International Journal of Gynecology and Obstetrics 127 (2014) S6–S9
Contents lists available at ScienceDirect
International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo
FIGO LOGIC INITIATIVE
United Nations Millennium Development Goals 4 and 5: Augmenting the role of health professional associations Liette Perron a,⁎, Bart Vander Plaetse b, David Taylor b a b
Society of Obstetricians and Gynaecologists of Canada, Ottawa, Canada International Federation of Gynecology and Obstetrics, London, UK
a r t i c l e
i n f o
Keywords: Africa Asia FIGO LOGIC initiative Health professional associations Maternal and newborn health Millennium Development Goals Organizational capacity building
a b s t r a c t The present study aimed to assess changes in the organizational capacity of health professional associations (HPAs) before and after a structured capacity building intervention, which included strategic investment of resources at institutional and technical levels. Self-assessments of organizational capacity were conducted by seven HPAs from low-resource countries involved in the FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health. The self-assessment tool comprised a questionnaire focusing on five core organizational dimensions, completed through a participatory and externally facilitated process. Differences were assessed using the two-sided sign test. All seven HPAs made improvements, with gains in an overall index (P = 0.017) and in the specific dimensions of culture (P = 0.016), operational capacity (P = 0.016), performance (P = 0.03), and functions (P = 0.016). Increased capacity contributed to the ability of each HPA to enhance their credibility and assume leadership in national efforts to improve maternal and newborn health. © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
1. Introduction The global movement to accelerate progress toward reaching the United Nations Millennium Development Goals (MDGs) related to newborn, child, and maternal health (MDGs 4 and 5) mobilized a variety of new partners, including health professional associations (HPAs) [1]. The involvement of HPAs is most apparent in the Partnership for Maternal, Newborn and Child Health whereby relevant societies formed their own official constituency group and used this forum to define their specific contribution to the sector, share knowledge and skills, coordinate their activities, and, in some instances, pool resources. The HPAs recognized their unique leadership role in influencing clinical practice at a service delivery level and as advocates for policy and legislative changes, including increased priority and investment in maternal and newborn health (MNH) [2,3]. The HPAs also acknowledged that for many professional societies, the ability to assume a leadership role—especially in low-resource countries—was contingent on the ability to strengthen overall organizational capacity to achieve goals and objectives in support of their mission and strategic directions [2]. Although maternal mortality rates are declining, the rates in lowresource countries remain high, particularly in Sub-Saharan Africa and South Asia, which account for 85% of maternal deaths globally [4].
⁎ Corresponding author at: Society of Obstetricians and Gynaecologists of Canada, 780 Echo Drive, Ottawa, ON K1S 5R7, Canada. Tel.: +1 613 730 4192; fax: +1 613 730 4314. E-mail address: [email protected] (L. Perron).
Consequently, the International Federation of Gynecology and Obstetrics (FIGO) resolved to accelerate its efforts and activities in the area of MNH. Recognizing the limited organizational capacity of some member HPAs, particularly those in countries where MNH outcomes were among the poorest worldwide, FIGO committed to support capacity building efforts as a means to enable them to assume leadership in the field [5]. In 2009, FIGO launched the Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in MNH. Funded by the Bill and Melinda Gates Foundation, FIGO LOGIC aimed to contribute to the improvement of MNH policy and practice by strengthening the organizational capacity of member HPAs. The project was implemented in eight countries in Sub-Saharan Africa (Burkina Faso, Cameroon, Ethiopia, Mozambique, Nigeria, and Uganda) and South Asia (India and Nepal). 2. Methods 2.1. Organizational Capacity Improvement Framework The capacity development process was guided by the Society of Obstetricians and Gynaecologists of Canada (SOGC) Organizational Capacity Improvement Framework (OCIF), a tool developed by SOGC to support its own capacity building efforts with peer obstetrics and gynecology associations from low-resource countries. The OCIF defines capacity as “the ability of an individual, an organization, or a system to perform planned functions effectively, efficiently and sustainably” and
http://dx.doi.org/10.1016/j.ijgo.2014.08.004 0020-7292/© 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
L. Perron et al. / International Journal of Gynecology and Obstetrics 127 (2014) S6–S9
