Annex 14.2 : Health Institution Capacity Assessment Guide

1 Program Manager, CSHGP, Bangladesh 2 Field Operation Manager, CSHGP, Bangladesh

Institutional Capacity Assessment Guide

A self-assessment process, developed on the basis of

‘Appreciative Inquiry Philosophy’ for developing capacity of municipal authority for better health services

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1Dr. Shamim Jahan, MPH 2Abdul Matin Sardar, MBA

Supported

By

Municipal Health Partnership Program Concern Worldwide, Bangladesh

TABLE OF CONTENTS

 

I.   Introduction .............................................................................................. 1 

II.  Participants ............................................................................................... 1 

III.  Materials ................................................................................................ 1 

IV.  Venue ..................................................................................................... 2 

V.  Philosophical Base ................................................................................... 2 

VI.  Key Processes ........................................................................................ 2 

VII.  Tentative Workshop Schedule ............................................................ 3 

VIII.  Detailed Lesson Plan ............................................................................ 5 

IX.  Notes for Facilitators ............................................................................ 9 

X.  Schedule of HICAP Review Workshop ............................................... 10 

Annexes Annex 1: Symbolic findings Annex II. Likert Scale: Sowing Seeds to the Bearing Fruit Tree Annex III. Capacity Assessment Tool Annex IV: Facilitators Pool in MHPP

I. Introduction

This is a guide for those who wish to facilitate a Municipal Institutional Capacity Assessment Exercise. The Municipal Capacity Assessment process has been developed on the basis of the experience of conducting a Child Survival Sustainability Assessment (CSSA) in the context of the MHPP-working municipalities in Bangladesh. The tool itself and this process were both built with the learning and experience from an original program implemented in Saidpur and Parbatipur Municipalities, which now serve as a ‘Learning Center’ for scaling up seven new municipalities in Bangladesh. The tool and this Guide are not only for MHPP-working municipalities, and are meant to be easily adaptable for use by other municipalities in Bangladesh. Appreciative Inquiry (AI) methodology serves as the philosophical base for the workshop session. The capacity assessment process itself is specifically aimed at developing the capacity of municipal authorities to ensure better health service delivery to the citizens for whom they are responsible. As such, the assessment serves as a map, guiding the municipal authority in the organizational development process by presenting a clear picture of what each step on the path would look like. The assessment focuses on crucial issues of health service delivery, and at the same time, maintains a continued focus on the capacity development process of the municipality.

The specific objectives of the Municipality Capacity Assessment process are:

1. To create a shared understanding of the capacities required for the municipality to provide better health services.

2. To determine the municipality’s present position and target position in terms of overall capacity to provide health services to the citizens of the municipality.

3. To identify a list of actions detailing the steps that need to be taken for the municipality to reach its target position, and incorporate these actions into the annual health plan of the municipality.

4. To establish a schedule to conduct follow-up or review assessments in conjunction with an annual health planning session of the municipality.

Throughout the workshop session, facilitators may make necessary adjustments to tools and to the general process, as appropriate. It is of primary importance that the facilitator actively fosters a sense of ownership of the capacity assessment process by the municipal authority (i.e. cabinet members and MHD).

II. Participants

The Pouro Parishad (Municipal Cabinet) members

The Pourashava Chairman and the Ward Commissioners and Female Commissioners for reserved seats

Pourashava Secretary

All staff of Pourashava Health Department.

III. Materials

Artline marker

Whiteboard marker

VIPP Card (4 colors)

Pens

Writing pad

Brown paper/ flip-paper

OHP with Transparency Sheet or Multimedia with computer

Cloth Duster

Tools/ handout

Name Tag (Name card holder)

Other materials as required for local context

IV. Venue The venue for the workshop should ideally have the following:

Space for 50 people to sit in a “U” or oval shape

Good hostel and dining facilities for all participants and facilitators

Minimal-to-no background noise

A comfortable temperature and amount of ventilation

A full-time power supply

Toilet facilities for both – men and women

V. Philosophical Base The workshop rests on the following philosophical beliefs:

There is no differentiation between who knows more or less, who is senior or junior, man or woman;

The dormant power of person may be transformed into great strength;

Each person is important in his or her family, society and organization. His or her own thoughts, activities are no way too small or dismissable;

Every person has intellectual power and personal strengths that motivate him or her towards various good and/or bad things. Highlighting each person’s strengh and successes stimulates future success; and

Only the people can contribute towards long-lasting, appropriate development of their society or organization.. They, rather than external forces, have that power and capability.

