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PERMISSION FOR USE AND COPYING
Intellectual property rights for this material rests with the Authors.
Permission to use and copy this resource is freely granted for educational purposes. These Units are designed to
be delivered intact as complete Units, however there may be situations where use of part of the Unit is
warranted in educational contexts. If you are reproducing in part only, please credit:
Hughes R, Black C, Kennedy NP. Public Health Nutrition Intervention Management: Capacity
Assessment. JobNut Project, Trinity College Dublin. 2008.
ADDITIONAL COPIES
The complete suite of 18 Public Health Nutrition Workforce Development units developed by the JobNut Project
and the related Educator’s Guide are available for downloading at the following website:
http://www.medicine.tcd.ie/nutrition-dietetics/jobnut/
DISCLAIMER
This workforce development unit has been produced as part of the JobNut Project, supported by the Leonardo
Da Vinci Program, Education & Culture, European Commission. The opinions and conclusions expressed in this
paper are those of the author(s) and no official endorsement by the funder is intended or should be inferred.
ACKNOWLEDGEMENTS
Funding to support the JobNut Project was provided by the Leonardo Da Vinci Program, Education & Culture,
European Commission.
This Unit has been developed by Professor Roger Hughes, Christina Black and Dr Nick Kennedy of the Unit of
Nutrition and Dietetic Studies, School of Medicine, Trinity College Dublin.
Capacity Assessment
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Intelligence
Unit 5 – Capacity Assessment
Learning Objectives
On completion of this unit, students should be able to:
1. Describe the role and importance of capacity building needs analysis in the
public health nutrition intervention management process
2. Discuss the measurement issues and challenges associated with capacity building needs
analysis
3. Describe and apply the various capacity building needs analysis methods and tools to assess
organisational capacity needs, training needs and capacity gaps
4. Describe how capacity building strategies can be integrated with the public health nutrition
intervention management cycle
Intelligence
Unit Readings
•
Baillie, E., Bjarnholt, C., Gruber, M. and Hughes, R. A capacity building
conceptual framework for public health nutrition practice. Public Health Nutrition. 2008.
Cambridge Journals online.
•
Ebbesen, L., Heath, S., Naylor, P. and Anderson, D. Issues in measuring health promotion
capacity in Canada: a mulit-province perspective. Health Promotion International. 2004. 19: 8594.
•
Deutsche Gesellschaft fur Technische Zusammenarbeit. Capacity Building Needs Assessment
(CBNA) in the Regions (version 2.0) Module B. Methods and instruments for the capacity building
cycle. 2005. Deutsche Gesellschaft fur Technische Zusammenarbeit: Jakarta. p. 129.
Capacity Assessment
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Contents:
Page No.
What is Capacity
5
A Framework for Capacity Analysis, Capacity Building and Evaluation
• Capacity Assessment for Capacity Building
6
9
Challenges in Measuring Capacity
9
Selecting Tools for Capacity Analysis
13
Tools and Strategies for Analysing Capacity
• Organisational Capacity Analysis Tools
16
19
Training Needs Assessment
21
Summary of key points
26
Additional Resources and Readings
27
References
27
From: Hughes R, Margetts B. Public Health Nutrition: A Practitioners Handbook. Blackwell Publishing, 2009.
Capacity Assessment
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Capacity Assessment
Preamble
A community’s ability to effectively address public health nutrition challenges (hereafter
referred to as capacity) will be determined by many factors. Capacity is therefore clearly of
relevance to public health practice, and intervention management in particular. Without
capacity, the most innovative and brilliant ideas for interventions will not be implemented,
won’t be effective and will therefore fail to achieve its objectives. A failure to adequately
assess capacity and its determinants in the formative stage of intervention planning will increase
the chances that existing resources, ideas, skills, commitment etc will not be identified and
utilised, compromising intervention effectiveness and the quality of public health nutrition
practice.
Capacity assessment involves identifying and building upon existing capacities at various levels
and types of capacity, to focus needed capacity building strategy development and to establish
baseline measures for capacity building evaluation. Capacity analysis involves numerous
measurement issues and challenges. Selecting tools and strategies that are contextually
appropriate and use of a multi-method process can be used to overcome challenges and enable a
comprehensive capacity assessment.
What is Capacity?
Capacity is a nebulous term and part of the immense vocabulary of jargon in the health promotion
literature. Capacity, most simply defined, is the ability to carry out stated objectives (1).
In the context of PHN practice, capacity relates to the ability of individuals, groups, organisations,
communities, workforce and systems to perform effective, efficient and sustainable action that
achieves objectives such as improved nutrition-related health outcomes. For example, if the
Community A identified childhood obesity as a local issue and set the objective of introducing healthy
food policies in 100% of schools and childcare centres within 2 years, the capacity to achieve this
objective would involve factors such as the levels of community engagement and empowerment,
adequate resources, and the ability of local organisations to effectively contribute.
Capacity building refers to the process by which individuals, groups, organisations and societies
increase their ability to perform solve problems, define objectives, understand and deal with
development needs to achieve objectives in a sustainable manner (2). As noted previously in unit
Introduction and unit 1, capacity building is an essential and central component of PHN practice.