capacity development as the means by which “the abilities and elements to succeed are obtained, strengthened, adapted and maintained in a sustainable manner over time” [6]. The tool devised by SOGC employs a “learn as you apply” approach. Consequently, users acquire understanding of the basic concepts of capacity development and its link to strong and sustainable HPAs; at the same time, they initiate capacity building actions within their own organizations. The OCIF includes four key elements: capacity assessment; data analysis; development of a capacity improvement plan; and implementation and performance measurement of the improvement plan in an integrated manner. The four OCIF elements are linked sequentially in 3- to 5-year cycles to enable managed capacity development that is aligned with the HPA’s goals, objectives, and strategic priorities. Each cycle builds on the previous one to incrementally progress the HPA toward a state of increased integrated capacity [7]. The OCIF enables HPAs to consider and take action on five core dimensions: culture; operational capacity; performance; external relations and how the HPA is perceived; and functions (Table 1). Critical to the success of the OCIF are the organizational capacity selfassessment exercises completed at the beginning and end of each cycle by representatives of the HPA. These exercises permit each HPA to determine its level of capacity (rated basic, moderate, intermediate, or high) in the five core dimensions. In addition, self-assessment facilitates the identification of organizational strengths and weaknesses, establishes the priorities of the HPA, and aids the development of an improvement plan. The results from each exercise also provide baseline data that can be used for monitoring and evaluation throughout the capacity building cycle. 2.2. Application of the Organizational Capacity Improvement Framework Within FIGO LOGIC, the OCIF was used to support the participating HPAs in the completion of a 3-year cycle of organizational capacity development. This approach was coupled with investment of technical and financial resources to strengthen capacity at both institutional and technical levels by: • Facilitating the baseline organizational capacity assessments and the development of HPA improvement plans.
S7
• Providing financial and technical support for the implementation of improvement plans to progress HPAs toward increased capacity. • Providing financial and technical support for activities that were not immediately part of the implementation plan but allowed HPAs to undertake policy and practice initiatives in parallel with improvements made at the organizational level. • Facilitating end-of-project organizational capacity exercises (Table 2). The results of the initial and end-of-project self-assessments were used to evaluate organizational change developed during the program.
2.3. The self-assessment process Self-assessments of organizational capacity at baseline (2010) and end-of-project (2013) were facilitated by SOGC among seven of the eight HPAs involved in FIGO LOGIC. Although the HPA in India did complete an initial assessment, it was not included in the study because it had already reached the target capacity from the onset of the FIGO LOGIC initiative. These exercises were completed through participatory two-day workshops that brought together members of each HPA’s Board and/or Executive Committee, other HPA leaders, and project staff. Assessment workshops were led by a SOGC consultant familiar with the OCIF and its tools and with experience in supporting the capacity development efforts of HPAs from low-resource countries. The workshops were designed to: • Provide an opportunity for all participants to gain knowledge and understanding about capacity development and what makes HPAs strong and sustainable. • Complete the OCIF self-assessment tool as a group. • Use the results to inform the development of the HPA improvement plans. The self-assessment tool comprised a questionnaire of approximately 150 items that were specifically designed to allow society leaders to consider their HPA across the core dimensions and capacity areas of the OCIF (Table 1). A combined score of 0–4 was attributed to each question and a short narrative provided to justify the score given.
Table 1 Core organizational dimensions and capacity areas.a Core organizational dimension
Description
Capacity areas
Culture
Focuses on what motivates an HPA to succeed, function, and survive
Operational capacity
Represents a complex relationship of eight core areas that support the ability of an HPA to perform, remain relevant, to grow, and to survive
Performance
Examines four areas that relate to the ability of an HPA to meet its goals and objectives and remain viable
External relations and how the HPA is perceived
Addresses four areas reflecting the reality that HPAs are not isolated entities but are affected by their environment and context
Functions
Addresses four essential functions of HPAs
Mission and vision Values Rewards and incentives Governance Leadership in management Strategy Financial management Human resources Program and project management Communication Infrastructure Effectiveness Efficiency Relevance Financial position Rules and norms Legal and political framework Linkages and network Ownership and participation Membership services Promoting quality and standard of care Advancing professional practice Influencing medical practice and health policy
Abbreviation: HPA, health professional association. a As defined by the Society of Obstetricians and Gynaecologists of Canada Organizational Capacity Improvement Framework.