VI. Key Processes The contents of the workshop cover the following four main components:

1. Discovery: Through story-telling, this component probes the successful experiences of participants that inspire vision, and the key factors and themes identified in ensuring success.

2. Dream: While the above provides a basis from which to model organizational development goals and vision, dreaming enables participants to think about the organization in the future, and the specific goals an organization would like to attain.

3. Design: This component outlines the process, beginning from a baseline, by which goals, or the above dream, can be achieved.

4. Delivery or Destiny: This component involves the drafting of a detailed action plan to be implemented reach the organizational dream and goals.

VII. Tentative Workshop Schedule Day-1: Time Topic Objective Method 9:30 a.m. - 9:45 a.m.

Opening / Formal Inauguration

To respect local culture as well as municipal authority

Ceremonial

9:45 a.m. - 10:45 a.m.

Knowing Participants To explore participants’ strengths and qualities

Peer Introduction

10:45 a.m. - 11:15 a.m.

Health break

11:15 a.m. - 11:35 a.m.

Objectives and Schedule of the workshop

To acquaint participants with the workshop objectives and come to a consensus on the schedule of the workshop

Lecture-discussion with slides

11.35 a.m. - 1.00 p.m.

Participants’ Strengths: stories from real life experience

To explore existing strengths of the Municipality through sharing real life experience (Pouro Parishad and MHD staff)

Individual story telling in large group

1:00 p.m. - 2:00 p.m.

Lunch & Prayer break

2.00 pm - 1.15 pm

Moving out of the Comfort Zone

To develop the understanding of moving out of one’s comfort zone for greater achievement and an enhanced learning environment that will contribute to the dreaming exercise (next session)

9-Dot Game: Each of the participants is asked to draw 4 lines which should touch all 9 dots.

2:15 p.m. - 4:15 p.m.

Dreaming Exercise: A Vision for the Future

To lead the participants in determining a vision for their Pourashava, particularly the Municipal Health Department, for 5 years that will enhance both capacities and commitment.

Participants build their vision based on their existing strengths in small groups, and then present them in the large group to come to a consensus.

4:15 p.m. - 4:45 p.m.

Evaluation and closing of the day

To review the main points and lessons from the day’s sessions, and conclude the day with encouraging the participants to come the next day’s session on time.

Questions and discussion

4:50 p.m. Refreshment

Day-2: Time Topic Objective Method 9.00 am - 9.30 am

Recap 1) To review the output of the previous day (i.e. strengths and dream/vision), 2) To link the session with previous day’s session, and 2) To warm up the environment for greater participation.

Open

9:30 a.m.- 10:15 p.m.

Introduction to the Capacity Assessment tools and techniques

To introduce the participants to the self-assessment (HICAP) tools and techniques, including brief overview of the background, development process, capacity areas, indicators and scale.

Lecture-discussion with slides

10.15 am- Tea Break

10.45 am 10.45 a.m.- 1:15 p.m.

Analyzing the present situation and position, and targeting for future (small group exercise); and Coming to consensus on present situation and position, and deciding on a target (large group)

To discuss and determine the current position of the Pourashava (highlighting the Pourashava Health Department) in small groups using the assessment tools and techniques; and To arrive at consensus on the current position and future position (targeted) of the Pourashava (highlighting the Pourashava Health Department) through discussion and analysis of the small group work in large group.

Small group exercise

1:15 p.m. – 2:15 p.m

Lunch

2:15 p.m. - 4.00 pm

Planning exercise To make a plan of action to reach the target position decided in the earlier session.

Small group exercise

4:00 p.m.- 4:15 p.m.

Closing of the workshop by the Pourashava Chairman

To close the workshop in a manner that respects culture as well as municipal authority.

VIII. Detailed Lesson Plan 1. Formal Inauguration Objective: To open the workshop in a way that demonstrates respect for both the local culture and for the municipal authority. Process:

Have the Chairman of the municipality inaugurate the workshop; and In whatever manner is appropriate, communicate respect for local culture as well as the

culture of the municipality. 2. Introductions: Getting to Know the Participants Objective: To explore the personal strengths and qualities that each participant brings to the capacity assessment workshop process. Process:

Have each of the participants form pairs with each other. Explain that each participant has 5 minutes to talk about him or herself with his or her

partner. As part of introductions, have each participant identify 2-3 positive qualities or personal strengths of his or her partner.