Capacity building is of relevance to many of the core functions of public health practice including
workforce development, intervention management and partnership development, and involves the
target community or population, organisations and systems.
Capacity Assessment
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There are several key attributes of capacity building in practice, these include;
• Capacity building is a continuous process
• Capacity building contributes to better performance and linked with the achievement of
objectives
• Capacity building works towards the establishment of a sustainable local health system where
the community are competent to address the current health problem and tackle other health
issues
• Capacity building operates at numerous levels (individual, organisational and systematic level)
(3).
The capacity building literature outside public health suggests that the capacity building process
should be an interlinked, continual process consisting of several components;
• Assessment of capacity needs
• Planning of a capacity building program
• Implementation of the capacity building activities
• Evaluation impacts of capacity building activities – to restart the capacity building process (4).
Note that In the bi-cyclic framework for intervention management described in Unit 1, these stages of
capacity building are integrated with the development and delivery of PHN interventions.
A Framework for Capacity Analysis, Capacity Building and Evaluation
Building on the work of scholars in the health promotion arena, Baillie et al (2008) have identified the
domains of capacity building in PHN practice to provide a focus for assessing, planning, implementing
and evaluating capacity building strategies in practice. A conceptual framework (Figure 1) presents
these domains, showing key foundations for capacity building in PHN practice as leadership, resourcing
and intelligence. Building on these layers are five strategic domains including partnerships,
organisational development, project management quality, workforce development and community
development. These capacity domains are core components of the PHN competency framework
illustrating that capacity building practice is key element of quality PHN performance.
Capacity Assessment
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Figure 1.
Capacity Building Conceptual Framework
Sustainable Public Health outcomes
Community Development
Workforce Development
Project Management Quality
Organisational Development
Partnerships
CAPACITY
Leadership
Intelligence
Resourcing
Source: (3)
Intelligence
Reading
Baillie, E., Bjarnholt, C., Gruber, M. and Hughes, R. A capacity building conceptual
framework for public health nutrition practice. Public Health Nutrition. 2008. Cambridge Journals
online.
Capacity Assessment
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Exercise 1.
After reading the article by Baillie et al (2008) brainstorm how or why each of the
domains of capacity might impact on PHN intervention management. Use your
scenario as a focus for this brainstorming.
Use the table below to make notes.
Workshop/tutorial option:
Complete the exercise in small groups followed by a whole-class debriefing.
DOMAIN
Potential Impacts on intervention
Notes relevant to scenario
Resourcing
Intelligence
Leadership
Partnership
Organisational
development
Project
management
quality
Workforce
development
Community
development
Capacity Assessment
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Capacity Assessment for Capacity Building
Conducting a capacity analysis is a fundamental element of capacity building. Before beginning to
build capacity within public health interventions, practitioners need to identify and respect the preexisting skills, structures, partnerships and resources, to be able to work with these pre-existing
capacities (5). Capacity assessment also involves identifying and building upon existing capacities at
each of the various levels of capacity building namely individual, managerial, organisational and
systematic, to enable strategy development and to establish baseline measures for capacity building
evaluation.
“Experience elsewhere has shown that the process of assessing or measuring capacity is as important as the
implementation of targeted capacity building initiatives, especially if the assessment process involves participatory
group discussions, workshops and joint assessment exercises. The selection of tools and instruments must therefore
be geared towards creating such discussion and learning opportunities for the members of an project team,
organisation or community ”
Source: (6)
Effective capacity building practice links local people with community expertise together with
practitioners with technical and capacity building expertise. Such links allow for an exchange of
identified and valued knowledge between groups which aids the development of trust and enhanced
community engagement. Capacity analysis can often, in itself, lead to capacity building because it
engages and empowers community stakeholders.
Interventions that are integrated into existing structures and linked to existing positions and
accountability processes are more likely to be sustained (7). Capacity analysis ensures capacity
building strategies are contextually appropriate and tailored to the specific conditions of the
community/ population or organisation. For successful capacity building interventions practitioners
need the ability to observe accurately, to interpret observations intelligently and impersonally, and
then deliver the appropriate intervention at the appropriate time (8).
Challenges in Measuring Capacity
Building capacity to effectively implement community-based interventions is an integral part of the
“doing of” public health nutrition. The “doing” focus on capacity building in public health
interventions is integrally linked to and is dependent upon measuring capacity.
Capacity assessment serves to:
• Identify a communities readiness for action
• Engages the community
• Focuses strategies for capacity building and
• Provides baseline data for capacity building strategy evaluation.
Assessment of capacity is required at various stages of capacity development and different measures
may be necessary at each stage. Initial assessment of capacity provides the context for capacity
building and indentifies capacity building possibilities and gaps. Progressive assessments monitor
change in capacity at individual, organisational and systematic levels. Impact measurement assesses
the amount of capacity gain at the various levels, as well as the successful elements of the capacity
building strategy and their contribution to the intervention outcomes.