S8
L. Perron et al. / International Journal of Gynecology and Obstetrics 127 (2014) S6–S9
Table 2 Capacity building activities supported by the FIGO LOGIC Initiative in Maternal and Newborn Health. Core organizational dimensiona
Capacity building activity
Culture
Definition of mission, vision, and organizational values within the context of strategic planning exercises Means by which to promote the mission, vision, and organizational values of the HPA both internally and externally Reviews of constitutions and bylaws Strategic planning exercises Establishment and/or upgrades of national secretariats Support for the recruitment of core HPA staff Development of administrative policies and procedures (e.g. human resources and financial) Establishment of computerized accounting systems Training opportunities (e.g. financial management, project design, and management) Training and technical support related to project management Financial sustainability workshops and discussions Support to lead or participate in meetings with other stakeholders in the field Support to participate in international meetings (e.g. FIGO World Congress of Gynecology and Obstetrics) Support for media work Training and technical support related to maternal mortality audits Technical support related to the development of clinical guidelines Training and support for advocacy
Operational capacity
Performance
External relations and how the HPA is perceived
Functions
Abbreviations: FIGO LOGIC, International Federation of Gynecology and Obstetrics Leadership in Obstetrics and Gynecology for Impact and Change; HPA, health professional association. a As defined by the Society of Obstetricians and Gynaecologists of Canada Organizational Capacity Improvement Framework.
2.4. Statistical analysis Data were analyzed using Stata version 13.1 (Stata Corp LP, College Station, TX, USA). The sum of the scores for the five core dimensions for each HPA was used as a simple index of its overall capacity. Differences in scores before and after intervention in the overall index and in each of the five OCIF dimensions were evaluated using the twosided sign test. A P value of 0.05 for the change in the overall index was considered statistically significant.
Fig. 1. Capacity building: Culture. The core dimension of culture was assessed at baseline (2010) and at the end of the FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health (2013).
in advancing professional practice was particularly strengthened—a finding that reflects the innate expertise of the officers and members of the HPAs. Modest gains were made in the core dimensions of performance and external relations and perceptions; individual HPAs had either improved their organizational capacity by one level or else had made some gains within the original capacity level. An in-depth review was conducted of the organizational changes associated with the core dimension of functions. All HPAs had improved their membership services; increased their activities related to the promotion of quality and standard of care and advancement of professional practice; and used their knowledge to influence policy and practice. These gains in turn raised credibility and enabled HPAs to increase their contribution to national efforts to meet MDGs 4 and 5. Within the duration of FIGO LOGIC, all HPAs proved successful in gaining official recognition as the technical partners of choice by their respective ministries of health. In addition, HPAs were able to increase the scope and number of collaborations in the field of reproductive medicine and MNH. For example, through the development and dissemination of clinical practice guidelines; in-service training of health professionals; review of curricula; technical support for initiatives implemented by other development partners; and public education activities. Finally, HPAs assumed leadership in the promotion of innovative practices recognized to improve MNH, such as maternal mortality and near-miss review.
3. Results There was a significant increase in the overall index (P = 0.017). There were increases among four of the five OCIF dimensions: culture (P = 0.016), operational capacity (P = 0.016), performance (P = 0.03), and functions (P = 0.016). At face value these differences are also significant, but the P values are products of multiple testing and should be treated with caution. The difference in “external relations and how the HPA is perceived” was not statistically significant (P = 0.25). Overall these data provide good evidence that participating HPAs enhanced their organizational capacity with the support of FIGO LOGIC, although the OCIF dimension of external relations and perceptions remains a work in progress. As shown in Figs. 1–5, the semi-quantitative data derived from the self-assessments indicated that the major gains were in the core dimensions of culture, operational capacity, and functions. These dimensions were all increased by at least one or two capacity levels (e.g. from basic to moderate or from basic to intermediate). The HPAs considerably enhanced their vision, mission, and values within the dimension of culture. Increased operational capacity was observed in the areas of strategy and financial management, with four of the seven HPAs starting from a very low baseline. In the dimension of functions, capacity
Fig. 2. Capacity building: Operational capacity. The core dimension of operational capacity was assessed at baseline (2010) and at the end of the FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health (2013).
L. Perron et al. / International Journal of Gynecology and Obstetrics 127 (2014) S6–S9
Fig. 3. Capacity building: Performance. The core dimension of performance was assessed at baseline (2010) and at the end of the FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health (2013).
