The CEDARS Center / SHOUT Group Blog

The CEDARS Center / SHOUT Group Blog
Return to CEDARS' Home Page.
Join the SHOUT Group by registering on CEDARS to be allowed to upload projects and experiences.
Contribute to this blog.

Thursday, December 3, 2015

Scenario Planning for Development

CEDAR's Sustainability Framework has long talked about the importance of planning for various scenarios by taking the long view in project planning, management, and evaluation activities, reiterated again in a recent paper by Eric Sarriot et al., A causal loop analysis of the sustainability of integrated community case management in Rwanda which also studied scenarios.

As Wilson Center's New Security Beat writes in its article Scenario Planning for Development: It's About Time, "scenario planning systematically looks at existing and emerging trends and their plausible - though sometimes unlikely - combinations in order to reduce risk. It's an exercise that does not produce single point predictions, but examines a range of possible situations to help prepare for the unexpected."

It's interesting, and heartening, to see USAID changing its approach to development over the last few years by incorporating longer term goals, "adaptive programming" to better respond to external influences such as natural disasters, disease outbreaks, or shifts in governance structures, and increasing focus on "exit pathways". New Security Beat writes of these adaptive approaches that are increasingly embraced, in line with and in response to the rise in uncertainty, preparedness/response shortfalls, and growing complexity. This indeed seems a direction to impact development work for years to come.

Read more about scenario planning and its increasing use by USAID here.

Tuesday, December 1, 2015

Social accountability - review of existing literature and learning

Social accountability is an essential element to improving health outcomes and facilitating health sector reform. The following links provide two important summaries of some literature on the topic. 
CORE Group

 This review discusses three social accountability models used in various sectors at community, district, and national levels, to increase accountability and improve health outcomes. The approaches reviewed, analyzed, and described are: (1) Citizen Voice and Action, implemented by World Vision; (2) Partnership Defined Quality, implemented by Save the Children; (3) and the Community Score Card, implemented by CARE.

Voice and Accountability in the Health Sector
Health & Education Advice & Resource Team (HEART)

This resource by HEART is a nice and concise review of key peer publications of voice and accountability in the health sector, assessing specific initiatives in the health sector, using Bangladesh as a country example, and providing available models for increasing social accountability.

Wednesday, November 25, 2015

Training Opportunity

CEDARS tends to focus on health-in-development and related topics, and we have focused a lot of attention on design, management and evaluation processes to enhance sustainability, making use of quantitative data as much as possible, while being firmly anchored in implementation.

Here's however a major training opportunity for people who are interested in the hard science, the quantitative underpinnings of some of the major issues in sustainability. No better place to do it than the Santa Fe Institute. The focus is on urban sustainability, but it's probably a good opportunity to learn about methodologies which we need to pay more attention to.

Here's to the young innovators ready to learn new things. And if you're not that young, you just qualified by virtue of thirsting to learn.

Check out the course information here.


Friday, January 30, 2015

General Relativity Comes to Global Health—thinking about sustain-scale in health systems interventions

ICF International Center for Design and Research in Sustainability | Sustainable Health & Human Development (CEDARS), January 2015

A metaphor for sustain-scale?
I want to offer a metaphor to question some of  the ways that we, as the global health  community, have been talking about and dealing  with two concepts: sustainability and scale.

I need to start with a little bit of recent history…

Tuesday, November 4, 2014

Resources for adaptive management practices and cost-effectiveness in development

We recently added two new documents to our CEDARS Center resource repository to help development professionals think about adaptive management practices and program cost-effectiveness during implementation, planning, or evaluation.

Have a read through below and click through the links. As always, should you have comments or questions (or additional resources we can share with the sustainable health and human development community), do not hesitate to reach out to us.