Capacity Assessment
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The method of measuring baseline capacity, changes in capacity and the benefits of capacity building
on health can be challenging and a number of issues influencing measurement of capacity have been
identified from Canadian health promotion capacity building experience (9). These identified issues
are not mutually exclusive, with many of them interacting with each other. These are not that
different from measurement issues in other areas of research and evaluation. The key issues and
challenges in measuring capacity are our outlined in Table 1.
Table 1.
Issues in Measuring Capacity
Issues
Multiple understandings of terms
Description
Lack of consistent understanding of health promotion
terminology across settings, organisations and individuals
present a measurement challenge as a shared terminology
cannot be assumed when exploring health promotion
capacity with key informants at multiple levels of an
organisation or across sectors. This issue has implications in
the design and format of measurement tools, and for data
analysis.
Evolving understanding of
capacity
The definition and nature of capacity is evolving, thus
measurement tools – particularly quantitative tools - can be
lengthy and complex in order to tap into actual or potential
dimensions. Respondent burden becomes an issue.
Invisibility of capacity building
Community empowerment is explicit in health promotion,
which often creates a culture of invisibility around capacity
building (i.e. Because capacity building practitioners want
the community to take ownership and credit for capacity
gains and the associated outcomes, they may not overtly
communicate or promote capacity building strategies)
Invisibility causes difficulty in recognising, describing and
measuring capacity building.
The health system is one that is dynamic, and always seems
to be threatening dramatic restructuring. Prominent
contextual aspects that have influenced the measurement
of capacity include: staff turnover, health system renewal,
conflicting
perspectives
across
informants
within
organizations, conflicting personalities within organizations
and between informants and practitioners, “turf”
protection” by health workers in different departments,
and organizational staff understanding and valuing the
capacity building process.
Dynamic contexts
Capacity Assessment
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Time course for change
The long-term outcome is that enhanced capacity will
ultimately contribute to improved health in the population.
Organisational and/or individual capacity serve as
intermediate outcomes, as do enhanced health promotion
and prevention skills, services and programmes. The time
course for such individual or system changes to occur is a
challenge for projects with set timeframes.
Building and trust and dealing
with sensitive issues
It is important to develop a trusting relationship between
practitioners
and
organisational
or
community
representatives to ensure high quality data collection.
Equally important is the longitudinal nature of the research
which required multiple connections over time. The
relationships underlying these multiple connections depend
on trust and are a mediating factor that cannot be underestimated. The development of appropriate questions, the
documenting and sharing of such sensitive information
without breaching confidentiality or trust poses a
measurement challenge.
‘Snap-shot’ measurements
Quantitative instruments provide a ‘snap-shop’ in time.
Qualitative interviews allow the exploration of critical
events, milestones or snapshots, however they count on
accurate and comprehensive recall of informants,
sometimes months after a particular occurrence. This can
be a limitation because of “recall bias”.
Validity and reliability of
quantitative measures
There is no “gold standard” tool to measure health
promotion capacity. Establishing criterion validity is
therefore
compromised.
External
validity,
the
generalisability of findings to and across populations of
subjects and settings, is difficult to reach because each
project is context specific.
Attribution for change in capacity
The process for building health promotion capacity is
participatory, in that organizations and individuals who are
‘recipients’ of the capacity-building interventions are
integrally involved in developing, planning and evaluating
the process. If the principles of participatory action and
health promotion are adhered to, then ‘others’ take
ownership and embrace the work as their own. This
ownership is both a positive aspect of the process and an
outcome however, identifying both the successful elements
of the capacity-building strategy and the independent
contributions of the intervention becomes complex.
Source: (9)
Capacity Assessment
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A number of strategies to address the identified issues in measuring capacity have been suggested
based on the health promotion capacity research in Canada (9). The practice of implementing these
strategies showed that a single strategy could address more than one of the measurement issues, and
that a single measurement issue could be addressed by several strategies. The strategies to address
issues in measuring capacity, and the measurement issues that strategy can address are presented in
Table 2.
Table 2.
Strategies to address key capacity measurement issues
Strategy
Utilise participatory processes as
intervention
Measurement issue addressed
Multiple understandings of terms
Evolving understanding of capacity
Building trust and dealing with sensitive issues
Acknowledge the context
Invisibility of capacity building
Dynamic context
Incorporate mixed methods (qualitative
and quantitative)
Invisibility of capacity building
Dynamic contexts
Time course for change
Building trust and dealing with sensitive issues
‘Snap-shot’ measures
Validity and reliability of quantitative methods
Attribution for change in capacity
Build on previous phases of community
and stakeholder engagement
Multiple understandings of terms
Building trust and dealing with sensitive issues
Establish validity of quantitative measures
Validity and reliability of quantitative methods
Establish trustworthiness of qualitative
intelligence
Multiple understanding of terms
Evolving understanding of capacity
Time course for change
Building trust and dealing with sensitive issues
‘Snap-shot’ measures
Be flexible and adaptable
Dynamic contexts
Multiple understanding of terms
Building trust and dealing with sensitive issues
Identify intervention contributions
i.e. intervention specific evaluations
Attribution for change in capacity
Source: (9)
Capacity Assessment
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Intelligence
Reading
Ebbesen L, Heath S, Naylor P, Anderson D.Issues in measuring health promotion
capacity in Canada: a multi-province perspective. Health Promotion International 2004. 19: 85-94
Selecting Tools for Capacity Analysis
Capacity building is contextual and bound to the specific conditions of each community, so the
approach for conducting a systematic capacity analysis should take these specific conditions into
account and select tools and instruments for the analysis process which can then be adjusted to the
existing conditions. Each analysis will be different, and use a different mixture of diagnostic tools (6).