S9
Fig. 5. Capacity building: Functions. The core dimension of functions was assessed at baseline (2010) and at the end of the FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health (2013).
4. Discussion and conclusion
Acknowledgments
The results of the OCIF self-assessments demonstrated that the strategy applied within FIGO LOGIC had provided HPAs with the guidance and support required to initiate or continue organizational capacity building processes. In turn, increased organizational capacity contributed to the ability of HPAs to enhance their credibility and assume greater leadership in national and collaborative MNH initiatives. Although the long-term sustainability of these capacity building efforts remains to be demonstrated, the available evidence suggests the HPAs that participated in FIGO LOGIC have laid the organizational foundations required to support future growth. The strengths of the OCIF lie in its dual ability to enable an HPA to understand the basic concepts of capacity building while at the same time initiating capacity building actions. The structured approach of the OCIF permits HPAs to develop and implement action plans that can incrementally enable strategically selected capacity areas aligned with current organizational priorities, programs, and projects to be strengthened or improved. However, two key limitations of the OCIF should be highlighted. First, sophisticated tools for self-assessment, monitoring, and evaluation must be designed for HPAs with high capacity. Second, the self-assessment technique might be enriched by the addition of an external assessment. Supporting the capacity building efforts of HPAs, particularly among countries with poor MNH outcomes, represents an innovative and sustainable approach to meeting MDGs 4 and 5.
The contributors to the present article go beyond the authors listed above to include leaders of the eight member associations involved in the FIGO LOGIC initiative who trusted the process and committed to initiating capacity building processes within their respective associations. These included representatives of the Society of Gynaecologists and Obstetricians of Burkina Faso; The Society of Gynecologists and Obstetricians of Cameroon; The Ethiopian Society of Obstetricians and Gynecologists; The Federation of Obstetric and Gynaecological Societies of India; The Mozambican Association of Obstetricians and Gynaecologists; The Nepal Society of Obstetricians and Gynaecologists; The Society of Gynaecology and Obstetrics of Nigeria; and The Association of Obstetricians and Gynaecologists of Uganda. The authors acknowledge the financial support of the Bill and Melinda Gates Foundation and the Society of Obstetricians and Gynaecologists of Canada who made their framework, tools, and experience available for the capacity building component of FIGO LOGIC. In addition, the authors thank Professor Colin Sanderson for assistance and advice with the statistical analysis. Conflict of interest The authors have no conflicts of interest. References [1] Fauveau V, Sherratt DR, de Bernis L. Human resources for maternal health: multipurpose or specialists? Hum Resour Health 2008;6:21. [2] Partnership for Maternal, Newborn and Child Health. Joint statement: Health professional groups key to reaching MDGs 4 and 5. http://www.who.int/pmnch/ events/2006/HCPjointstaterev0102207.pdf. Published 2007. Accessed July 8, 2014. [3] Partnership for Maternal, Newborn and Child Health. Statement by the HCPA Constituency – PMNCH Forum. Published 2011 http://www.who.int/pmnch/events/ partners_forum/20101120_hcpaconstituency_statement.pdf?ua=1; 2010. Accessed August 1, 2014. [4] World Health Organization, UNICEF, UNFPA, The World Bank. Trends in Maternal Mortality: 1990 to 2010.. WHO, UNICEF, UNFPA, and The World Bank Estimates Geneva: WHO; 2012. http://whqlibdoc.who.int/publications/2012/9789241503631_ eng.pdf?ua=1. [5] International Federation of Gynecology and Obstetrics. Strategic plan 2013–2016. Published 2013 http://www.figo.org/files/figo-corp/FIGO%20Strategic%20Plan% 202013%20-%202016%20For%20the%20Website.pdf. Accessed August 1, 2014. [6] Lalonde AB, Senikas V, Bateson DS, Perron L. SOGC Partnership Program 1998–2006: Building organization capacity to support improved maternal and neonatal health. J Obstet Gynaecol Can 2008;30(11):1014–24. [7] Society of Obstetricians and Gynaecologists of Canada. Strengthening organizational capacity of professional health associations. Ottawa, Canada: SOGC; 2009.
Fig. 4. Capacity building: External relations and perception. The core dimension of external relations and how the health professional association is perceived was assessed at baseline (2010) and at the end of the FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health (2013).
