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Sustainability

Planning Workshop

9 – 13 January, 2012

HealthPartners Uganda Project Office Tank Hill Cell, Ward II, Central Division,

Bushenyi, Uganda

Developed by ICF International’s Center for Design and Research in Sustainability (CEDARS)

for HealthPartners Collaborations Project

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Getting Started

Identifying key collaborators and a planning team. Many decisions must be made and work done leading up to the workshop, and you will find it helpful to have a team to handle many of the details. The workshop planning team should include people who are:

o Familiar with the workshop material and the Sustainability Framework. o Familiar with the organizations that will be invited. o Knowledgeable about the training site.

Fitting training into a broader scheme of monitoring and evaluation (M&E).

This workshop makes the most sense when it is part of an organization’s broader M&E plan. Following the training, staff and partners at all levels can look for ways to integrate the concepts and tools into their work, especially M&E.

Selecting facilitators. Workshop facilitators should have experience with the Sustainability Framework and participatory learning. Ideally, the ratio of facilitators to participants should be at least 1:8 in order to maximize facilitator-participant interaction, especially during group work. Thus for a group of 25-30 participants, three co-facilitators are recommended.

Selecting participants. This workshop is designed for all stakeholders, including: o Field-based staff who are currently implementing or planning to implement

community-based maternal and child health programs; o Headquarters backstops who can replicate the training in other country/project

sites; and o Local stakeholders – staff from Ministries of Health, non-governmental

organizations, healthcare providers, and other community-based organizations – who will be involved in designing or implementing the programs.

Selecting a location. The workshop should be conducted in a comfortable setting, such as a conference room that is large enough for plenary sessions and for small groups to work without disturbing each other. In most of the sessions, participants will work with their small groups, therefore, setting up permanent small groups at the beginning of the training with same group members seated at the same tables will ensure that participants are in a configuration that promotes maximum sharing, minimizes time spent reorganizing seating for small group work, and enhances the learning environment.

Conducting a Learning Needs and Resource Assessment. Workshop planners will benefit from learning about participants’ experience and interests prior to the workshop. Several weeks before the workshop, send a set of questions to registered participants. Members of the workshop planning team may need to follow up with participants to encourage them to submit their responses. Share participant responses with all facilitators prior to the workshop.

Preparing Materials. All the materials you need for conducting the Sustainability Planning workshop are included in this guide. Feel free to add or remove learning tasks as you see appropriate. Also, the checklist on the next page will help ensure that you have all of your training materials before the workshop.

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Training Supply Checklist Sustainability Framework “puzzle” (5-6 copies)

4-5 pads of flip chart paper; 2 easels

2 rolls of masking tape

2 sets of multi-colored markers

1 pen or pencil per participant

1 file folder or 3 ring binder per participant (for organizing the handouts)

1 name tag per participant

Adhesive stickers

Scissors

1 ream of copy paper

200 note cards or ‘3x5' cards (a couple of different colors, if available)

Sticky notes (or Post-it notes) (4-5 packs)

1 Certificate of Completion per participant

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WHO: the learners and the facilitators

Participants will include HealthPartners Collaboration Project (HP) staff and other key stakeholders, including the Uganda Ministry of Health. Participants have different levels of experience in the health sector with most experience coming from the community-based health insurance, malaria prevention and treatment, and the HIV/AIDS sector. Although participants have had little exposure to the Sustainability Framework, most have experience with program planning, monitoring, and evaluation. Participants are interested in increasing access to quality health care through financially sustainable community-owned health co-ops. Participants plan to replicate this training for co-ops involved in the Collaborations Project. In partnership with the HealthPartners, ICF International will be facilitating the Sustainability Workshop. ICF International operates a virtual Center for Design and Research in Sustainability (CEDARS) and brings experience in sustainability planning and assessment. This workshop will be facilitated by two CEDARS colleagues, Will Story and Ilona Varallyay. Will (Social Policy & Community Systems Fellow) has over ten years of experience in global public health focused on providing technical support to maternal and child health, HIV/AIDS and malaria programs in South Asia and Sub-Saharan Africa. He has developed training materials for sustainability planning and assessment and has conducted sustainability workshops in two different countries. Ilona (Team Coordinator) has several years of international experience implementing health projects in HIV prevention and care, health systems strengthening, organizational capacity building, nutrition, and health education, including experience in northern Uganda. She was involved in the development of a program design training curriculum focusing on sustainability planning and, subsequently, co-facilitated a sustainability training for the Elizabeth Glaser Pediatric AIDS Foundation.

WHY: why learners are coming

The main objective of the Collaborations Project is to increase access to quality health care, especially among women, through financially sustainable community-owned health co-ops. HP will use the Sustainability Framework to plan for and measure progress towards sustainability. This framework will expand the vision of HP beyond that of traditional health project planning. In traditional health project planning there is an exclusive emphasis on the health outcomes and the health services delivery improvements needed to achieve them. In addition to these two components, the Sustainability Framework also requires that planners think about the underpinnings that will support these gains during the project period and beyond; these additional components include the capacity and viability of local organizations, community capacity and the environment in which this local system is situated. The higher the level of attainment for each of the components, the greater the chance of sustaining the health gains made during the project period. Ultimately, the Sustainability Framework will help HP to plan and manage its interventions by thinking systematically of the essential components that will support the long-term maintenance of positive health outcomes and dynamic, self-sustaining co-ops. HP will continue to work to ensure that these programmatic components are measurably strengthened over the life of the project in a way that maximizes the likelihood of achieving and sustaining the desired programmatic outcomes. Monitoring and evaluation and learning efforts will ensure that all actors in the local system have sufficient information on which to focus their respective efforts.

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In addition to HealthPartners’ use of the Sustainability Framework to plan and manage the Collaborations Project, they will also be training the health co-ops on sustainability planning and management. Participants of this workshop will be equipped to replicate the training with stakeholders in each health co-op.

WHEN and WHERE: the place and time

Monday, 9 January – Friday, 13 January, 2012 8:00am to approximately 5:00pm each day with an hour break for lunch and one 30-minute break each day. The first day will start at 9:30am in order for the workshop facilitators to prepare the room for the week. We will cover all material in the first four days. A select group of participants will come back on the fifth day to practice facilitating some of the exercise we used during the workshop. HealthPartners Uganda Project Office: Tank Hill Cell, Ward II, Central Division, Bushenyi, Uganda We will all meet in one room with tables and chairs for small groups. There will be plenty of table space and wall space for group work.

WHAT: the content Knowledge, Skills, & Attitudes

WHAT FOR: the Achievement-Based Objectives: By the end of the lesson, participants will have practiced the following tasks and be equipped to train others in these tasks …

Opening/Welcome/What is Sustainability?

Introduced themselves to one another and defined sustainability. Completed a sustainability pretest. Reviewed the schedule and objectives for the workshop. Identified their expectations for the workshop. Listed a set of norms for workshop participation.

Introduction to the Sustainability Framework

Defined sustainability. Compared and contrasted the five main steps in sustainable program design to approaches you have previously used. Defined and classified the six components of the Sustainability Framework

Local System Mapping and Stakeholder Analysis

Named and analyzed the key stakeholders in the Collaborations Project. Prioritized which stakeholders to involve, ensuring gender considerations.

Developing a Vision Described the characteristics of a future scenario where communities have access to quality health care. Categorized the ideas generated into meaningful groups. Created a vision statement.

Our Sustainability Scenario

Defined sustainability scenario. Developed a sustainability scenario for their project.

Applying the Framework: An Example from Kenya

Reviewed to a description of use of the Sustainability Framework by a child survival project in Kenya. Described the types of indicators selected and how they were measured. Assess for data quality issues, i.e. sex disaggregated data.

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How Do We Get There? Reviewed the local system assessment plan that defines what will be measured, identifies tools/data sources for collecting the data, and assigns roles and responsibilities for carrying out the assessment. Identified the gaps in existing information for each of the six components. Examined criteria for developing or selecting good indicators.

Sustainability Framework Component Goals

Developed goals for each component of the sustainability framework.

Component 1: Program Outcomes (e.g., Coverage and/or Performance of Health Services)

Selected indicators from the HealthPartners M&E Plan and other sources that can be used in the Sustainability Framework. Assessed how women and men will be impacted by the program. Created a compendium of indicators for use with the cooperatives.

Component 2: Health Services (e.g., Quality of and/or Access to Services)

Determined the key health services and the providers from which services will be procured (MOH and/or private sector). Examined a tool(s) for collecting information on health service delivery. Selected indicators that can be used in the Sustainability Framework at the macro- and micro-level.