After 5 minutes, bring all participants back together and have each partner introduce his or her partner and their strengths to the larger group.

As they are doing so, write down the strengths or qualities of the participants and then put them on the board for the group to see.

Once introductions are done, read all the strengths that the participants bring to the group, and emphasize that these are the strengths of the municipality.

3. Objectives and Workshop Schedule Objective: To familiarize the participants the workshop objectives, and to come to a group consensus on the schedule of the workshop. Process:

Using slides or posters as visual aids, at this point the facilitator should introduce the specific objectives of the workshop to the participants.

Discuss these objectives as a group, answer all questions, and ensure that the group has come to a common understanding of each objective.

Once this has been made clear, discuss the schedule of the workshop and come to a group consensus, as best as possible, as to the necessary time required for the entire process.

4. Participant Strengths and Personal Qualities: Stories from Real Life Experience Objective: To explore the existing strengths of the Municipality through sharing real life experiences (Pouro Parishad and MHD staff). Process:

Invite participants to tell brief stories of best practices, or successes, from their lives that have helped promote something positive in society and/or in their professional lives. Encourage participants to explore and analyze the key factors of the stories shared,

particularly those that highlight participants’ capabilities, and how these factors contributed to successful outcomes.

Based on the analysis, have the group pick the key strengths of each storyteller in the stories told. Write down the key strengths of the person or municipality on VIPP cards. Share the outcome of the analysis within large group at the end of each story.

Throughout the process, introduce the concepts of leadership, local resource mobilisation, coordination, M&E, etc., and emphasize the link between these concepts and the strengths they have each shared.

To close, encourage participants to powerfully examine the capacities they have individually and together as a group. Reinforce that the storytellers belong to the municipality, and as such, their strengths are directly linked with the strengths of municipality.

5. Moving Out of the Comfort Zone Objective: To develop the understanding of moving out of the comfort zone in order to both enhance the learning environment and ultimately obtain greater achievement as a group. Process:

Draw nine dots up on poster board or the whiteboard, and explain the 9-Dot Game, in which participants are asked to draw 4 lines which touch all nine dots.

Have each participant solve the problem in his or her notebook, and then share their solutions with the group using the whiteboard. If any participants are unable to solve the problem, provide assistance as needed to ensure that the concept is understood.

Once solutions have been shared, use this game as an example to show the importance of going beyond one’s typical understanding in order to succeed, and emphasize that this is particularly important in the visioning or dreaming development process.

6. Dreaming Exercise Objective: To lead the participants in determining their vision for their Pourashava (the Pourashava Municipal Health Department), for 5 years, that will enhance both their capacities and commitment. Process:

Divide participants into 3-4 small groups. Form small groups purposively, so that each of the groups consists of a combination of men, women, commissioners, and health staff. Ask participants to build their vision based on their existing strengths in their small group.

After this is being discussed in small groups, have each small group draw out their vision in a poster format, using different symbols or pictures.

Once all groups are done with their posters, have each small group present their dream to the larger group. Together, analyze the dreams put forth, and as a group, examine how it might be achievable in next 5 years. Throughout this discussion, as the facilitator, encourage the participants to consider the link between the dream and the existing strengths and capacities of the municipality.

In doing so, conclude by introducing the pre-defined organisational capacity and viability areas.

7. Introduction to Capacity Assessment Tools and Techniques Objectives:

1. To introduce participants to the self-assessment (HICAP) tools and techniques; 2. To discuss and determine the current position of the Pourashava (highlighting the

Pourashava Health Department) using the assessment tools and techniques; and 3. To arrive at a consensus agreement regarding the current position of the Pourashava

(highlighting the Pourashava Health Department) through discussion and analysis of the small group work in large group.

Process:

Begin with a discussion of the importance of determining the present position of the Health Department’s capacity. Share the history and the development process of the tool that will be used for measuring the municipal capacity.

Distribute a hard copy of the tools to all the participants. First, discuss the capacity and viability areas, linked with the strengths of participants and the municipality identified earlier. Explain how these are linked through a participatory process of development.

Once the capacity and viability areas are clear, briefly discuss each indicator and sub-indicator of the capacity and viability areas.

Next, introduce the measurement scale. Show the group how the five-point scale can be visualised symbolically by using different growth stages of a plant.

Explain to the group how to determine the present position of specific indicators under a specific capacity or viability areas. To determine the present position, as well as the target position, of capacity and viability areas, divide the larger group out into smaller groups. The groups can be the same as the groups previously formed, or new groups, and have each group work on 2-3 capacity and viability areas (out of 9).