Contents lists available at ScienceDirect
International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo
FIGO LOGIC INITIATIVE
United Nations Millennium Development Goals 4 and 5: Augmenting the role of health professional associations Liette Perron a,⁎, Bart Vander Plaetse b, David Taylor b a b
Society of Obstetricians and Gynaecologists of Canada, Ottawa, Canada International Federation of Gynecology and Obstetrics, London, UK
a r t i c l e
i n f o
Keywords: Africa Asia FIGO LOGIC initiative Health professional associations Maternal and newborn health Millennium Development Goals Organizational capacity building
a b s t r a c t The present study aimed to assess changes in the organizational capacity of health professional associations (HPAs) before and after a structured capacity building intervention, which included strategic investment of resources at institutional and technical levels. Self-assessments of organizational capacity were conducted by seven HPAs from low-resource countries involved in the FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health. The self-assessment tool comprised a questionnaire focusing on five core organizational dimensions, completed through a participatory and externally facilitated process. Differences were assessed using the two-sided sign test. All seven HPAs made improvements, with gains in an overall index (P = 0.017) and in the specific dimensions of culture (P = 0.016), operational capacity (P = 0.016), performance (P = 0.03), and functions (P = 0.016). Increased capacity contributed to the ability of each HPA to enhance their credibility and assume leadership in national efforts to improve maternal and newborn health. © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
1. Introduction The global movement to accelerate progress toward reaching the United Nations Millennium Development Goals (MDGs) related to newborn, child, and maternal health (MDGs 4 and 5) mobilized a variety of new partners, including health professional associations (HPAs) [1]. The involvement of HPAs is most apparent in the Partnership for Maternal, Newborn and Child Health whereby relevant societies formed their own official constituency group and used this forum to define their specific contribution to the sector, share knowledge and skills, coordinate their activities, and, in some instances, pool resources. The HPAs recognized their unique leadership role in influencing clinical practice at a service delivery level and as advocates for policy and legislative changes, including increased priority and investment in maternal and newborn health (MNH) [2,3]. The HPAs also acknowledged that for many professional societies, the ability to assume a leadership role—especially in low-resource countries—was contingent on the ability to strengthen overall organizational capacity to achieve goals and objectives in support of their mission and strategic directions [2]. Although maternal mortality rates are declining, the rates in lowresource countries remain high, particularly in Sub-Saharan Africa and South Asia, which account for 85% of maternal deaths globally [4].
⁎ Corresponding author at: Society of Obstetricians and Gynaecologists of Canada, 780 Echo Drive, Ottawa, ON K1S 5R7, Canada. Tel.: +1 613 730 4192; fax: +1 613 730 4314. E-mail address: [email protected] (L. Perron).
Consequently, the International Federation of Gynecology and Obstetrics (FIGO) resolved to accelerate its efforts and activities in the area of MNH. Recognizing the limited organizational capacity of some member HPAs, particularly those in countries where MNH outcomes were among the poorest worldwide, FIGO committed to support capacity building efforts as a means to enable them to assume leadership in the field [5]. In 2009, FIGO launched the Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in MNH. Funded by the Bill and Melinda Gates Foundation, FIGO LOGIC aimed to contribute to the improvement of MNH policy and practice by strengthening the organizational capacity of member HPAs. The project was implemented in eight countries in Sub-Saharan Africa (Burkina Faso, Cameroon, Ethiopia, Mozambique, Nigeria, and Uganda) and South Asia (India and Nepal). 2. Methods 2.1. Organizational Capacity Improvement Framework The capacity development process was guided by the Society of Obstetricians and Gynaecologists of Canada (SOGC) Organizational Capacity Improvement Framework (OCIF), a tool developed by SOGC to support its own capacity building efforts with peer obstetrics and gynecology associations from low-resource countries. The OCIF defines capacity as “the ability of an individual, an organization, or a system to perform planned functions effectively, efficiently and sustainably” and
http://dx.doi.org/10.1016/j.ijgo.2014.08.004 0020-7292/© 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
L. Perron et al. / International Journal of Gynecology and Obstetrics 127 (2014) S6–S9
