This chapter illustrates what capacities are, the meaning of capacity building and development and why they are important.
- Capacities emphasize the organizational, human, financial and other resources, which enable actions to be taken by responsible authorities to improve health and reduce health inequalities (Aluttis et al, 2013).
- Capacity development highlights how capacities change over time, the process through which individuals, organizations, and societies obtain, strengthen, and maintain the capabilities to set and achieve their own development objectives over time (UNDP, 2008).
- Capacity building is sometimes used interchangeably with capacity development although it refers only the initial stages of building or creating capacities and alludes to an assumption that there are no existing capacities to start from. It is therefore less comprehensive than capacity development (UNDP, 2008).
Knowledge is important, but not enough. Previous approaches to stimulating development and change at an individual / organizational / institutional / local or national level were often limited to the provision of knowledge, making the assumption that actions / interventions would be adapted to additional information and better knowledge. But while knowledge and know-how are critical, they are not compelling enough.
An adjustment in knowledge will not occur provided that individuals / organizations / other actors in the institutional framework are unwilling or not allowed to implement the change, or are confronted with external limitations (e.g. lack of resources; Sida, 2000)(Table 5). Capacity building and development strategies have to take this into account.
|Don’t know what to do (=lack of knowledge)||Don’t want to do it, or not allowed to do it||External limitations (money or material)|
|The institutional framework|
Assets, participation and commitment. One limitation of development policies is the assumption that technical advice and expertise provided by external supervisors would be sufficient. It is not only in development policies that such approaches have often proved unsuccessful; it becomes imperative that: a) capacities should be developed by taking existing capacities or assets (strengths) into account and b) stakeholders should participate in the development of capacities (UNPD 2008).
Within the Health Equity 2020 Project, administrative divisions such as regions, districts and municipalities are involved in developing and implementing policies that can reduce health inequities. Reducing health inequities means planning and implementing changes to the factors which create or reduce them, and capacities have to be built and developed to make these changes possible.
With regard to capacity building and development, two approaches with distinctive scopes can be identified:
A focused approach to develop capacities for strategies or programmes to improve health equity.
To address health inequities, regions need to build and enhance their capacities to deliver services or other kinds of activities. This targets not only (public) health services, but also (health) education, transport, housing, architecture, social security etc.Capacity building and development is linked to the development of programme responses to either particular health problems or an enlargement of an existing programme. It can also refer to problem-solving capabilities of organizations and communities (“capacity of a more generic kind to identify health issues and develop appropriate mechanisms to address them”, NSW 2001).This approach is particularly useful for Policy Officers, Technical Officers, Health Professionals and Health Care Service Providers.
Integral whole approach to enhance system capability to improve health equity.
An whole approach to enhance system capability to improve health equity looks at the “big picture”. It builds on the previous focused approach but deepens the discussion by correlating gaps and needs with strategic capacities necessary to lead the change process (e.g. by looking at the enabling environment, institutional / organizational issues, technical or functional capacities).Therefore, reducing health inequities also implies: addressing capacity building and development at the level of capabilities to coordinate, plan and implement programmes and projects to address health inequities.
As part of the Health Equity 2020 project, regions are encouraged to establish a Regional Action Group (RAG) with representatives from different sectors, e.g. regional planning, public health and management authorities for the European Structural Funds. This is a concrete approach designed to build and develop capacities for programmes and projects addressing the development of capacities for the provision of services and activities that have a direct impact on health.
Setting up Regional Action Groups and developing and implementing a regional action plan are important steps in capacity building and development to reduce health inequities at a regional level.