8. Position Analysis Objectives:

1. To discuss and determine the current position of the Pourashava (highlighting the Pourashava Health Department), and

2. To arrive at consensus on the present position and target position of the Pourashava (highlighting the Pourashava Health Department).

Process:

If not already divided, divide the participants into three smaller groups to review the stages for each category carefully. With each group, a co-facilitator can read aloud each indicator and the corresponding stages, and answer any questions the group may have.

Once co-facilitators feel everyone in the small group has a good understanding for each indicator and its corresponding stages, have participants come back together in the large group. Together, vote on each indicator. If everyone does not vote the same way, discuss this as a group until a consensus is reached. Be sure that each person reads through the stages of the indicators.

Next, bearing in mind that it might not match exactly, help each smaller group determine the stage that most closely matches the status of the municipality. Remind participants that the goal is to get an idea of where the Health Department is in terms of their own organizational development, and what the areas are that need to be prioritized in order to reach their stated vision.

Put up a score sheet, for all to see. Have all participants come back into the large group.

Explain to the group that they will be voting on stages for each capacity area and indicator in order to assign them a score. Write down the scores on the poster size score sheet.

Ask participants to read and vote on the first capacity area and the first indicator. If everyone does not vote for the same stage, have the group discuss this and share their different perspectives. Take another vote, if necessary, and take the necessary time to work with the group to come to a consensus in a respectful manner.

When a consensus is reached on the present score for the indicator, ask: What stage would we like to see ourselves in two years? Through a brief discussion, decide on the target score, and record this on the score board. Once there are present and target scores for all the indicators of one capacity area, give the composite current and target scores for the capacity area. Then, move on to the next capacity area.

Once there are composite scores for all capacity areas, review all of the scores, including the indicator scores, if there is time, and give the overall score and corresponding stage for the assessment. Then, have the group decide on their overall target score for two years from now.

When scoring is complete, congratulate the group on the completion of their first capacity assessment. Explain that the group now knows where they are in our development and where they would like to be, and that in the next exercise, the group will have to decide how to actually get there.

9. Planning Exercise Objective: To make a plan of action to reach the target determined in the earlier session. Process:

Post the planning format (what, when, how and by whom) in a place where all can see. Have participants read the actions identified together during the during capacity

assessment. Add any other actions, as a group, as needed. Once there is agreement on the actions required, encourage the group to come to a

consensus agreement to the plan. 10. Concluding the Capacity Assessment Workshop Objective: To conclude the workshop by sharing participants’ experiences with the whole capacity assessment workshop process, and to acknowledge the importance of the output of the workshop for the group and the municipality. Process:

In order to close the session, invite participants to share their views on the whole process and on the output. Ensure that a diverse array of voices are heard, and stress the importance and strengths of the capacity assessment process for the municipality.

Express gratitude to the municipal authority for their time and great work.

IX. Notes for Facilitators

• Shared understanding on objectives, context and processes of the workshop is essential among the facilitating team members. On the previous day of the workshop, facilitators’ team and project team should have a discussion for common understanding about workshop, session’s objectives, timing and process. Schedule of the workshop would be finalised on the basis of context of the particular municipality.

• As far as possible, the workshop should be conducted in the most comfortable language for participants. Create a comfortable, relaxed atmosphere where people do feel encouraged to participate/ talk.

• Go general to specific. Start first session with broad general issue and then go to the specific, it will contribute to the participation of all.

• AI is an open ended process, which throws extra challenge in quality facilitation compared to any closed ended process of capacity assessment.

• Always critically evaluate the sequence and the linkage between sessions.

• Request for clarification (if possible with example) but do not challenge the answers of participants.

• In order to avoid being too prescriptive, broad, open (non-leading) questions should be asked as much as possible.

• Use the popular words of different capacity and viability areas from the beginning of the workshop through different techniques.

• Do not look for high level of precision in measuring indicators. Try to get the overall perception of participants along with their logic. Respect the best judgement of participants.

• Ensure full time participation of participants and co-facilitator. The person responsible for management issue should not engage as a facilitator or co-facilitator of workshop. Keep facilitators’ team away from extra responsibility that may decline level of participants’ concentration.