capacity development as the means by which “the abilities and elements to succeed are obtained, strengthened, adapted and maintained in a sustainable manner over time” [6]. The tool devised by SOGC employs a “learn as you apply” approach. Consequently, users acquire understanding of the basic concepts of capacity development and its link to strong and sustainable HPAs; at the same time, they initiate capacity building actions within their own organizations. The OCIF includes four key elements: capacity assessment; data analysis; development of a capacity improvement plan; and implementation and performance measurement of the improvement plan in an integrated manner. The four OCIF elements are linked sequentially in 3- to 5-year cycles to enable managed capacity development that is aligned with the HPA’s goals, objectives, and strategic priorities. Each cycle builds on the previous one to incrementally progress the HPA toward a state of increased integrated capacity [7]. The OCIF enables HPAs to consider and take action on five core dimensions: culture; operational capacity; performance; external relations and how the HPA is perceived; and functions (Table 1). Critical to the success of the OCIF are the organizational capacity selfassessment exercises completed at the beginning and end of each cycle by representatives of the HPA. These exercises permit each HPA to determine its level of capacity (rated basic, moderate, intermediate, or high) in the five core dimensions. In addition, self-assessment facilitates the identification of organizational strengths and weaknesses, establishes the priorities of the HPA, and aids the development of an improvement plan. The results from each exercise also provide baseline data that can be used for monitoring and evaluation throughout the capacity building cycle. 2.2. Application of the Organizational Capacity Improvement Framework Within FIGO LOGIC, the OCIF was used to support the participating HPAs in the completion of a 3-year cycle of organizational capacity development. This approach was coupled with investment of technical and financial resources to strengthen capacity at both institutional and technical levels by: • Facilitating the baseline organizational capacity assessments and the development of HPA improvement plans.
S7
• Providing financial and technical support for the implementation of improvement plans to progress HPAs toward increased capacity. • Providing financial and technical support for activities that were not immediately part of the implementation plan but allowed HPAs to undertake policy and practice initiatives in parallel with improvements made at the organizational level. • Facilitating end-of-project organizational capacity exercises (Table 2). The results of the initial and end-of-project self-assessments were used to evaluate organizational change developed during the program.
2.3. The self-assessment process Self-assessments of organizational capacity at baseline (2010) and end-of-project (2013) were facilitated by SOGC among seven of the eight HPAs involved in FIGO LOGIC. Although the HPA in India did complete an initial assessment, it was not included in the study because it had already reached the target capacity from the onset of the FIGO LOGIC initiative. These exercises were completed through participatory two-day workshops that brought together members of each HPA’s Board and/or Executive Committee, other HPA leaders, and project staff. Assessment workshops were led by a SOGC consultant familiar with the OCIF and its tools and with experience in supporting the capacity development efforts of HPAs from low-resource countries. The workshops were designed to: • Provide an opportunity for all participants to gain knowledge and understanding about capacity development and what makes HPAs strong and sustainable. • Complete the OCIF self-assessment tool as a group. • Use the results to inform the development of the HPA improvement plans. The self-assessment tool comprised a questionnaire of approximately 150 items that were specifically designed to allow society leaders to consider their HPA across the core dimensions and capacity areas of the OCIF (Table 1). A combined score of 0–4 was attributed to each question and a short narrative provided to justify the score given.
Table 1 Core organizational dimensions and capacity areas.a Core organizational dimension
Description
Capacity areas
Culture
Focuses on what motivates an HPA to succeed, function, and survive
Operational capacity
Represents a complex relationship of eight core areas that support the ability of an HPA to perform, remain relevant, to grow, and to survive
Performance
Examines four areas that relate to the ability of an HPA to meet its goals and objectives and remain viable
External relations and how the HPA is perceived
Addresses four areas reflecting the reality that HPAs are not isolated entities but are affected by their environment and context
Functions
Addresses four essential functions of HPAs
Mission and vision Values Rewards and incentives Governance Leadership in management Strategy Financial management Human resources Program and project management Communication Infrastructure Effectiveness Efficiency Relevance Financial position Rules and norms Legal and political framework Linkages and network Ownership and participation Membership services Promoting quality and standard of care Advancing professional practice Influencing medical practice and health policy
Abbreviation: HPA, health professional association. a As defined by the Society of Obstetricians and Gynaecologists of Canada Organizational Capacity Improvement Framework.