Components 3 & 4: Organizational Capacity for Service Delivery (e.g., providers, DHT) & Community Mobilization (e.g., Main local NGO, Co-ops)

Distinguished between capacity and skill. Identified the organization(s) that is/are most critical to the support of service delivery and building community capacity. Examined a tool(s) for collecting information on capacity, viability, management, and gender equity. Defined capacity areas that should be monitored for the Collaborations Project. Selected indicators that can be used in the Sustainability Framework at the macro- and micro-level.

Component 5: Community Capacity (e.g., VHTs, VSLAs)

Identified the community structure(s) that is/are most critical for sustainability. Examined a tool(s) for collecting information on capacity, viability, and gender equity (e.g., co-op performance reports). Defined capacity areas that should be monitored for the Collaborations Project. Selected indicators that can be used in the Sustainability Framework at the macro- and micro-level.

Gender Equity and Capacity Assessment

Examined the importance of gender equity in capacity assessment tools. Identified opportunities, constraints and potential strategies for integrating gender into local system assessment.

Component 6: Enabling Environment

Reviewed the six sub-components of the enabling environment. Selected the sub-components and indicators that can be used in the Sustainability Framework at the macro- and micro-level.

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Monitoring and Evaluation & the Sustainability Framework

Distinguished between your M&E plan and the Sustainability Framework. Reviewed an M&E exercise for use with the cooperatives.

Transforming Indicators into a Summary Score for Each Component

Defined the relationship between an Indicator, Score, Scale and Index. Described and classified two types of scales.

Data for Decision Making: Interpreting the Dashboard

Discovered the usefulness of a dashboard to measure sustainability. Interpreted a dashboard plotted at two points in time. Developed a discussion plan with stakeholders of how to respond to evolving dashboard results.

Program Planning & Results Frameworks

Distinguished between the program results framework and the Sustainability Framework. Reviewed an example of a pro-sustainability results framework. Practiced selecting program strategies and activities that will contribute toward moving the local system closer to its vision.

Where Do We Go From Here?

Prioritized next steps for using the Sustainability Framework. Reviewed key points for replicating the Sustainability Planning Workshop with co-ops.

Using Excel to Create a Sustainability Dashboard

Practiced using Excel software to develop a dashboard for your program.

Practice Facilitation Practiced facilitating learning tasks from the Sustainability Planning Workshop.

HOW: the program and the tasks

Monday, 9 January 2012 Task 9:30am – 10:45am Task #1: Opening/Welcome/What is sustainability? 10:45am – 11:15am Tea Break 11:15am – 12:45pm Task #2: Introduction to the Sustainability Framework 12:45pm – 1:45pm Lunch 1:45am – 3:15pm Task #3: Local System Mapping and Stakeholder Analysis 3:15pm – 4:50pm Task #4: Developing a Vision 4:50pm – 5:00pm Closing/Preview of Day 2/Evaluation of the Day Tuesday, 10 January 2012 Task 8:00am – 8:30am Task #5: Review of Concepts from Day 1 8:30am – 9:45am Task #6: Our Sustainability Scenario 9:45am – 10:30am Task #7: Applying the Framework: An Example from

Kenya 10:30am – 11:00am Tea Break 11:00am – 12:30pm Task #8: How Do We Get There? 12:30pm – 1:15pm Task #9: Sustainability Framework Component Goals 1:15pm – 2:15pm Lunch

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2:15pm – 3:45pm Task #10: Component 1: Program Outcomes (e.g., Coverage and/or Performance of Health Services)

3:45pm – 4:45pm Task #11: Component 2: Health Services (e.g., Quality of and/or Access to Services)

4:45pm – 5:00pm Closing/Preview of Day 3/Evaluation of the Day Wednesday, 11 January 2012 Task 8:00am – 8:30am Task #12: Review of Concepts from Day 2 8:30am – 9:00am Task #11 (cont.): Component 2: Health Services (e.g.,

Quality of and/or Access to Services) 9:00am – 10:30am Task #13: Components 3 & 4: Organizational Capacity

Service Delivery (e.g., providers, DHT) & Community Mobilization (e.g., Main local NGO or Co-ops)

10:30am – 11:00am Tea Break 11:00am – 12:15pm Task #13 (cont.): Components 3 & 4: Organizational

Capacity Service Delivery (e.g., providers, DHT) & Community Mobilization (e.g., Main local NGO or Co-ops)

12:15pm – 1:00pm Task #14: Component 5: Community Capacity (e.g., VHTs, VSLAs)

1:00pm – 2:00pm Lunch 2:00pm – 3:15pm Task #14 (cont.): Component 5: Community Capacity

(e.g., VHTs, VSLAs) 3:15pm – 4:15pm Tasks #15: Gender Equity and Capacity Assessment 4:15pm – 5:00pm Task #16: Component 6: Enabling Environment 5:00pm – 5:10pm Closing/Preview of Day 4/Evaluation of the Day Thursday, 12 January 2012 Task 8:00am – 8:30am Task #17: Review of Concepts from Day 3 8:30am – 9:00am Task #16 (cont.): Component 6: Enabling Environment 9:00am – 9:45am Task #18: Monitoring and Evaluation & the

Sustainability Framework 9:45am – 10:30am Task #19: Transforming Indicators into a Summary

Score for Each Component 10:30am – 11:00am Tea Break 11:00am – 11:30am Task #20: Data for Decision Making: Interpreting the

Dashboard 11:30am – 1:15pm Task #21: Program Planning and Results Frameworks 1:15pm – 2:15pm Lunch 2:15pm – 3:30pm Task #22: Where Do We Go From Here? Sustainability

Planning 3:30pm – 4:30pm Closing/Participant Recognition/Workshop Evaluation Friday, 13 January 2012 Task 8:00am – 10:30am Task #23: Using Excel to Create a Sustainability

Dashboard 10:30am – 11:00am Tea Break 11:00am – 1:00pm Task #24: Practice Facilitation (Groups 1-3: Each group

will have 30 mins. to present their learning task followed by 5 mins. for feedback)

1:00pm – 2:00pm Lunch 2:00pm – 3:30pm Task #23: Practice Facilitation (Groups 4-5: Each group

will have 30 mins. to present their learning task followed by 5 mins. for feedback)

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Day 1: Monday, 9 January 2012

Task #1: Opening/Welcome/What is Sustainability?

Achievement Based Objectives: By the end of this task, participants will have:

Introduced themselves to one another and defined sustainability.

Completed a sustainability pretest.

Reviewed the schedule and objectives for the workshop.

Identified their expectations for the workshop.

Listed a set of norms for workshop participation. Time: 1 hour 15 mins. Materials:

- Handout 1: Sustainability Planning Workshop Pre/Post Test

- Flip chart - “Our Expectations” (with expectations from LNRA)

- Flip chart – “Norms and Procedures”

- Flip chart – “Parking Lot”

Steps: 1A. (30 mins.) Let’s take some time to meet our fellow participants. Choose a partner and

find out a little about each other – name, job position, where you live, family. In pairs, walk around the area and find something that reminds you of, or is a symbol of “sustainability.” Bring it back to the room. We will then hear from all of the pairs: your introductions about yourself, see your symbol of sustainability, and hear why your symbol represents sustainability. We will highlight a few of the key themes that emerged from your symbols of sustainability.

1B. (15 mins.) Please take a few minutes to fill-out the pre-test. This will give us an

opportunity to see how your understanding of sustainability planning, assessment, and evaluation improves over the course of this week.

1C. (10 mins.) Review the Who, Why, What, What For, and How in your manual. Underline

anything that is confusing or for which you need greater clarity. Circle anything that is especially important to you. We will hear a sample of your thoughts. What are your questions?

1D. (5 mins.) Review your expectations that were provided in the Learning Needs and

Resources Assessment. What would you like to add to this list? 1E. (5 mins.) As a large group, brainstorm the norms and procedures you want to follow to

create the best learning environment. We will record your suggestions on a flip chart. 1F. (5 mins.) As we go through this workshop, we need to consider both the macro- and

micro-level. The macro-level refers to the sustainability plan for the HealthPartners Collaborations Project. The micro-level refers to the sustainability plan for each individual cooperative within the Collaborations Project. As we walk through each learning task, we will address both perspectives.

1G. (5 mins.) Many people will replicate this workshop for specific Co-ops in the

Collaborations Project. We will be modeling the Learner-Centered Adult Education methodology during this workshop, and from time to time we will be making comments specifically about facilitation techniques. Look for the hat! In addition, tips for

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facilitation will be preceded by this symbol and learning tasks/steps that are

recommended for replication will be preceded by this symbol. Tips for Facilitation

Throughout the workshop we will be practicing the 12 Principles for Effective Adult

Learning from Jane Vella’s book Learning to Listen, Learning to Teach (2002):

1) Needs assessment: participation of the learners in naming what is to be learned.