Deciding on the assessment approach and the tools to be applied requires an initial examination of the
contextual factors that impact on tool selection. Some of the key factors to be considered are
outlined in Table 3.
Table 3.
Factors influencing the selection of capacity analysis tools
Factor
Internal (self) assessment verses
external assessment
Description
Some of the tools and instruments can by applied by the
organisation itself. Others require the use of external
consultants,
moderators
and/or
facilitators.
Both
approaches have their strengths and weaknesses:
•
Internal assessment can be biased and subjective;
however has a better understanding and knowledge of
the organization’s culture and members.
•
Level of assessment
External assessment has less bias, however can miss
some important aspects of an organisation if the
external assessor is not given the inside information
needed. Cost is another factor since external
consultants or moderators are (normally) paid.
The mixture of instruments used for the assessment of
capacity needs to capture capacity building information for
all three levels of capacity ( i.e. systems level,
organisational level, and individual level).
Not all instruments will be useful and feasible for all
levels of the analysis. (See Table 4. for recommended
analysis tools for each level of capacity).
Capacity Assessment
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Table 3. continued
Type of organisation/s
Comparability across organisations
Comparability over time
Is the organisation public, private, for-profit or nonprofit? Many available tools and instruments for capacity
assessment have been developed for a specific type of
organisation however, can usually be adjusted to
capture the characteristics and conditions of other
organisations.
Whether one wants to compare capacities across
organisations, or limit the capacity assessment to one
single organisation can have a bearing on the selection
of tools. Comparison requires the tool to measure the
same capacity areas for all organisations, use the same
scoring criteria and the same measurement process.
Such a standardized tool might therefore be less
capable to capture the specific situation of an individual
organisation.
Do you intend to assess capacity over time (i.e.
repeatedly) in order to observe and document the
capacity changes, or is the capacity analysis a one-time
only exercise?
Comparability over time requires consistency in method
and approach, and the measurement instrument needs
to be applied the same way each time it is used. A
baseline would also need to be established.
Data collection methods
Some methods are more participatory than others, some
are simple, and others need specialist expertise.
• Open, structured or semi-structured interviews
with individuals, document analysis, observation
and field visits.
• Focus group discussions are some of the different
ways to collect data.
In most cases, the combination of several data
collection methods will bring better results than the use
of just one method.
Objectivity
Measures of institutional capacity are usually subjective
in relying on individual perception, analysis and
judgment. They provide qualitative information, rather
than quantitative data. Subjective perception of
capacity can, to a certain extent, be balanced by other
more empirical tools.
Table 3. continued
Capacity Assessment
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Quantification
Depending on the measurement tools, organisational
capacity can be expressed in numbers, using ordinal
scales.
Take note that these numbers are not absolute but
relative. Combining quantitative data with qualitative
descriptions can provide a better, more accurate
picture of an organisation’s capacity.
Practicality and efficiency
Diagnostic tools should provide useful information and
not be too complicated, time-consuming and costly. In
selecting tools, consider the level of effort (burden) and
resources required to develop the instrument, and
collect and analyse the data.
Selecting only one tool might be tempting because of
easier use and faster (and perhaps cheaper) application.
However, using several tools can provide richer and
more comprehensive information. Using multiple tools
can also help to balance their respective weaknesses.
Source: (6)
Table 4.
Level of capacity and suggested analysis tool
Level of assessment
Suggested tool
System/ institutional level
Document analysis
Force field analysis
Focus group analysis
Stakeholder analysis
Organisational level
Document analysis
Organisational capacity assessment
SWOT analysis
Focus group discussion
Stakeholder analysis
Individual level
Document analysis
Focus group discussion
Task and job analysis
Training needs assessment
Source: (6)
Capacity Assessment
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Tools and Strategies for Analysing Capacity
Many of the tools used in capacity analysis can draw upon intelligence already collected from the
previous steps in the intelligence stage of the public health nutrition intervention management bicycle. Capacity analysis involves building upon the information collected in the community
engagement and stakeholder analysis steps, and the subsequent identification and formation of the
project management committee (refer to capacity building strategies later in this unit).
Practice Note
One of the most useful and important capacity building strategies in most public
health nutrition management situations is the development of a Project Management
Committee. This committee serves as a partnership or coalition of key stakeholders
(usually those stakeholders that you have previously engaged with and assessed as being interested
and with influential in the community context). This committee becomes a system for intervention
governance (decision making, accountability etc), which is important for ethical and effective PHN
practice.
