improve national NTD program efficiencies.  Most recently in the first half of FY2013, END in Africa partner JSI developed standard operating procedures (SOP) to efficiently manage NTD drugs as well as complementary training materials in French and English to support the country programs in adapting the procedures to their country-specific situations.

Comprehensive in nature, the new SOPs are intended to improve efficiencies across all aspects of NTD drug management. As such, they offer standardized procedures in the following areas: reverse logistics, storing and inventory control, waste management, medicine handling during and after mass drug administration (MDAs) to maintain quality and ensure ability to track and consolidate supplies, physical inspection of drug packaging, distribution planning including reverse logistics and redistribution, forecasting, customs clearance, and documenting severe adverse effects (SAE).

The general template version of the new SOPs is available under the Guidelines and Resources section of the Documents and Resources page.

Better financial management on demand

Counterpart-driven, performance-based capacity building tool empowers countries to identify and resolve financial management bottlenecks in national NTD programs

While money may make the world go round, strong financial management skills keep it spinning on track. In fact, the success or failure of a program often hinges largely on the strength of its financial management system.

This is certainly true in the case of national NTD control programs, where sound financial management systems are vital for a multitude of activities related to program oversight: ensuring information transparency, tracking expenses, standardizing procedures and processes, monitoring program resources, establishing proper controls to enable more efficient operations, and achieving greater financial integrity to improve the NTD program impact.

In June 2012, Deloitte piloted a capacity building assessment workshop to help program managers and ministry officials analyze their NTD financial management processes and systems, define gaps in performance, and identify areas for improvement. Through an interactive stakeholder workshop, Deloitte worked collaboratively with the Ghana Health Services’ NTD Country Program (GHS/NTDCP), helping staff move through a customized capacity building assessment framework, called a “Maturity Model.”

Deloitte’s Maturity Model helps programs initiate a continuous process of self-reflection, diagnostics and planning. As part of this process, staff develop:

  1. A shared future vision of the program and its defined performance targets for the next 6 months (i.e. Where do we want to be?)
  2. Baseline measures of the program’s current capacity across elements of sustainability and performance (i.e. What is standing in the way of us getting there?)
  3. A road map to meet the performance targets. (i.e. How do we overcome barriers to get closer to our performance targets?)

Combined, these steps engender stakeholder buy-in, collective thinking on the strengths and weaknesses of a program’s financial management system, and a shared vision for how the program will overcome the weaknesses to achieve agreed-upon performance targets.

The assessment tool moves beyond “yes/no” type questions and gauges the program’s ability to have impact, as measured by its self-defined performance targets.

“The workshop does not train people in financial management,” said Kimberly Switlick-Prose, Deloitte Emerging Markets Manager at END in Africa. “Rather, it strengthens financial management performance by helping government agencies first define a collective vision and then identify specific ways to achieve that vision through a methodical process of improvements in the financial management arena.”

Switlick-Prose continued, “Unlike traditional capacity-building activities that deliver a standard curriculum developed by expert trainers, this exercise is innovative in that it is purely demand-driven. The country and the participants themselves get to decide the direction of the workshop and define the areas targeted for process improvement and capacity building, which increases buy-in, participation, and ownership.”

The comments from workshop participants showed that they agreed with this assessment. They said that, “working together to identify challenges and bottlenecks to achieving performance targets,” “setting performance targets together,” and “developing a detailed action plan” that “prioritizes problems under relevant [capacity maturity] domains,” were among the skill sets that were strengthened during the exercise.

The END in Africa project continues to work with the GHS and NTDCP to help them execute the work plan that was defined during the exercise, which will help them get closer to meeting their performance targets.

The END in Africa program expects the benefits of the capacity building exercise to extend well beyond simply improving financial accountability, transparency and management in the Ghana NTD program. It also expects the exercise to contribute to the END program’s overall sustainability (by generating cost and operational efficacies in national NTD program and financial management) and to reduce in-country NTD program fragmentation.

The program plans to hold a follow-up workshop in Ghana in 6 months, and to expand the capacity-building exercise to the other END in Africa countries, namely Burkina Faso, Niger, Sierra Leone and Togo. The participants in the June workshop are already on board with these plans. “In all, the training program is laudable and needs to be organized again to refresh the minds of the participants,” said one. Another agreed, “it [the capacity building exercise] must be continuous, perhaps held every year.”

Workshop participants also commented other, unanticipated benefits of the exercise—its success in strengthening teamwork and its potential to foster collaboration across agencies and departments and among the local, regional and national government officials that contribute to the national NTD program. The words of one participant sum up the group consensus: “the exercise is needed for all levels of GHS program implementation in Ghana, to strengthen capacities of officers in the regions and districts.”

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Photo Credit: Yaobi Zhang, Helen Keller International


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