2) Safety in the environment and the process. We create a context for learning. That

context can be made safe.

3) Sound relationships between teacher and learner and among learners

4) Sequence of content and reinforcement.

5) Praxis: action with reflection or learning by doing.

6) Respect for learners as decision makers.

7) Ideas, feelings, and actions: cognitive, affective, and psychomotor aspects of

learning.

8) Immediacy of the learning.

9) Clear roles and role development.

10) Teamwork and use of small groups.

11) Engagement of the learners in what they are learning.

12) Accountability: how do they know they know?

Step 1A: You will use this information in Task 2, so be sure to write down the key themes

that are mentioned.

Step 1D: Be sure to keep the list of participant’s expectations in order to refer to them at

the end of the workshop.

Step 1E: You are looking for ideas such as respect everyone’s answers/questions, turn off

cell phones, start and stop on time, etc.

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Task #2: Introduction to the Sustainability Framework


Defined sustainability.

Compared and contrasted the five main steps in sustainable program design to approaches you have previously used.

Defined and classified the six components of the Sustainability Framework. Time: 1 hour 30 mins. Materials:

- PowerPoint slides on the Sustainability Framework and Program Design Process

- Handout 2: Definition of Sustainability

- Handout 3: Introduction to the Sustainability Framework

- Sustainability Framework “puzzles” for each group

- Flip chart – “Sustainability Program Design Process”

Steps: 2A. (15 mins.) The word “sustainability” is used a lot with little, if any, consensus on what it

means. There is consensus around the importance of sustainability, but there is no consensus on what it really means or how we can work towards it.

Compare the definition of sustainability in Handout 2 with the key themes identified in

the previous session. What are the key elements or concepts in the definition? How were your earlier ideas similar or different to this definition?

We will record your ideas on a flip chart. 2B. (30 mins.) Listen to the following presentation about the Sustainability Framework

and program design process. As you are listening, consider the following questions: Do any of the steps/tools presented in the overview of the program design process

appear the same or similar to what you currently use for designing programs? What about the proposed approach is new to you? What part of the process seems most challenging to you?

We will hear a sample of your responses. We will be referring to the poster of the program design process throughout the

workshop so that it is clear which tasks are associated with which steps in the process. 2C. (45 mins.) You have been given an envelope which contains six equal sized triangles

and one larger triangle. Each triangle represents one component of the Sustainability Framework. Locate and place the triangle in the pattern described in Handout 3. After finding EACH triangle, choose a volunteer to read the grey box associated with it. Write on the back of each triangle piece the meaning of the component in your own words.

After you have reviewed all six components of the Sustainability Framework, discuss the following question in your small groups: In what ways can you measure change in the six components you just defined?

We will hear a sample.

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Tips for Facilitation

Explain that this framework is not a simplistic answer to a complex problem. It is based on

years of research on implementing projects in complex low resource environments. The

basic premise is that given the complexity of the local environments within which we are

tasked with implementing health projects and the limited funding which comes with results

and targets attached, we have to prioritize what to work on in order to achieve anything.

Historically, we targeted trying to improve health outcomes because that is what we were

asked to do—but when funding ended, the health outcome indicators usually dropped back

to pre-project levels. That prompted the question: What happened? What was wrong with

the way activities were implemented? The fact is that many of those projects focused on

improving health outcomes without recognizing the need to build capacity in other areas

such as organizational leadership, financial management, human resource management,

supervisory skills, community demand creation and behavior change or perhaps most

important of all, they didn’t build in local ownership of and commitment to the activity.

They also often didn’t account for the geographic, infrastructure and communication

challenges of the location or the human development index indicators for that country or

area.

The Sustainability Framework takes the point of view of a local system into which a project

is awarded and which the project hopes to change for the better. Explain that the chance of

sustaining project-facilitated health improvements is greatest when local system actors and

local organizations have sufficient capacity and viability to carry out the tasks needed to

produce the desired changes in the health of the population.

Step 2A: Highlight the key concepts – that it is systems focused as opposed to program

focused; focus is on sustaining health outcomes, not the program activities or elements.

Discuss how these working definitions and the groups’ ideas fit into the current context of

the Collaborations Project.

Step 2B: If you do not have access to a computer or projector for this step, then you can

improvise by using a poster or flip chart with the 5 steps of the program design process.

You can use the notes from our PowerPoint presentation to walk through the 5 steps. For

each step, describe the purpose, what is involved in carrying out the step, and what is the

outcome or result of the step. Explain how the process is cyclical – that the program M&E

step includes scheduling regular meetings to review progress of the local system towards its

sustainability scenario and vision and plan next steps. During the discussion, highlight the

following key points:

The participants may be familiar with a lot of the steps/tools in the process, but that

they are not necessarily engaging in a systematic process for carrying out program

design.

All of the steps are not entirely new to participants, but rather that the way in which

they are carried out is new.

Step 2C: Make sure that groups are writing a new definition of each component in their

own words. This can be difficult to do, but it is important so that they engage with the

component in a way that is relevant to them. You can provide guidance based on your own

experience in this workshop.

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Task #3: Local System Mapping and Stakeholder Analysis


Named and analyzed the key stakeholders in the HealthPartners’ Collaborations Project.

Prioritized which stakeholders to involve, ensuring gender considerations. Time: 1 hour 45 mins. Materials:

- Handout 4: Defining the Local System

- Handout 5: Stakeholder Involvement Analysis Matrix

- Sticky notes

- Flip chart paper

- Markers

Steps: 3A. (15 mins.) Individually, read Handout 4. When you are finished turn to a partner and

examine the following question: What are the key structures and persons who should work together to provide

access to quality maternal and child health care? We will hear a sample. 3B. (45 mins.) Divide into four groups. Each group will draw a circle on a piece of flip chart

paper representing the “local system.” In the center of the circle, draw a picture of a mother and child. Consider your responses to the question in the previous step. Write the names of the key stakeholders who are within the local system on a sticky note (or small piece of paper). The stakeholders who have the greatest impact on the health of mother and child should be placed closest to the picture of the mother and child. The stakeholders who have a less significant impact on the health of the mother and child should be placed further away from the picture. The stakeholders who are not within the local system, but still have an impact on the health of the mother and child, should be placed outside the circle.

When you are finished with your diagram, post it on the wall for others to see. We will

walk around and look at each other’s diagrams looking for similarities and differences. 3C. (45 mins.) We will now prioritize which stakeholders to involve and how to involve them

using Handout 5: Stakeholder Involvement Analysis Matrix. Remaining in the same groups, write the name of each stakeholder in the appropriate quadrant on your matrix. When you are finished, one group will present how they filled out their matrix to the larger group. A large matrix and sticky notes (or note cards) with the name of each stakeholder will be available at the front of the room. After the first group has finished presenting, the other groups will have an opportunity to share any differences they had in their matrix. The volunteer from the first group will rearrange the stakeholders on the matrix with help from the larger group. This matrix maps stakeholders according to their interest in your vision for the Collaborations Project and by their power/influence over whether the vision is achieved.

As you review your final Stakeholder Involvement Matrix, consider the following

question: Is there equal gender participation in all aspects of program development and

implementation, including gender ministries and women’s groups?

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Explain that in order to plan for sustainability we need to start out by defining the local

system within which the project will be working. It is not always easy to map the local

system or to understand how to involve stakeholders. Defining who your stakeholders are

and how they should be involved is very much specific to the scope/aim of the project and

local system.

Step 3B: Be sure to include funding agencies and other organizations that may not be

directly involved in with the health co-ops. It is important to consider every stakeholder in

the local system even if they are not directly involved in your program because they will

still have an impact on the sustainability of the health co-ops and their vision.

Explain that the purpose of conducting a stakeholder analysis is to identify stakeholders that

are interested in the specific population, the health issues, outcome and/or vision; and those

with the power to influence the outcome or vision, regardless of their interest in doing so.

This analysis helps to determine whose interests should be taken into account when

developing the program, what stakeholders to engage and how to engage with them based

on their power/influence and their interest in the subject.