It is important and advantageous to involve the project management committee in capacity
analysis. As this group typically includes representatives from the community, key stakeholder
groups and management they have an essential role in identifying capacity potential, capacity gaps
and resources to support capacity building. Working with the identified project management group
members to determine the scope, responsibilities and tasks, and methodology and tools for the
capacity analysis helps to enhance stakeholder commitment to and involvement in the capacity
building process.
Document analysis
Document analysis is the systematic examination of documents to identify organisational objectives,
policy mandates, resources and associated needs, potential and challenges. The analysis should be a
critical examination rather than a mere description of the documents. Document analysis can provide
insight into systematic, organisational or individual positions on an issue. Document analysis is a
useful preliminary activity for focus group discussions, interviews and observations. Document
analysis requires little resourcing, primarily time to select and analyse the documents, however
missing or incomplete documents and limited access to confidential documents are limitations.
In the context of PHN intervention management, document analysis includes review of national, local
and organisational mandates for action of relevance to PHN. Reviewing mandates for action is
covered in detail in Unit 6 of the PHN intervention management learning package.
Focus group discussion
A focus group is a qualitative research method that brings together participants who share an interest
in a certain subject matter, and who therefore have a certain knowledge or understanding in this
subject. It is essentially a group interview process. Focus group participants can be heterogeneous or
homogeneous, depending on the purpose of the intelligence gathering process (6).
Capacity Assessment
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Focus groups can be used to collect information and opinion, to test or get feed back on ideas and
suggestions, and to increase the understanding of the different participants on their respective
perceptions and approaches. Facilitators direct the discussion process in the group and help to
visualise and document arguments and inputs from the participants. Facilitators can support the
formulation of action plans if needed and appropriate. Focus groups can make use of tools like the
SWOT analysis in order to structure their discussion. See Unit 3 of the learning package for details of
stakeholder analysis and SWOT analysis.
Force field analysis
A Force Field Analysis (FFA) can be used to identify internal and external factors and forces which
support or work against the solution of an issue or problem. In the context of formulating a capacity
building program, a FFA could for instance be used to discuss whether suggested capacity building
initiatives can indeed be carried out, respectively what could be done to make capacity building
initiatives possible (6).
A FFA can present the positive and the negative features of an existing situation so that they are
easily compared with each other. It brings participants of the exercise to think about different aspects
of the desired change, and encourages them to agree about the relative priority of factors on each
side of the field, thus building consensus for the follow-up activities. The FFA works often best when
focusing on the restraining forces, not the driving forces. It does not require lengthy preparations and
infrastructure, but can be applied on the spot as the need arises. Figure 2 gives a simple example of
such a force field analysis.
Figure 2.
Force field analysis – example
Force Field
Improvement of training system
Ideal state: Training improves individual skills and institutional performance
Driving Factors
Restraining Factors
Individual interests in career
advancement
Limited funds for training
Staff placement/ career
development disconnected from
training and skill development
Improved institutional performance
increases standing/ reputation
of senior management
Lack of adequate programmes
for technical and functional
training
Improved institutional performance
leads to increased institutional revenue
Low quality of training provides
Political and public pressure
to improve quality of services
Superiors pay little attention
to staff skills and competencies
Existing work culture does not
favour introducing changes
and innovations
Source: Adapted from (6)
Capacity Assessment
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Exercise 2.
Using the data from a workforce needs survey (Table 5) that sought to investigate
the barriers and incentives for further competency development in the public
health nutrition workforce. Do a force field analysis replicating Figure 2 above) to
plot the various driving and restraining factors relevant to workforce development in this
example.
What capacity building strategies does this analysis suggest are needed?
Workshop/tutorial option:
Complete the exercise in small groups followed by a whole-class debriefing.
Exercise 2:
Table 5. Barriers and incentives to further developing competencies in PHN
% reporting
barrier/major
barrier*
9
7
12
23
17
21
26
20
28
13
23
24
47
63
84
84
85
Incentive/ barrier
% reporting
unsure/neither
18
Motivation to self-improve/learn
32
My own assessment of my need to develop skills in this area
40
Personal rewards of further training/awards
40
Opportunities to apply training
56
Level of support from others
74
No relevant training available
Level of support from management
46
65
Access to information
51
Contact or access to mentors
83
Other training more important
72
Courses are not sufficiently practical
Lack of professional credit/recognition
71
Scope for employment/progression once further trained
30
Funding availability
27
Time available – work
12
15
Cost of further training
Time available - personal
10
Percentages are rounded to the nearest integer
* Likert scale collapsed from 5-point to 3-point (barriers, unsure/neither and incentives)
Source: (10)
Capacity Assessment
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% reporting
incentive/major
incentive*
73
60
48
37
27
5
28
15
21
4
6
6
23
10
5
1
5
Organisational Capacity Analysis Tools
There are a number of tools available to assess and discuss the capacity of an organisation. Many of
these tools have been used in the context of non-public sector organisations, however usually they can
be modified to reflect better the specific context of regional government institutions.