S8
L. Perron et al. / International Journal of Gynecology and Obstetrics 127 (2014) S6–S9
Table 2 Capacity building activities supported by the FIGO LOGIC Initiative in Maternal and Newborn Health. Core organizational dimensiona
Capacity building activity
Culture
Definition of mission, vision, and organizational values within the context of strategic planning exercises Means by which to promote the mission, vision, and organizational values of the HPA both internally and externally Reviews of constitutions and bylaws Strategic planning exercises Establishment and/or upgrades of national secretariats Support for the recruitment of core HPA staff Development of administrative policies and procedures (e.g. human resources and financial) Establishment of computerized accounting systems Training opportunities (e.g. financial management, project design, and management) Training and technical support related to project management Financial sustainability workshops and discussions Support to lead or participate in meetings with other stakeholders in the field Support to participate in international meetings (e.g. FIGO World Congress of Gynecology and Obstetrics) Support for media work Training and technical support related to maternal mortality audits Technical support related to the development of clinical guidelines Training and support for advocacy
Operational capacity
Performance
External relations and how the HPA is perceived
Functions
Abbreviations: FIGO LOGIC, International Federation of Gynecology and Obstetrics Leadership in Obstetrics and Gynecology for Impact and Change; HPA, health professional association. a As defined by the Society of Obstetricians and Gynaecologists of Canada Organizational Capacity Improvement Framework.
2.4. Statistical analysis Data were analyzed using Stata version 13.1 (Stata Corp LP, College Station, TX, USA). The sum of the scores for the five core dimensions for each HPA was used as a simple index of its overall capacity. Differences in scores before and after intervention in the overall index and in each of the five OCIF dimensions were evaluated using the twosided sign test. A P value of 0.05 for the change in the overall index was considered statistically significant.
Fig. 1. Capacity building: Culture. The core dimension of culture was assessed at baseline (2010) and at the end of the FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health (2013).
in advancing professional practice was particularly strengthened—a finding that reflects the innate expertise of the officers and members of the HPAs. Modest gains were made in the core dimensions of performance and external relations and perceptions; individual HPAs had either improved their organizational capacity by one level or else had made some gains within the original capacity level. An in-depth review was conducted of the organizational changes associated with the core dimension of functions. All HPAs had improved their membership services; increased their activities related to the promotion of quality and standard of care and advancement of professional practice; and used their knowledge to influence policy and practice. These gains in turn raised credibility and enabled HPAs to increase their contribution to national efforts to meet MDGs 4 and 5. Within the duration of FIGO LOGIC, all HPAs proved successful in gaining official recognition as the technical partners of choice by their respective ministries of health. In addition, HPAs were able to increase the scope and number of collaborations in the field of reproductive medicine and MNH. For example, through the development and dissemination of clinical practice guidelines; in-service training of health professionals; review of curricula; technical support for initiatives implemented by other development partners; and public education activities. Finally, HPAs assumed leadership in the promotion of innovative practices recognized to improve MNH, such as maternal mortality and near-miss review.
3. Results There was a significant increase in the overall index (P = 0.017). There were increases among four of the five OCIF dimensions: culture (P = 0.016), operational capacity (P = 0.016), performance (P = 0.03), and functions (P = 0.016). At face value these differences are also significant, but the P values are products of multiple testing and should be treated with caution. The difference in “external relations and how the HPA is perceived” was not statistically significant (P = 0.25). Overall these data provide good evidence that participating HPAs enhanced their organizational capacity with the support of FIGO LOGIC, although the OCIF dimension of external relations and perceptions remains a work in progress. As shown in Figs. 1–5, the semi-quantitative data derived from the self-assessments indicated that the major gains were in the core dimensions of culture, operational capacity, and functions. These dimensions were all increased by at least one or two capacity levels (e.g. from basic to moderate or from basic to intermediate). The HPAs considerably enhanced their vision, mission, and values within the dimension of culture. Increased operational capacity was observed in the areas of strategy and financial management, with four of the seven HPAs starting from a very low baseline. In the dimension of functions, capacity
Fig. 2. Capacity building: Operational capacity. The core dimension of operational capacity was assessed at baseline (2010) and at the end of the FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health (2013).
L. Perron et al. / International Journal of Gynecology and Obstetrics 127 (2014) S6–S9
Fig. 3. Capacity building: Performance. The core dimension of performance was assessed at baseline (2010) and at the end of the FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health (2013).