Step 3C: Review the categories within the stakeholder involvement analysis matrix and the

guidance that it includes on how best to involve stakeholders. Walk participants through

each of the categories in the Analysis matrix, giving 1-2 examples of how you would

classify a stakeholder and what this would mean in terms of how you would involve that

particular stakeholder. When you are finished with this exercise, explain that it is not

always simple to decide when and how to engage stakeholders. But rather it can be

complex. You will likely have stakeholders that are involved in each step of the process

and others that are only involved at certain points. By conducting this analysis, it helps to

guide you in thinking about how to involve stakeholders from the very beginning. It is

possible that over time, the involvement of stakeholders will change, and a new stakeholder

analysis will need to be done.

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Task #4: Developing a Vision


Described the characteristics of a future scenario where communities have access to quality health care.

Categorized the ideas generated into meaningful groups.

Created a vision statement. Time: 2 hours Materials:

- Handout 6: Examples of Vision Statements

- Blank paper for each participant

- Pens or pencils

- Flip chart paper

- Markers

Steps: 4A. (15 mins.) Place your pencil in the middle of a blank piece of paper. You will now be

drawing a full-body self-portrait. Your pencil is currently pointing at your belly button. You must close your eyes and draw only what the facilitator tells you to draw. You may lift your pen off the paper and move it anywhere you want, but you can never look at your paper. When the facilitator is finished giving you instructions, you may look at your self-portrait. Consider the following questions: What made it difficult for you to draw the self-portrait? How is this task similar to your experience as front-line community workers?

4B. (10 mins.) A vision is a description of the preferred future reality for the local system

and how it will ensure the health of the community. It represents what the local system partners are able to imagine as an ideal long-term sustainable health situation for their community.

Read the examples of vision statements in Handout 6.

What similarities do you notice among these statements?

Notice that a vision statement should be challenging to achieve, yet realistically attainable over the long term. A vision does not represent “the goal” of your project or the activities you will carry out; it should be an ideal (what do you imagine your “perfect future” to look like) that will serve as a starting point for assessing the local situation.

4C. (70 mins.) Divide into four groups (different groups from Task #3) and imagine a future

scenario in which everyone has access to quality maternal and child health care through community-owned health cooperatives. As you think of this future scenario, do not allow present barriers (e.g., lack of funding or political support; poor infrastructure; etc.) to constrain you from imagining the ideal conditions. Assume that no barriers are in place.

As you imagine this future scenario, allow the following questions to guide your

thoughts (be specific and descriptive): In your perfect future, how would you describe health outcomes? How would you describe the health services? Which organizations would be responsible for supporting these? How would the community be involved? What would the surrounding environment look like?

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Step 4A: The purpose of this first step is to help the participants understand what it is like

to try to attain a goal without having “vision.” During you discussion, bring up the

following points:

Without “vision” it is difficult to know where you are going.

This is especially true if things to not happen in the order that you expect them to.

Even if you have a clearly defined project with specific activities, you can easily get off

track without “vision.”

Step 4C: As you listen to each group explain their future scenario, keep the six components

of the Sustainability Framework in your mind. Ask the participants to list the “key

elements” on note cards and try to categorize them according to the six components of the

Sustainability Framework. As you group the note cards in the front of the room, place a

heading above each group/category that is similar to one of the six components. The

groups will use these categories during the next step.

Step 4D: Make sure that the vision statement includes an aspect of all six components of

the Sustainability Framework. Also, ensure that interests of and potential impact on women

and other vulnerable groups are addressed in the vision statement. If groups are having

trouble agreeing on a final statement, encourage them to break it into 2 or 3 sentences. Be

sure to congratulate the group once they have agreed on a final vision statement!

Discuss your future scenario with your group. After each person has shared their future scenario, summarize your thoughts in a picture. Each group will share their future scenario/picture with the larger group. As you look at and listen to the future scenario described by each group, consider the following question: What are the key elements that were presented by each the group? We will list the key elements on note cards and categorize the key elements from our future scenarios.

4D. (25 mins.) Combine with one other group to form two larger groups. In your larger

groups, synthesize the categorized ideas into a vision statement that is clear, motivating, and can be owned by all stakeholders. Once both groups have developed a vision statement, the two groups will select one spokesperson and come together. The spokespersons will work together to agree upon the wording of your new vision statement and present it to the group.

[17]


The point of this exercise is to have everyone work together to review the concepts from the

previous day. It is not about getting the answer right or wrong. If someone is struggling to

come up with an answer, encourage others to help them out or give them a hint. Be sure to

recognize everyone after they are finished with their question.

Day 2: Tuesday, 10 January 2012 Task #5: Review of Concepts from Day 1


Reviewed key concepts from Day 1

Reviewed the schedule and objectives for Day 2 Time: 30 mins. Materials:

- Ball made from flip chart paper secured with masking tape

- Strips of paper with review questions written on them (facilitator should prepare the questions and attach each to the ball so that it can be easily unraveled one question at a time)

- Schedule and objectives for the day

Steps: 5A. (20 mins.) Form a circle. As the ball is thrown to you, you must each pull off one strip

of paper and answer the question written on it; after you respond, please throw the ball to someone else. You can ask others for help in answering the question if necessary.

5B. (10 mins.) Let’s review the schedule and objectives for today. We will also go over the

evaluation of day one if anything needs to be adjusted or addressed.

[18]

Task #6: Our Sustainability Scenario


Defined sustainability scenario.

Developed a sustainability scenario for their project. Time: 1 hour 15 mins. Materials:

- Handout 7: Example of a Sustainability Scenario

- Flip chart paper

- Markers

- Stickers

Steps: 6A. (10 mins.) The sustainability scenario is a clear consensus statement by stakeholders

in the local system of how they believe that their vision of a healthy population will be attained and sustained. By stating this scenario clearly, the roadmap to attain this vision is made more clear and explicit. This, in turn, gives guidance as to how to plan for the roles and activities of the key actors, and finally the subcomponents that should be monitored to track progress in each of the components of the Sustainability Framework. The sustainability scenario is a broad picture of how to attain the vision; it does not delve into the details. These details – the specific strategies and activities – will be planned later on with stakeholders after they have had a chance to review the results from the local system assessment.

Read the example of a sustainability scenario in Handout 7.

How is the sustainability scenario different from the vision statement? Are you able to identify/see any of the components of the Sustainability Framework

in the description? The sustainability scenario should begin to broadly identify the following:

a) Key strategies for attaining the vision b) Broad roles/responsibilities of stakeholders c) Capabilities that are needed in order to fulfill the roles d) Flow of inputs needed e) Supportive environmental attributes that will help achieve the vision

6B. (65 mins.) Remain in your groups from Task #4 and reflect on the following questions:

What outcomes are you striving for in this local system (i.e. changes in health status, knowledge, behaviors, etc)? Who are the beneficiaries?

What services are essential for achieving the outcomes described in your vision? What capacities/capabilities are needed for these services to be delivered? Who will be responsible for producing the desired outcome and how will they do

this? For example, what are the roles of the local MOH/government, local NGOs, health service providers, and the community?

What resources (HR, technical, managerial/institutional, financial) will those responsible for producing the desired outcome need to carry out the work/effort – both in the short term and over the long term? Who will support them to ensure they can continue to access the resources that they need?

Is there anything outside the local system that can help or hinder this process now or in the foreseeable future? (i.e. government effectiveness, policy, etc.)

Use your answers to these questions and the vision statement developed in Task #4 to

help develop your sustainability scenario. Write your sustainability scenario on a piece

[19]


Explain that their sustainability scenario should describe how the local system can expect to

achieve and maintain its vision in the long term. Reiterate that the scenario should broadly

identify the roles and responsibilities of stakeholders, the capabilities they would need to

carry out these roles, the flows of inputs needed, and any potential attributes of the

environment that would be supportive of the vision.

Explain that the vision and sustainability scenario will be what the rest of the program

planning and implementation phase will be based off of. In the next steps in the program

design process, we will use the vision and scenario to help plan how we can get ourselves

on the path towards that vision.

Step 6B: As the groups are working on their sustainability scenarios, assess if there are

components of the Sustainability Framework that were not considered in the scenarios. If

there are any missing elements, probe the groups to think about these missing elements.

of flip chart paper. When you are finished, post your sustainability scenario on the wall for everyone to see. Walk around the room and read all four scenarios and place a sticker on your favorite one (you can only vote once). The scenario with the most votes will be adopted and revised by the whole group.

[20]


Step 7A: Although we do not recommend replicating this Task, you could replicate it by

creating a handout from the PowerPoint slides.

Step 7B: If you would like to replicate this step, please write down the responses to the

questions as we discuss them.

1)

2)

3)

Task #7: Applying the Framework – An Example from Kenya


Reviewed to a description of use of the SF by a child survival project in Kenya.

Described the types of indicators selected and how they were measured.