A key element of assessment tools like PROSE and OCAT is that it is the organisational members that
assess the capacity of their own organisation. This internal assessment can be complemented by
external assessments and by empirical observations/research in order to balance the subjective
perception of the members. It is also the members of the organisation who determine the capacity
areas and the criteria to be used for each capacity area. This approach ensures that the process of
capacity analysis constitutes a process of capacity building, because it engages the members of the
organisation in the analysis of the present and the desired condition of their organisation. Both tools
create opportunities for two-way learning - a key for institutional capacity building.
Tools
Participatory, results-oriented self-evaluation (PROSE)
The PROSE method has the dual purpose of both assessing and enhancing
organisational capacities. The PROSE method produces an assessment tool customised to the
organisations being measured. It is designed to compare capacities across a set of peer
organisations, called a cohort group, which allows for benchmarking and networking among the
organisations. PROSE tools measure and profile organisational capacities and assess, over time, how
strengthening activities affect organisational capacity. In addition, through a facilitated workshop,
PROSE tools are designed to allow organisations to build staff capacity; create consensus around
future organisational capacity-building activities; and select, implement, and track organizational
change and development strategies.
Tools
Organisational capacity assessment tool (OCAT)
The OCAT is designed to identify an organisation’s relative strengths and weaknesses,
thus providing the baseline information needed to develop capacity strengthening interventions. It
can also be used to monitor progress over time, and can be standardised and used across
organisations. OCAT differs from PROSE mainly by using an assessment team (i.e. a selection of
members of the organisation plus externals), and by using a variety of data sources for the
assessment.
Capacity Assessment
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Tools
Scorecards
A scorecard is a list of characteristics or events against which a Yes/No score or a
numerical score is assigned. These individual scores are aggregated and presented as an index.
Checklists can effectively track processes, outputs, or more general characteristics of an
organisation. In addition, they may be used to measure processes or outputs of an organisation
correlated to specific areas of capacity development. Scorecards can be used either to measure a
single capacity component of an organization or several rolled together. Scorecards/checklists are
designed to produce a quantitative score that can be used as an indication of existing capacities or
as a target for future capacity building to be achieved (a scorecard without an aggregate score is
also helpful).
Intelligence
Reading
GTZ, Capacity Building Needs Assessment (CBNA) in the Regions (version 2.0) Module
B. Methods and instruments for the capacity building cycle. 2005, Deutsche Gesellschaft fur
Technische Zusammenarbeit : Jakarta. p. 149
Capacity Assessment
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Training Needs Assessment
One of the most obvious capacity determinants (or resources) in any community is the health
workforce. It may also be one of the major gaps in capacity, depending on its level of development.
Up-skilling health and community-based professionals in nutrition (workforce development) is one of
the most common capacity building strategies used in PHN. This strategy recognises that nutrition
guidance and other forms of intervention at the interface with the community can be greatly
enhanced in terms of reach and exposure, if primary health carers have access to and apply
competencies gained by continuing education and support in nutrition. Needs assessments can provide
a mechanism to identify gaps in competency amongst front-line health workers, in order to focus the
capacity building effects of continuing education as a workforce development strategy.
Case Study
The Growing Years Project is a multi-strategy community-based nutrition and physical
activity promotion project targeting pregnant women and their infants. A key focus of
this project has been around capacity building approaches to intervention
management, including assessment of the capacity of the local health workforce to provide
effective guidance.
Training needs assessments can use different methods, as illustrated below.
Example 1
The following abstract from a study investigating the education and guidance practices of
community based pharmacists provides an example of how training needs assessment can be
conducted.
Mystery Shopping
Breastfeeding promotion is universally recognised as a public health imperative with significant
impact on health, social and economic outcomes. Amongst a complex array of determinants that
effect breastfeeding initiation and duration, inconsistent advice and support from health
professionals is recognised as an unacceptable feature of health service delivery. The role of
community pharmacy as a setting for breastfeeding promotion has received limited attention,
despite widespread accessibility, utilisation by women and trust amongst consumers. In order to
assess the quality of guidance practices relating to breastfeeding, a pseudo-customer (mystery
shopper) study was conducted amongst a randomly sampled group of 62 pharmacies on the Gold
Coast. A mystery shopper (a female dietetic student) was trained to act as the sister of a mother
with a 7 week old baby who was experiencing sore, red and cracked nipples, who was seeking
guidance from the pharmacy. Detailed notes of the guidance provided by pharmacy staff were
made by the student immediately post-exchange and were compared with observational notes
made by a second observer. Analysis of these exchanges indicated almost universal absence (58/62)
of pro-active breastfeeding advice and a range of dubious infant formula recommendations that
reflect formula company marketing more than the evidence-base. This study highlights the need for
pharmacy staff continuing education in infant feeding guidance if the full potential of pharmacy
services in this field are to be realised.
Capacity Assessment
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CASE STUDY continued
Example 2
The following abstract from a study investigating the continuing education needs of
community based health workers using a self-administered questionnaire.