Navigating Complexity: Adaptive Management at the Northern Karamoja Growth, Health, and Governance Program [document available here]

This paper, by Engineers Without Borders Canada, under contract with Mercy Corps (MC), is a case-study regarding adaptive management practices within Mercy Corps’ (USAID-funded) project, Growth, Health & Governance Program (GHG). The paper covers building the culture necessary for learning and adaptation, discusses some tools and processes that support adaptation, and some implications for funders and practitioners. Throughout the document, culture is emphasized as the most important factor to be successful in adaptive management and provides strategies and attitudes deemed necessary in achieving this culture. The tools and processes are presented with the purpose of reinforcing the described culture. One of the tools, the Results Chain, is an interesting way of conceptualizing the path to reaching the goals of the project and is similar to a results framework.

A blog post, with a summary is available here:

Cost-Effectiveness Measurement in Development: Accounting for Local Costs and Noisy Impacts [document available here]

This policy research working paper from the World Bank Group, Africa Region, can help individuals think about cost-effectiveness within their programs from implementation, planning, or evaluation perspectives. As evidence from rigorous impact evaluations grows in development, there have been more calls to complement impact evaluation analysis with cost analysis, so that policy makers can make investment decisions based on costs as well as impacts. This paper discusses important considerations for implementing cost-effectiveness analysis in the policy making process. The analysis is applied in the context of education interventions, although the findings generalize to other areas. First, the paper demonstrates a systematic method for characterizing the sensitivity of impact estimates. Second, the concept of context-specificity is applied to cost measurement: program costs vary greatly across contexts -- both within and across countries -- and with program complexity. The paper shows how adapting a single cost ingredient across settings dramatically shifts cost-effectiveness measures. Third, the paper provides evidence that interventions with fewer beneficiaries tend to have higher per-beneficiary costs, resulting in potential cost overestimates when extrapolating to large-scale applications. At the same time, recall bias may result in cost underestimates. The paper also discusses other challenges in measuring and extrapolating cost-effectiveness measures. For cost-effectiveness analysis to be useful, policy makers will require detailed, comparable, and timely cost reporting, as well as significant effort to ensure costs are relevant to the local environment.

You can find additional information on this paper here:

Tuesday, September 2, 2014

Learning from a post-project evaluation study, applying systems thinking and addressing complexity in community health

By Michelle Kouletio

It doesn't happen enough, but every once in a while a seed of a sustainable health intervention is planted in the ground.  In this case, the seed was planted at the doorstep of a mayor's office in northwestern Bangladesh, amid narrow, busy roads with open sewers of common of bustling secondary cities. Among the middle class families live the extreme poor.  Along with several other challenges, the poor are failed by the government health system whose facilities are overwhelmed by patient volume and whose outreach workers do not serve.   While national policy assigned elected municipal leaders with responsibility for ensuring coverage of equitable health services, these leaders were provided little guidance nor resources.

With support from the USAID Child Survival and Health Grants Program, Concern Worldwide worked in this and other municipalities in Bangladesh to empower municipal leaders to develop a replicable model for social mobilization in complex urban environments. What made this project unique from so many well intended and ambitious community health projects was the embedment of a systematic sustainability planning and monitoring system that established a shared vision and measurement framework across the Mayor’s office, elected representatives, service providers, social leaders and health volunteers along with the project team.

As the technical advisor for Concern Worldwide, I had the privilege of backstopping this initiative.  It took quite of bit of extra effort, particularly in developing practical capacity measuring tools from scratch and maintaining regular reviews at the neighborhood and municipality level. Sustainability planning also required tackling structural barriers and inter-ministerial relations which could have otherwise been ignored in a conventional project. However, the benefits of this deeper analysis and shared accountability approach resulted in real improvements in equitable health outcomes and an enduring political mobilization approach that allowed the population to continue reaping benefits years after the project closed.

Two recently published articles on this work further validate the importance of the hard work of the Concern Worldwide staff in Bangladesh and their contribution to the developing body of evidence on adaptive health systems and sustainability planning:

Post-script from Eric Sarriot:

These two papers coincide in their release to form a useful series on the Concern CSHGP Bangladesh experience. The first one is part of a larger and important Supplement of Health Research Policy and Systems on Systems Thinking in Health, coordinated by Taghreed Adam of WHO’s Alliance for Health Policy and Systems Research.