Assess for data quality issues, i.e. sex disaggregated data. Time: 45 mins. Materials:

- PowerPoint slides on Plan’s Child Survival project in Kenya

- Handout 8: Plan’s Results Framework

- Handout 9: Plan’s Sustainability Framework Dashboard

Steps: 7A. (15 mins.) Listen to the following presentation on the use of the Sustainability

Framework for a maternal and child health program in Kenya. Each of you will receive a copy of Handout 8: Plan’s Results Framework and Handout 9: Plan’s Sustainability Framework Dashboard. As you listen, consider the types of indicators that would be relevant for each component. We will have time at the end of the presentation to discuss any of your questions.

7B. (30 mins.) Divide into pairs and discuss the following questions:

Which results in the Results Framework link directly to the Sustainability Framework components? What is the benefit of designing a project with direct links to the Sustainability Framework components?

What do you notice about the amount of indicators? How many indicators would be manageable?

Are indicators gender-sensitive? Which components in the Sustainability Framework had increases during the life of

the project? Can you make hypotheses about the relationships among or between certain components? Do you think there may be a certain “driver” for this project—that is, something that, if improved, would then improve other areas?

We will hear a sample of your responses.

[21]


Explain that the purpose of this task is to understand where the data for the Sustainability

Framework exists and whether or not there are gaps in the data.

Step 8B: It would be helpful to have flip charts of Handout 11 (one piece of flip chart paper

per component) drawn up ahead of time. This will give you time to write in their responses

as they list them. We will come back to the information from Handout 11 throughout the

workshop.

Step 8C: If you do not have access to a computer/projector, you can create a handout from

the PowerPoint slides used in this step.

Task #8: How Do We Get There?


Reviewed a local system assessment plan that defines what will be measured, identifies tools/data sources for collecting the data, and assigns roles and responsibilities for carrying out the assessment.

Identify the gaps in existing information for each of the six components.

Examined criteria for developing or selecting good indicators. Time: 1 hour 30 mins. Materials:

- PowerPoint slides on Developing Indicators for a Local System Assessment Plan

- Handout 10: Plan’s Local System Assessment Plan

- Handout 11: Data Availability for the Sustainability Framework

Steps: 8A. (25 mins.) In groups of four, briefly review Handout 10: Plan’s Local System

Assessment Plan together. In your groups, respond to the following questions: How often is data about each of the indicators collected? Are you currently collecting this type of information in your project? Which components are you measuring the best in your project? Which components are the most challenging to measure in your project? We will hear a sample of your responses.

8B. (45 mins.) Let’s look at some information you already have regarding the six

components of sustainability and your local area. Remaining in your small groups, complete the charts in Handout 11: Data Availability for the Sustainability Framework. First, consider the existing sources of information for each component that are immediately available. Second, consider sources of data of which you are knowledgeable, but would need to find it or ask permission to use it. Last, consider new data collection instruments that may need to be developed in order to collect this type of information. When you have completed your charts, we will ask each group to present their chart for one component until we have covered all six components. We will record your responses on a flip chart.

8C. (20 mins.) Before we move on to developing our assessment plan for each component,

we would like to review some of the basic concepts of developing or selecting good indicators. Listen to the following presentation about how to create good indicators. What are your questions?

[22]


It is important to remember that the guidance for each component during this workshop

may differ for the workshops with the co-ops. Specifically, you will have to consider which

organization(s) will be assessed for Components 2, 3, 4, and 5.

These goal statements will be used throughout the workshop, so be sure they accurately

reflect each component.

Task #9: Sustainability Framework Component Goals


Developed goals for each component of the sustainability framework. Time: 45 mins. Materials:

- Handout 12: Sample Vision and Component Goals

- Flip chart paper

- Markers

Steps: 9A. (45 mins.) Divide into six groups. Each group will be assigned one component and

brainstorm a goal for their component. Handout 12: Sample Vision and Component Goals will give you an idea of what a goal looks like. In addition, the following points will help provide guidance:

Component 1 may be very similar to the vision, since Program Outcomes are the very things we hope to sustain.

Component 2 should focus on the necessary attributes of health services that will help you move towards and sustain your vision.

Component 3 should focus on the organization(s) and the personnel you interact with most frequently in order to improve health service delivery. Also, consider what capacities are necessary to help you move towards and sustain your vision.

Component 4 should focus on the organization(s) that are responsible for building community capacity. Also, consider what capacities are necessary to help you move towards and sustain your vision.

Component 5 should focus on the community group(s) that has the greatest influence on your program outcomes. Consider how the community will be involved in sustaining your vision.

Although you may not have direct control over Component 6, more can be achieved in a more favorable environment than a less favorable one. Consider what a favorable social-ecological environment would look like in order to sustain your vision.

Once your group has decided on a goal statement, write it on a piece of flip chart paper and post it on the wall. Each group will present their goal and everyone will have an opportunity to comment on the goal. We will make revisions as needed before accepting each goal statement.

[23]

Task #10: Component 1: Program Outcomes


Selected indicators from the HealthPartners M&E Plan and other sources that can be used in the Sustainability Framework.

Assessed how women and men will be impacted by the program.

Created a compendium of indicators for use with the cooperatives. Time: 1 hour 30 mins. Materials:

- Handout 13: Local System Assessment Plan

- Handout 14: HealthPartners Collaborations Project Monitoring & Evaluation Plan

- Flip chart paper

- Markers

Steps: 10A. (45 mins.) Let’s select the indicators that will measure whether or not we are on our

way towards our goal for Component 1. Divide into four groups. Complete the first two columns of the table in Handout 13: Local System Assessment Plan. Use the following questions to help you fill out the last two columns of the table: How would you measure change in this component? What information are you already collecting that could be used to measure your

progress towards this goal (refer to Handout 11)? Which specific indicators do you want to add to Component 1 of the Sustainability

Framework? One volunteer from each group will share the last two columns of their table with everyone. We will record your answers on a flip chart.

10B. (15 mins.) Review the last two columns of the table—indicators and data sources—and

answer the following questions: Which (if any) of the indicators has information about gender and age? We will

highlight the indicators that can be disaggregated by gender and age. What differences you might see in the disaggregated data? Why this is important? We will hear a sample of your responses.

10C. (15 mins.) Macro-level: Review Handout 14: HealthPartners Collaborations Project

Monitoring and Evaluation Plan. You will see that the indicators have been highlighted to represent each Sustainability Framework component that is being measured. Which indicators are currently being used to measure Component 1: Program Outcomes? Based on our work in the previous steps, are there any additional indicators that you would like to recommend adding to Component 1? If so, which indicators would be most appropriate?

10D. (15 mins.) Micro-level: As we prepare to select indicators with each of the health

cooperatives, it will be helpful to have some level of standardization for the indicators for each component. In order to have some standardization without prescribing which indicators to use, we will prepare a compendium, or “menu,” of indicators from which they can choose. Review the indicators listed on the flip chart for Component 1 and answer the following questions: Are the indicators relevant to all cooperatives? Are the indicators feasible for cooperative stakeholders to collect? Are there any indicators that you would recommend removing from the “menu”?

[24]


The facilitation of tasks for each component of the Sustainability Framework will differ

slightly for the co-op workshops. During this workshop we will be developing a “menu” of

indicators for each component from which co-op stakeholders can choose. This will allow

for some level of standardization across co-ops. Therefore, we will develop a separate

handout with possible indicators for them to choose. These handouts will be similar to

some of the handouts that we are using (see Handouts 15, 17, 18, and 22).

Step 10A: Introduce the menu of indicators that we developed as a handout during this

step. Simply state, “Fill out the last two columns of the table using Handout XX: Program

Outcome Indicators, which provides a list of standardized indicators, and the following

questions…”. If there is significant disagreement about the best 5-7 indicators, then use a

creative technique to gain consensus, such as using a blind vote for their favorite indicators.

Step 10B: Feel free to write some notes on the responses to our questions about

disaggregating the data by gender and age:

[25]

Task #11: Component 2: Health Services


Determined the key health services and the providers from which services will be procured (MOH and/or private sector).

Examined a tool(s) for collecting information on health service delivery (e.g., Health Facility Assessment [HFA]).

Selected indicators that can be used in the Sustainability Framework at the macro- and micro-level.

Time: 1 hour 30 mins. Materials:

- Handout 13: Local System Assessment Plan (additional copies)


- Handout 15: Health Facility Assessment Indicators

- Flip chart paper

- Markers

Steps: 11A. (15 mins.) Before we select indicators for Component 2, we need to identify the key

providers that will be assessed in order to achieve the goal for Component 2. Who are the providers you are interested in assessing at the macro-level? Who are the providers you are interested in assessing at the micro-level? Are they different?