S9
Fig. 5. Capacity building: Functions. The core dimension of functions was assessed at baseline (2010) and at the end of the FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health (2013).
4. Discussion and conclusion
Acknowledgments
The results of the OCIF self-assessments demonstrated that the strategy applied within FIGO LOGIC had provided HPAs with the guidance and support required to initiate or continue organizational capacity building processes. In turn, increased organizational capacity contributed to the ability of HPAs to enhance their credibility and assume greater leadership in national and collaborative MNH initiatives. Although the long-term sustainability of these capacity building efforts remains to be demonstrated, the available evidence suggests the HPAs that participated in FIGO LOGIC have laid the organizational foundations required to support future growth. The strengths of the OCIF lie in its dual ability to enable an HPA to understand the basic concepts of capacity building while at the same time initiating capacity building actions. The structured approach of the OCIF permits HPAs to develop and implement action plans that can incrementally enable strategically selected capacity areas aligned with current organizational priorities, programs, and projects to be strengthened or improved. However, two key limitations of the OCIF should be highlighted. First, sophisticated tools for self-assessment, monitoring, and evaluation must be designed for HPAs with high capacity. Second, the self-assessment technique might be enriched by the addition of an external assessment. Supporting the capacity building efforts of HPAs, particularly among countries with poor MNH outcomes, represents an innovative and sustainable approach to meeting MDGs 4 and 5.
The contributors to the present article go beyond the authors listed above to include leaders of the eight member associations involved in the FIGO LOGIC initiative who trusted the process and committed to initiating capacity building processes within their respective associations. These included representatives of the Society of Gynaecologists and Obstetricians of Burkina Faso; The Society of Gynecologists and Obstetricians of Cameroon; The Ethiopian Society of Obstetricians and Gynecologists; The Federation of Obstetric and Gynaecological Societies of India; The Mozambican Association of Obstetricians and Gynaecologists; The Nepal Society of Obstetricians and Gynaecologists; The Society of Gynaecology and Obstetrics of Nigeria; and The Association of Obstetricians and Gynaecologists of Uganda. The authors acknowledge the financial support of the Bill and Melinda Gates Foundation and the Society of Obstetricians and Gynaecologists of Canada who made their framework, tools, and experience available for the capacity building component of FIGO LOGIC. In addition, the authors thank Professor Colin Sanderson for assistance and advice with the statistical analysis. Conflict of interest The authors have no conflicts of interest. References [1] Fauveau V, Sherratt DR, de Bernis L. Human resources for maternal health: multipurpose or specialists? Hum Resour Health 2008;6:21. [2] Partnership for Maternal, Newborn and Child Health. Joint statement: Health professional groups key to reaching MDGs 4 and 5. http://www.who.int/pmnch/ events/2006/HCPjointstaterev0102207.pdf. Published 2007. Accessed July 8, 2014. [3] Partnership for Maternal, Newborn and Child Health. Statement by the HCPA Constituency – PMNCH Forum. Published 2011 http://www.who.int/pmnch/events/ partners_forum/20101120_hcpaconstituency_statement.pdf?ua=1; 2010. Accessed August 1, 2014. [4] World Health Organization, UNICEF, UNFPA, The World Bank. Trends in Maternal Mortality: 1990 to 2010.. WHO, UNICEF, UNFPA, and The World Bank Estimates Geneva: WHO; 2012. http://whqlibdoc.who.int/publications/2012/9789241503631_ eng.pdf?ua=1. [5] International Federation of Gynecology and Obstetrics. Strategic plan 2013–2016. Published 2013 http://www.figo.org/files/figo-corp/FIGO%20Strategic%20Plan% 202013%20-%202016%20For%20the%20Website.pdf. Accessed August 1, 2014. [6] Lalonde AB, Senikas V, Bateson DS, Perron L. SOGC Partnership Program 1998–2006: Building organization capacity to support improved maternal and neonatal health. J Obstet Gynaecol Can 2008;30(11):1014–24. [7] Society of Obstetricians and Gynaecologists of Canada. Strengthening organizational capacity of professional health associations. Ottawa, Canada: SOGC; 2009.
Fig. 4. Capacity building: External relations and perception. The core dimension of external relations and how the health professional association is perceived was assessed at baseline (2010) and at the end of the FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health (2013).