Thursday, August 21, 2014

Putting vulnerability first – the need to revise targeting and delivering aid to promote sustainability and resilience

By Debra Prosnitz, MPH

The Humanitarian Policy Research Group (HPG) recently released a policy brief on resilience: Political flag or conceptual umbrella? Why progress on resilience must be freed from the constraints of technical arguments (1). Reading this brief, I began to reflect on the relationship between resilience and sustainability. In the context of development, resilience should address ability to cope and recover from crisis, and the sustainability should address the process of strengthening social capital to sustain progress in health, social progress, etc. (2). If sustainability is a process, perhaps resilience is one of the outcomes. I decided that the importance of this topic deserved a CEDARS blog update.

In this short (4-page) brief, Simon Levine succinctly captures two approaches to addressing resilience, brings to light the stalemate and consequent inaction in which they are stuck, and suggests a new way forward in theory through action (3).

Levine discusses two “broad arguments” for addressing resilience, both of which, he argues, distract us from the underlying need to identify and understand vulnerabilities of individuals and communities, and find ways to address these vulnerabilities: The political argument convinces us that something needs to be done - “since the shocks and stresses that cause crises cannot be prevented, the task is to ensure that people are better able to cope when things do go wrong,” and the technical argument calls for a refined definition of resilience and new approaches for addressing it because what has previously been implemented has not adequately addressed the complexity and challenges of resilience, such as climate change. While we may not yet know the best way to define resilience or the best strategies and approaches to address it, we must not let this stop or delay efforts to do so.  We know that vulnerabilities exist and should be addressed, and should move forward by identifying and understanding vulnerabilities of individuals and communities, and findings ways to address these vulnerabilities.

Resilience then—even if imperfectly conceptualized--can already be enhanced by ensuring that “vulnerabilities are the center of development policy and investment,” and that marginalization be addressed and minimized through development; resilience should not become another sector of development. Thus, Levine suggests that the definition of and theoretical framework for resilience can be developed and refined through action (rather than delaying action pending conceptual clarity).

While Levine addresses the complexity of development and the “structural, institutional and bureaucratic obstacles” to making change to how development aid is targeted and delivered, I wish he had made a clearer link between resilience and sustainability. I’m envisioning resilience as a pillar of sustainability, because while we can’t predict which shock will occur, the occurrence of shocks and changes following even the best of our interventions is almost a certainty. Further, neither resilience nor sustainability can be achieved by external intervention and leadership alone. Community involvement should be a prerequisite for approaching both, with communities and individuals leading efforts to identify vulnerabilities and define resilience.

Levine’s brief is a glimpse into larger bodies of work he has published on this subject (4), which can also be found on the HPG website. Whatever your stance on resilience as a concept, this paper is an important reminder of the old adage not to let the perfect become the enemy of the good; we should not be complacent in our thinking about models of aid delivery, and should be actively thinking about and advocating for changes in the way in which aid is both targeted and delivered. Vulnerability should be the primary criteria, with aid targeted toward the most vulnerable first and delivered in a way that bolsters resilience.  

(1) S. Levine, Political flag or conceptual umbrella? Why progress on resilience must be freed from the constraints of technical arguments. Policy Brief 60. Humanitarian Policy Research Group (London: ODI, 2014).
(2) Sarriot, et al. Taking the Long View: A Practical Guide to Sustainable Planning and Measurement in Community Oriented Health Programming. Macro International, Inc. (Calverton, MD, 2008) defined sustainability as “a process that advances conditions that enable individuals, communities, and local organizations to improve their functionality, develop mutual relationship of support and accountability, and decrease dependent on insecure resources…(and) enables local stakeholders to play their respective roles effectively, thus maintaining gains in health and development…”
(3) As our fearless CEDARS leader Eric Sarriot summed it up “praxis can improve without a perfect epistemology.” 
(4) S. Levine, Assessing resilience: why quantification misses the point. Humanitarian Policy Group Working Paper. (London: ODI, July 2014); and 
S. Levine and I. Mosel, Supporting Resilience in Difficult Places: A Critical Look at Applying the ‘Resilience’ Concept in Countries Where Crises Are the Norm, HPG Commissioned Paper for BMZ (London: ODI, 2014).