11B. (45 mins.) Now let’s select the indicators that will measure whether or not we are on

our way towards our goal for Component 2. Remain in your groups from the previous task. Complete the first two columns of the table in Handout 13: Local System Assessment Plan. Fill out the last two columns of the table using Handout 15: Health Facility Assessment Indicators, which provides a list of standardized indicators, and the following questions: How would you measure change in this component? What information are you already collecting that could be used to measure your

progress towards this goal (refer to Handout 11)? Which specific indicators do you want to add to Component 2 of the Sustainability

Framework? One volunteer from each group will share the last two columns of their table with everyone. We will record your answers on a flip chart.

11C. (15 mins.) Macro-level: Review Handout 14: HealthPartners Collaborations Project

Monitoring and Evaluation Plan. You will see that the indicators have been highlighted to represent each Sustainability Framework component that is being measured. Which indicators are currently being used to measure Component 2: Health Services? Based on our work in the previous steps, are there any additional indicators that you would like to recommend adding to Component 2? If so, which indicators would be most appropriate?


cooperatives, it will be helpful to have some level of standardization for the indicators for each component. In order to have some standardization without prescribing which indicators to use, we will prepare a compendium, or “menu,” of indicators from which they can choose. Review the indicators listed on the flip chart for Component 2 and answer the following questions:

[26]


Step 11A: You will only ask this question about the micro-level. Keep in mind that the key

providers that are mentioned by the co-op stakeholders may differ from your workshop and

they may differ from co-op to co-op. Be sure that the participants are as specific as possible

because this will help determine from where the information about Health Services will

come.

Step 11B: Introduce the menu of indicators that we developed as a handout during this step.

If there is significant disagreement about the best 5-7 indicators, then use a creative

technique to gain consensus, such as using a blind vote for their favorite indicators.

Are the indicators relevant to all cooperatives? Are the indicators feasible for cooperative stakeholders to collect? Are there any indicators that you would recommend removing from the “menu”?

[27]

Day 3: Wednesday, 11 January 2012 Task #12: Review of Concepts from Day 2


Reviewed key concepts from Day 2

Reviewed the schedule and objectives for Day 3 Time: 30 mins. Materials:


Steps: 12A. In teams of 4 or 5 people, compose a song that captures the ideas covered the first

two days and how the ideas can be used in your work. You will have 20 minutes to compose it. Each team will perform their song for the group.

12B. Let’s review the schedule and objectives for today. We will also go over the evaluation

of day two if anything needs to be adjusted or addressed.

[28]

Task #13: Components 3 & 4: Organizational Capacity for Service Delivery & Community Mobilization


Distinguished between capacity and skill.

Identified the organization(s) that is/are most critical to the support of service delivery and building community capacity.

Examined a tool(s) for collecting information on capacity, viability, and management.

Defined capacity areas that should be monitored for the Collaborations Project.


Time: 2 hours 45 mins. Materials:



- Handout 16: Somoto and Jamuna Group Stories

- Handout 17: Organizational Capacity Indicators

- Sticky notes

- Flip chart paper

- Markers

Steps: 13A. (30 mins.) Since many of the next Components have to do with capacity, let’s discuss

what it means to have capacity. Capacity is all about shared skills and well-established policies and procedures. Not only are skills learned, but learning is passed on and shared by all concerned. Similarly, not only are policies and procedures drawn up, but they are well understood, used and established as vital parts of the organization. Handout 16 will help us differentiate between the meaning of capacity and skill. Two groups should read the Somota group story, and two groups should do the Jamuna group story. Answer the questions at the end of your story. We will hear a sample in the large group.

13B. (20 mins.) Before we select indicators for Components 3 & 4, we need to identify the

key organization(s) that will be assessed in order to achieve the goal for these Components. What organizations are you interested in assessing at the macro-level for Component 3? Micro-level? What organizations are you interested in assessing at the macro-level for Component 4? Micro-level? What are the differences between the macro- and micro-levels for these two Components?

13C. (40 mins.) In pairs consider the following question: What are the essential capacity

areas that you will have to measure in order to assess whether or not you are moving towards the goal for Component 3 & 4? Write your responses on sticky notes (one response per sticky note) and post them on the flip charts with the respective goal statements at the front of the room. We will agree on the 4-5 of the most important capacity areas for each Component.

13D. (45 mins.) Now let’s select the indicators that will measure whether or not we are on

our way towards our goal for Component 3 & 4. Divide into four new groups. Two groups will work on Component 3 and two will work on Component 4. Complete the first two columns of the table in Handout 13: Local System Assessment Plan for your Component. Fill out the last two columns of the table using Handout 17:

[29]


Step 13A: Feel free to write some of the responses to the two stories here:

Somota:

Jamuna:

Step 13B: You will only ask this question about the micro-level. Keep in mind that the key

organizations that are mentioned by the co-op stakeholders may differ from your workshop

and they may differ from co-op to co-op. Be sure that the participants are as specific as

possible because this will help determine from where the information about Components 3

& 4 will come.

Step 13C: You can help guide the co-op stakeholders by providing a list of capacity areas

for each component.

Step 13D: Introduce the menu of indicators that we developed as a handout during this

step. If there is significant disagreement about the best 5-7 indicators for each component,

then use a creative technique to gain consensus, such as using a blind vote for their favorite

indicators.

Organizational Capacity Indicators, which provides a list of standardized indicators, and the following questions: How would you measure change in each capacity area from the previous step? What information are you already collecting that could be used to measure your

progress towards these capacity areas (refer to Handout 11)? Which specific indicators do you want to add to Components 3 & 4 of the

Sustainability Framework? One volunteer from each group will share the last two columns of their table with everyone. We will record your answers on a flip chart.

13E. (15 mins.) Macro-level: Review Handout 14: HealthPartners Collaborations Project

Monitoring and Evaluation Plan. You will see that the indicators have been highlighted to represent each Sustainability Framework component that is being measured. Which indicators are currently being used to measure Components 3 & 4: Organizational Capacity for Health Service Delivery and Community Mobilization? Based on our work in the previous steps, are there any additional indicators that you would like to recommend adding to Components 3 & 4? If so, which indicators would be most appropriate?

13F. (15 mins.) Micro-level: As we prepare to select indicators with each of the health

cooperatives, it will be helpful to have some level of standardization for the indicators for each component. In order to have some standardization without prescribing which indicators to use, we will prepare a compendium, or “menu,” of indicators from which they can choose. Review the indicators listed on the flip chart for Components 3 & 4 and answer the following questions: Are the indicators relevant to all cooperatives? Are the indicators feasible for cooperative stakeholders to collect? Are there any indicators that you would recommend removing from the “menu”?

[30]

Task #14: Component 5: Community Capacity


Identified the community structure(s) that is/are most critical for sustainability.

Examined a tool(s) for collecting information on capacity and viability (e.g., co-op performance reports).

Defined capacity areas that should be monitored for the Collaborations Project.


Time: 2 hours Materials:



- Handout 18: Community Capacity Indicators

- Note cards

- Flip chart paper

- Markers

Steps: 14A. (15 mins.) Before we select indicators for Components 5, we need to identify the key

organization(s) that will be assessed in order to achieve the goal for Component 5. What organizations are you interested in assessing at the macro-level? What organizations are you interested in assessing at the micro-level? Are they different?

14B. (30 mins.) In pairs consider the following question: What are the essential capacity

areas that you will have to measure in order to assess whether or not you are moving towards the goal for Component 5? Write your responses on note cards. Join with another pair and agree on the top three capacity areas. Each group of four will share their top three capacity areas with the large group. We will record your responses on a flip chart. We will agree on the 4-5 of the most important capacity areas for Component 5.

14C. (45 mins.) Now let’s select the indicators that will measure whether or not we are on

our way towards our goal for Component 5. Remain in your groups from the previous step. Complete the first two columns of the table in Handout 13: Local System Assessment Plan for Component 5. Fill out the last two columns of the table using Handout 18: Community Capacity Indicators, which provides a list of standardized indicators, and the following questions: How would you measure change in each capacity area from the previous step? What information are you already collecting that could be used to measure your

progress towards these capacity areas (refer to Handout 11)? Which specific indicators do you want to add to Components 3 & 4 of the

Sustainability Framework? One volunteer from each group will share the last two columns of their table with everyone. We will record your answers on a flip chart.