Needs surveys
Appropriate health education and guidance regarding nutrition and physical activity during key lifestages such as pregnancy and early parenthood, is an important determinant of healthy behaviours.
Primary health care practitioners provide services and guidance at the frontline of the health
system. This advice therefore needs to be an ongoing focus of service quality considerations. In
order to assess the quality of nutrition and physical activity guidance and identify continuing
education (CE) needs, this study involved a self-administered survey of primary health practitioners
conducted at a local health district level. A total of 218 surveys were completed capturing a range
of primary care system professional groups including medical (n=58), nursing (n=55) and community
pharmacy (n=86). The mean (+ SD) years experience of respondents was 14.7 (+ 11) years. This
health workforce sample has regular contact and provides advice to women with infants in the
Growing Years period (1 year either side of childbirth) but have varying degrees of confidence
regarding the accuracy and currency of their advice. This study has identified gaps in the guidance
knowledge base and a range of opportunities and preferences for CE at a local level. This data has
been used to develop local health service workforce development strategies as part of the Growing
Years Project intervention mix.
Note:
Each of these studies has informed the development of a range of localised and specific workforce
development strategies including staff up-skilling sessions, nutrition and physical guidance tools,
point-of-service education prompts. These studies provide baseline data to support later evaluation
of capacity development strategies.
Capacity Assessment
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Exercise 3.
Consider the key health and community workers in the health system of the
scenario you have been given, that are best placed to develop community
responses to the identified issue. Use the table below to complete this exercise.
Workshop/tutorial option:
Complete the exercise in small groups followed by a whole-class debriefing
CPD option:
Complete the above exercise considering the key health workers in the local area of your
current work role.
Health/community worker
group
Current level of competency
for the identified issue
Capacity Assessment
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Training needs
Practice Note
In practice it is useful to apply rapid assessment procedures to accelerate analysis and
inform strategy development band implementation.
The capacity assessment checklist (see attached tool) attempts to enable rapid assessment of
population level capacity relevant to public health nutrition intervention management. It has been
built on many of the tools and scholarship summarised in this and other units, and is intended as a
checklist that enables regular assessment (and evaluation) of capacity in the context of
interventions. It is intended to provide directionality to capacity building efforts by using the
various capacity determinant modules outlined against a conceptual framework.
Exercise 4.
Use the Baillie Capacity Assessment Checklist to do a “rapid” assessment of the
capacity relevant to your scenario.
Plot your scores on the “spider’s web” visual representation graph and comment
on gaps in capacity based on this analysis.
Note that progressive plotting of ratings over time should demonstrate an expansion in the area
on this graph (assuming capacity expansion).
Workshop/tutorial option:
Complete the exercise in small groups followed by a whole-class debriefing
CPD option:
Complete the above exercise considering the key health workers in the local area of your
current work role.
Assessment
Considering your selected scenario (from the four provided) draft a summary of
the relevant capacity analysis components of the intervention management
template. Limit this description to 350 words. Remember, the purpose of this
description is to clearly articulate strengths and weaknesses in capacity in the relevant
community-so that you can justify capacity building strategies and resourcing bids you make
later in your submission.
CPD option:
Conduct the above exercise in the context of your current work role and the community and
issue you are working with.
Capacity Assessment
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CAPACITY ASSESSMENT TOOL
COMMUNITY DEVELOPMENT DOMAIN
Contribution to capacity building in community interventions
COMMUNITY
DEVELOPMENT
1
2
3
4
5
Nil obvious
Limited
Average
Significant
Very significant
Problem
identification
There is no obvious
identification of the
problem by the
community
There is limited
identification of the
issue/problem by the
community
There is some
identification of the
issue by a few sections
of the community
There is significant
identification of the
issue by most sections
of the community
There is extensive
identification of the
issue by a broad
representation of the
community
Strategy
identification
The community does
not obviously identify
strategies to deal with
the issue
Small sections of the
community identify
limited strategies to
deal with the issue
Some sections of the
community identify
average strategies to
deal with the issue
Many sections of the
community identify a
significant range of
strategies to deal with
the issue
A major proportion of
the community identify
extensive strategies to
deal with the issue
Planning
involvement
The community has no
obvious involvement in
planning interventions
to deal with the issue
Small sections of the
community have
limited involvement in
planning interventions
to deal with the issue
Some sections of the
community have
average involvement in
planning interventions
to deal with the issue
Many sections of the
community have
significant involvement
in planning
interventions to deal
with the issue
A major proportion of
the community has very
significant involvement
in planning
interventions to deal
with the issue
Implementation
The community has no
obvious involvement in
the implementation of
strategies to deal with
the issue
Small sections of the
community have
limited involvement in
the implementation of
strategies to deal with
the issue
Some sections of the
community have
average involvement in
the implementation of
strategies to deal with
the issue
Many sections of the
community have
significant involvement
in the implementation
of strategies to deal
with the issue
A major proportion of
the community has
extensive involvement
in the implementation
of strategies to deal
with the issue
Service use
The community does
not obviously
participate in programs
relevant to the issue
Small sections of the
community participate
in a limited number of
programs relevant to
the issue
Some sections of the
community participate
in an average number
of programs relevant to
the issue
Many sections of the
community participate
in a significant number
of programs relevant to
the issue
A major proportion of
the community
participate extensively
in programs relevant to
the issue
MEAN:
Developed by Libby Baillie & Roger Hughes, University of the Sunshine Coast, Australia for the Growing Years Project, 2008.