14D. (15 mins.) Macro-level: Review Handout 14: HealthPartners Collaborations Project Monitoring and Evaluation Plan. You will see that the indicators have been highlighted to represent each Sustainability Framework component that is being measured. Which indicators are currently being used to measure Component 5: Community Capacity? Based on our work in the previous steps, are there any additional indicators that you

[31]


Step 14A: You will only ask this question about the micro-level. Keep in mind that the key

organizations that are mentioned by the co-op stakeholders may differ from your workshop

and they may differ from co-op to co-op. Be sure that the participants are as specific as

possible because this will help determine from where the information about Community

Capacity will come.

Step 14B: You can help guide the co-op stakeholders by providing a list of capacity areas

for Community Capacity.

Step 14C: Introduce the menu of indicators that we developed as a handout during this

step. If there is significant disagreement about the best 5-7 indicators for Community

Capacity, then use a creative technique to gain consensus, such as using a blind vote for

their favorite indicators.

would like to recommend adding to Component 5? If so, which indicators would be most appropriate?

14E. (15 mins.) Micro-level: As we prepare to select indicators with each of the health


[32]


Feel free to write notes on how to adapt this task for your co-op workshops:

Tasks #15: Gender Equity and Capacity Assessment


Examined the importance of gender equity in capacity assessment tools.

Identified opportunities, constraints and potential strategies for integrating gender into local system assessment.

Time: 1 hour Materials:

- Flip Chart – “Types of Empowerment triangle”

- Handout 19: List of Gender Questions

- Handout 20: Modified Gender Analysis Matrix

Steps: 15A. (15 mins.) In pairs, take some time to brainstorm information on organizational/

community capacity in each of the three areas of empowerment: social, political, and economic. Do any of these address gender? Which ones?

15B. (15 mins.) Divide into three groups. In your groups, go through Handout 19: List of

Gender Questions, and draw linkages with the other organizational/community capacity assessment tools we have reviewed. What implications do these have for collecting data with these assessment tools? Why is this important for organizational/community capacity?

15C. (30 mins.) Remain in your groups. Using the Gender Analysis Matrix, outline some

opportunities, constraints and potential strategies for integrating gender considerations into your assessment plan for Components 3, 4, and 5.

[33]

Task #16: Component 6: Enabling Environment


Reviewed the five sub-components of the enabling environment.

Selected the sub-components and indicators that can be used in the Sustainability Framework at the macro- and micro-level.




- Handout 21: Sub-Components of the Enabling Environment

- Handout 22: Enabling Environment Indicators

- Flip chart paper

- Markers

Steps: 16A. (15 mins.) Read Handout 21: Sub-Components of the Enabling Environment and

answer the questions below in pairs. We will share our responses together. What is the role of the enabling environment in the desired vision? Which of the five sub-components are most relevant to your project? How would you measure change in each of the relevant sub-components? Would the assessment of the enabling environment differ at the macro- and micro-

level? If so, how? 16B. (30 mins.) Now let’s select the indicators that will measure whether or not we are on

our way towards our goal for Component 6. Combine with two other pairs to form groups of six. Complete the first two columns of the table in Handout 13: Local System Assessment Plan for Component 6. Fill out the last two columns of the table using Handout 22: Enabling Environment Indicators, which provides a list of standardized indicators, and the following questions: What information are you already collecting that could be used to measure your

progress towards these capacity areas (refer to Handout 11)? Which specific indicators do you want to add to Component 6 of the Sustainability

Framework?

16C. (15 mins.) Macro-level: Review Handout 14: HealthPartners Collaborations Project Monitoring and Evaluation Plan. You will see that the indicators have been highlighted to represent each Sustainability Framework component that is being measured. Which indicators are currently being used to measure Component 6: Enabling Environment? Based on our work in the previous steps, are there any additional indicators that you would like to recommend adding to Component 6? If so, which indicators would be most appropriate?



[34]


Step 16A: You only need to ask the first three questions. It is important to think about

measuring change on a micro-level. If the co-op stakeholders do not have access to

national-level data and/or if national-level data is not relevant to their area, then help them

think of indicators that are relevant and easy to measure.

Step 16B: Introduce the menu of indicators that we developed as a handout during this step.

If there is significant disagreement about the best 5-7 indicators for Community Capacity,

then use a creative technique to gain consensus, such as using a blind vote for their favorite

indicators.

[35]


Feel free to substitute this review task for one of the previous two if you wish.

Day 4: Thursday, 12 January 2012 Task #17: Review of Concepts from Days 1-3


Reviewed key concepts from Days 1-3.

Reviewed the schedule and objectives for Day 4. Time: 30 mins. Materials:

- Note cards (a few cards of different colors for each table)

- Markers


Steps: 17A. In groups of 4-5 (1 group per table), you will develop 2-3 questions on key concepts

learned during the workshop. Write each question on one side of a note card and turn these cards with the written side down. Select a name for your team and decide who will select a card from one of the other tables for the first turn. One facilitator will keep score on the flip chart. In turn, a representative from each table will select a card from another table. The participants from the team having selected the card may confer with other team members, but will have only 1 minute to answer the question. For each correct response, the team wins 1 point (the team developing the questions judges whether or not the response is correct). We will continue until questions have all been responded to or until time is up.

17B. Review the schedule and objectives for the day.

[36]


Step 18A: Feel free to write notes about what you learned from this task:

Task #18: Monitoring and Evaluation & the Sustainability Framework


Distinguished between your M&E plan and the Sustainability Framework.

Reviewed an M&E exercise for use with the cooperatives. Time: 45 mins. Materials:

- Handout 23: Detailed Sustainability Assessment Plan

- Two Signs: one with “Agree” written on it, another with “Disagree” written on it

Steps: 18A. (30 mins.) We are going to take some time to distinguish between your HealthPartners

Collaborations Project Monitoring & Evaluation plan and the local system assessment plan. Everyone stand up and gather in the middle of the room. We are going to read a number of statements and you must decide whether you agree or disagree with the statements by moving to the sign that says “Agree” or “Disagree.” Please remain quiet and do not talk with anyone after the statement has been read; just walk over to either the “Agree” or “Disagree” sign. We will invite 1-2 of you to explain why you chose “agree” or “disagree.” We will also take some time to answer any of your questions.

Agree/Disagree Statements:

Many of the indicators selected for the local system assessment will also be included in the M&E plan.

The M&E plan should measure elements that are outside of the scope of the project.

The local system assessment plan should focus on evaluative indicators; monitoring indicators should not be included.

Local system assessment is typically conducted two times per year. 18B. (15 mins.) Once you have finished selecting indicators for all six components of the

Sustainability Framework, it will be important to take time to consolidate the indicators into a monitoring plan. Let’s review Handout 23: Detailed Sustainability Assessment Plan and answer the following questions: Do you have any suggestions/ideas on how you could carry out the local system

assessment steps with the program co-ops? Any suggested changes/adaptations?

What stakeholders do you think would be important to collaborate with on developing the assessment plan?

What stakeholders would be important to include when you are coming together to regularly review progress towards the vision and sustainability scenario?

How often do you think would be feasible to get stakeholders to review progress? Do you foresee any challenges or difficulties in carrying out this step?

18C. This concludes the information that you will present during the initial co-op workshops.

The rest of the material that we will cover would be appropriate for a one-day follow-up workshop.

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Task #19: Transforming Indicators into a Summary Score for Each Component


Defined the relationship between an Indicator, Score, Scale and Index.

Described and classified two types of scales. Time: 45 mins. Materials:

- Handout 24: Creating Scores from Scales

- Flip chart paper

- Markers

Steps: 19A. (20 mins.) Now we are going to think more about how to change the data from each

Indicator into Scores and how to compile the Scores into one Index for each Component. Indices are important for two reasons:

1) They allow us to compare a single measure across time and across areas. 2) They allow us to communicate what is happening more clearly.

Since each Component is composed of many Indicators, it is difficult to measure the impact of the Component as a whole. A Score is calculated from a Scale in order to measure the impact of each Indicator. An Index is then used to summarize the Scores of all Indicators in each Component. Listed below are the definitions of the new terms mentioned in italics. In small groups, draw a diagram representing the relationship between these new terms. One volunteer from each group should read all of the definitions aloud. Another volunteer will draw the diagram based on the discussion of the group. What are your questions?

Definitions: Component: One of the six elements in the Sustainability Framework determined to have an impact on sustainability.

Indicator: A measurable variable which helps to show changes relevant to the sustainability of the goals, objectives and targets of the Child Survival Project

Score: A standardized measure of each Indicator ranging from 0 to 100.

Scale: A tool used to create a uniform scoring system by transforming raw data from an Indicator into a standardized Score.

Index: A summary measure created from the average of all Scores in each Component.

19B. (25 mins.) First, we must learn how to transform our data from each Indicator into a

Score. In order to do this we must choose the appropriate ‘scale’ by which to measure our data so that we have consistent Scores. We will complete Handout 24: Creating Scores from Scales together.

It is clear that not all Scales will be the same for each Indicator. Once you understand

the variation in Scales, you will be ready to change our Indicators into Scores. On Day 5, a small group of you will learn how to do this using an Excel spreadsheet. Once a Score is established for each Indicator, the average Score for all Indicators in one Component is calculated. This average Score is the Index for that Component. Next we will learn how to interpret the Index for each Component using the Sustainability Dashboard.

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Feel free to write notes about what you learned from this task:

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Task #20: Data for Decision Making: Interpreting the Dashboard


Discovered the usefulness of a dashboard to measure sustainability.

Interpreted a dashboard plotted at two points in time.

Developed a discussion plan with stakeholders of how to respond to evolving dashboard results.

Time: 30 mins. Materials:

- Handout 25: An Example Sustainability Dashboard

Steps: 20A. (30 mins.) Divide into 3 groups. Designate one person to take notes for your group.

Answer the questions in Handout 25: An Example Sustainability Dashboard. After 15 minutes, each group will share what they learned from the dashboard.

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Task #21: Program Planning and Results Frameworks


Distinguished between the program results framework and the Sustainability Framework.

Reviewed an example of a pro-sustainability results framework.

Practiced selecting program strategies and activities that will contribute toward moving the local system closer to its vision.


- Handout 26: An Example Pro-Sustainability Results Framework

- Handout 27: Results Framework Template

- Handout 28: Program Planning Matrix

Steps: 21A. (20 mins.) We will now be covering the program planning step and practice developing

a draft pro-sustainability results framework for the program. Listen to the following presentation on the program planning step. You can also reference Handout 26: An Example Pro-Sustainability Results Framework.

21B. (10 mins.) Developing a draft pro-sustainability results framework is an important step

for you to practice with the cooperatives because the results framework will allow them to plan program activities focused on sustainability. Before we begin, there are few important points to review. First, while the results framework is aligned to the Sustainability Framework, it is also specific for the program. Because of this, the Results Framework may or may not include all of the components of the Sustainability Framework. It will depend on what lies within the scope of the program. However, it is also important to note that the program-specific results framework that is developed for the program is based on a number of assumptions – that other stakeholders will be working on the remaining key elements in order to achieve the vision.

Take a few minutes to reflect on the Sustainability Framework components. We will

answer the following questions as a large group: Based on your understanding of the HealthPartners Collaborations Project, what do

you think falls within the boundaries of the program? Are there components that fall outside the boundaries? How would other stakeholders be able to help with components that fall outside the

boundaries of this project? 21C. (45 mins.) The local system assessment should be reviewed and presented to

stakeholders prior to developing the results framework and selecting strategies – as the assessment should be used to inform the selection of strategies/activities. For our purpose of practicing this today, since we do not have the results of the assessment, we will use the vision and sustainability scenario to guide our thinking.

Remain in your groups from Task #19. Each group will be assigned 1-2 component

areas. Using Handout 27: Results Framework Template, you will write in the vision at the top of the results framework, develop a draft pro-sustainability strategic objective (SO) for the program, and draft an intermediate result (IR) and sub-intermediate results (sub-IRs) for your specific component(s). Refer to the vision and sustainability scenario, as well as the sub-components and indicators we listed out for each component to guide your thinking.

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Each group will present their portion of the draft results frameworks. After each group presents, you will have time to comment on the group’s results framework and ask questions. We will record your draft results framework for future use. In the next step we will begin developing a more detailed plan of the program’s strategies and activities.

21D. (30 mins.) After you develop a results framework with the cooperatives, it will be time to

plan out the strategies/activities that they will implement, the time frame, and stakeholder responsible for carrying out the activities. The results framework serves as the foundation of the program, as it informs the program’s activities and how the program will monitor and evaluate its progress.

Remain in your groups from the previous step. Your group will practice planning out

the strategies and activities for your component area(s). Review the IR and sub-IRs that were developed for each component area. Starting with the IR, develop a strategy that would allow you to achieve this result. Continue with the sub-IR’s that were listed out for the component area. Continue on to fill in the activities, time frame, and person responsible. Use Handout 28: Program Planning Matrix to develop the strategies, activities, timeline, and person responsible. This draft plan can help clarify the role of the program and how it will contribute towards the vision for the local system. It should also serve to clarify the boundaries of the program, so all stakeholders know that the program will not be contributing everything, such that they will need to identify others who can contribute to the elements for which the program is not responsible.

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Task #22: Where Do We Go From Here? Sustainability Planning


Reviewed the SF checklist for each of the five program cycle steps

Developed an action plan for activities/details that need to be modified or incorporated into the Health Collaborations project work plan to ensure all SF steps are adequately planned for

Planned for the initial stakeholders meeting with the Co-ops Time: 1 hour 15 mins. Materials: - Handout 29: Sustainability Framework Checklist - Handout 30: Sustainability Planning Action Plan Template

Steps: 22A. (5 mins.) Congratulations, you’ve reached our final task of the workshop! Thank you

for all the hard work that you have done over the past 4 days. There were many new concepts and materials covered this week, which may be overwhelming. This was meant to get you familiar with the steps in the program design process and get practice with carrying them out.

Now we will be working on 1) developing an action plan for the HealthPartners

Collaborations Project to ensure the program workplan includes all of the pro-sustainability steps reviewed this week and 2) detailing the activities that will be conducted with the co-ops during the initial Sustainability Stakeholders workshop.

22B. (10 mins.) Let’s review Handout 29: Sustainability Framework Checklist together. This

tool can be used to review program plans and processes in order to ensure that sustainability has been integrated into the design, implementation and evaluation of programs. The tool can also be helpful, not only when planning a project, but also during the early conception of a project, the review of a project proposal or during the review of a project that has already been implemented. This tool will help guide you in the next exercise to develop a sustainability action plan. What are your questions?

22C. (30 mins.) Divide into four groups. Review Handout 30: Sustainability Planning Action

Plan Template. Handout 29 is also a good tool and reference for you to use as you go through this exercise, as it helps lay out important steps in carrying out each step of the process. Since you are not likely starting from scratch, you may have already carried out parts of each of these steps – maybe not formally or completely, but keep that in mind as you are developing your action plan. For the next 30 minutes, work in your groups to complete the Sustainability Planning Action Plan. If you are unable to complete the action plan in 30 minutes, then be sure to develop a plan and time frame for completing the action plan. Each group will report out on activities for each step of the process.

(Note: this exercise may involve developing a supplemental plan that should be

integrated into the existing project work plan; or modifications can be made to the existing project work plan, highlighting pro-sustainability activities.)

22D. (30 mins.) The initial workshop with the co-ops will focus on introducing the

Sustainability Framework and engaging them in the initial consultative steps, which include: conducting a situation analysis, developing a sustainability scenario, and preparing for a local system assessment. The participants will be broken down into three groups so that each focuses on one of these steps. Review the learnings from

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the week, and identify the specific activities that will be conducted with the co-op groups for each step mentioned above. Each group will then summarize their discussion and present to the larger group, opening up a discussion for feedback.

22E. Note that in the next session on Day 5, those who will be facilitating sessions next

week with the co-ops will have the opportunity to conduct practice facilitation with constructive feedback and guidance from the ICF/CEDARS team.

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Day 5: Thursday, 13 January 2012 Task #23: Using Excel to Create a Sustainability Dashboard


Practiced using Excel software to develop a dashboard for their program. Time: 2 hours 30 mins. Materials:

- Handout 31: Creating a Sustainability Dashboard in Excel

- Computer

- Projector

Steps: 23A We will now learn how to transform our indicators into scores and indices using an

Excel spreadsheet. Once each component has a summary score, or index, it will be plotted on the Sustainability “dashboard.” This dashboard will allow us to make programmatic decisions for the sustainability of the HealthPartners Collaborations Project as well as the health cooperatives. We will use Handout 31: Creating a Sustainability Dashboard in Excel to guide us through this Task.

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Task #24: Practice Facilitation


Practiced facilitating learning tasks from the Sustainability Planning Workshop. Time: 3 hours 30 mins. Materials:

- See appropriate learning tasks

Steps: 24A. In pairs, you will practice facilitating a previously assigned learning task from the

Sustainability Planning Workshop. The ICF/CEDARS team will provide feedback and answer any of your questions about the upcoming workshops with the co-ops.

sustainability planning workshop - cedars center · sustainability workshop. icf international...

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