Capacity Assessment
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Evidence
Practice Note
Capacity building strategies are central and continuous to PHN practice whereby many
intervention strategies that can be used are capacity building strategies (such as
workforce development, intelligence gathering etc).
One of the most important initial and formative strategies (that has a critical role in capacity
assessment and evaluation) is the Project Management Committee.
Forming a Project Management Committee that formally includes key stakeholders in assessment,
decision making and accountability, and aids capacity assessment/building:
• Engages the stakeholders
• Helps identify and mobilise community resources
• Shares responsibility
• Increases access to intelligence
• Helps organise stakeholder so that they “pull together” rather than in different directions.
Key Points
•
In PHN practice, capacity building relates to the ability and process of
individuals, groups, organisations, communities, workforce and systems to
perform effective, efficient and sustainable action that achieves objectives
such as improved nutrition-related health outcomes.
•
Capacity analysis involves identifying and building upon existing capacities at each of the
various levels of capacity building, namely individual, managerial, organisational and
systematic, to enable strategy development and to establish baseline measures for capacity
building evaluation.
•
Capacity analysis involves numerous measurement issues and challenges. Selecting tools
and strategies that are contextually appropriate and use of a multi-method process can be
used to overcome challenges and enable a comprehensive capacity analysis.
•
Strategies to build capacity should be integrated and central to strategy selection and
implementation. It is artificial to assume strategies can be effective without consideration
of how they build capacity and what capacity there is to effectively implement them.
•
Establishment of Project Management Committees involving key stakeholders is a important
formative capacity building strategy that provides a governance and accountability
framework to community intervention management.
Capacity Assessment
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Additional resources and readings
Capacity building
• New South Wales Health Department. A Framework for Building Capacity to Improve Health.
2001. Better Health Centre - Publications Warehouse: Gladsville.
• Goodman, R., Speers, M., McLeroy, K., Fawcett, S., Kegler, M., Parker, E., Smith, S., Sterling,
T. and Wallerstein. N. Identifying and defining the dimensions of community capacity to
provide a basis for measurement. Health Education and Behaviour. 1998. 25: 258-278.
References
1.
Goodman, R., Speers, M., McLeroy, K., Fawcett, S., Kegler, M., Parker, E., Smith, S., Sterling, T. and
Wallerstein. N. Identifying and defining the dimensions of community capacity to provide a basis for
measurement. Health Education and Behaviour. 1998. 25: 258-278.
2.
Horton, D., Alexaki, A., Bennett-Lartey, S., Brice, K., Campilan, D., Carden, D., de Souza Silva, J.,
Thanh Duong, L., Khadar, I., Maestrey Boza, A., Kayes Muniruzzaman, I., Perez, J., Somarriba Chang, M.,
Vernooy, R. and Watts, J. Evaluating Capacity Development: experiences from research and
development organisations around the world. 2003. International service for National Agriculture and
Research/ International Development Research Centre:The Netherlands
3.
Baillie, Bjarnholt, Gruber and Hughes. 2008
4.
Gesellschaft fur Technische Zusammenarbeit. Capacity building needs assessment (CBNA) in the Regions
Module A. The concept of capacity building and the process of assessing capacity building needs. 2003
Deutsche Gesellschaft fur Technische Zusammenarbeit (GTZ): Jakarta.
5.
New South Wales Health Department. A Framework for Building Capacity to Improve Health. 2001.
Better Health Centre - Publications Warehouse: Gladsville.
6.
GTZ, Capacity Building Needs Assessment (CBNA) in the Regions (version 2.0) Module B. Methods and
instruments for the capacity building cycle. 2005, Deutsche Gesellschaft fur Technische
Zusammenarbeit : Jakarta.
7.
Bossert, T. Can they get along without us? Sustainability of donor-supported health projects in Central
America and Africa. Social Science and Medicine. 1999. 30(9): 1015-1023.
8.
Kaplan, A. Capacity Building: Myth or Reality? 1994 Community Development Resources Association
Annual Report.
9.
Ebbesen L, Heath S, Naylor P, Anderson D.Issues in measuring health promotion capacity in Canada: a
multi-province perspective. Health Promotion International 2004. 19: 85-94.
10.
Hughes R. Competency development needs of the Australian public health nutrition workforce. Public
Health Nutrition. 2003. 6: 839-847.
11.
Maher, J. and Hughes, R. Breastfeeding guidance practices in community pharmacies: Results of a
mystery shopper study. Nutrition and Dietetics. 2008 65 S1:
Capacity Assessment
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