Some of the participants faced difficulties to determine present status of capacity and viability areas, as participants’ perceptions did not reflect all the sub-bullet points of sub-indicators of specific stage (Likert scale). Instead of using bullet point in each of the scale of the sub indicators, narrative forms may be easier to understand by participants that might be helpful to determine the status.

X. Schedule of HICAP Review Workshop Time Topic Objectives Method 9:30 a.m. - 9:45 a.m.

Opening / Formal inauguration

1. Respect local culture as well as municipal authority

Ceremonial

9:45 a.m. - 10:15 a.m.

Knowing each other 1. Explore participants’ strengths contributing to the municipal capacity

2. Create warm atmosphere for active participation of all the participants

Peer Introduction

10:15 a.m. – 10:45 a.m.

Objectives and Schedule of the workshop

1. Ensure that participants understand the assessment will help them identify where they are in the organizational development process, and build a vision and plan for the future.

2. Participants come on consensus on their organizational capacity and subsequent Annual health Plan

Lecture-discussion with slides

10:45 a.m. - 11:00 a.m.

Health break

11.00 a.m. - 11.30 a.m.

Recapping the assessment tools and techniques

1. Ensure that participants recall the tool structure, capacity areas, indicators and scoring process.

Lecture-discussion with slides

11.00 a.m.- 1:15 p.m.

Assessing capacity (reviewing previous position, and determining present and future position), and deciding major activities for desired position

1. Reach unanimous decision on current score for each indicator and target score in future. Calculate composite scores for each capacity area and overall assessment score based on indicator scores.

2. Review the previous score/position, and determining the current as well as target-position for each capacity area.

3. Select some priority major activities necessary to achieve the target-position

Questioning and discussion in large group

1:15 p.m.- 2:00 p.m

Lunch

2:00 p.m. - 2:30 p.m.

Review of last year’s annual plan, and deciding activities for the next year

1. Review the last year plan, discuss why the progress is good or not good, and select activities for the next year

Poster presentation to review and decision

2:30 p.m. - 2:45 p.m.

Highlights on WHC Annual Plan-2007

1. Ensure that WHC-level activities are considered in developing Municipality Annual Health Plan

Plenary/Station method to share the Summary of the WHCs Plan

2:45 p.m. - 4.00 pm

Planning Exercise 1. Prepare a detailed “Municipality Annual Health Plan” for a 1-year period

Large-group discussion and presentation using a format on Poster papers

4:00 p.m. - 4:15 p.m.

Wrap-up 1. Share views of the some participants on the whole process, and getting acknowledged the output of the workshop as a

Lecture

valuable thing. 4:15 p.m. 4:30 p.m.

Closing of the workshop by the Pourashava Chairman

1. Formal close Lecture

Annex 1: Symbolic findings with Analysis

Capacity &viability area

Symbolic Baseline

Summary of Analysis Symbolic target

BOGRA MUNICIPALITY

Human Resources Supervision and Development

stage 2

First, participants consider the 5 point

symbolic Likert scale (Annex-II).

Secondly, they determine the specific

position of sub-indicators of every

capacity and viability area through

group exercise. Then, considering the 5

point scale, they tally all the scores of

sub-indicators together and average the

score as the overall status of a capacity

or viability area. When the decided

position of a sub-indicator is under

stage 1 (seed sowing) of 5 point Likert

scale, the score is considered 1. When it

is under point 2 the score is 2. Thus:

1+2+ 1+3+2 9 ______________= _____= 2.25 4 4

4 refers to total no sub-indicators

Result 2.25 refers to germinating stage

Here > 0. 60 considered as 1.

Stage 3

Municipal Authority Leadership

stage 4 Stage 5

Planning and Implementation

Stage 3 stage 4

External Coordination and Local Resource Mobilisation

Stage 3 stage 4

Monitoring and Evaluation

Stage 2 Stage 3

Trust among Partners

Stage 2 Stage 3

Continuity of Service

Stage 3 stage 4

Supportive Health Policy

Stage 2 Stage 3

Capacity &viability area

Symbolic Baseline

Summary of Analysis Symbolic target

Political Accountability of Commissioners

Stage 3 stage 4

Annex II. Likert Scale: Sowing Seeds to the Bearing Fruit Stages of a Tree

Scale with symbol What is meant

1st stage

In this stage, no results are visible, but the origin (the seed) exists. This seed represents potential and the fact that it has been put in the soil represents the initiative put forth for reaching a dream (the tree). As it is not visible, caregivers have less interest and give less attention to it, but continuous care is of utmost importance in order to attain the desired outcome.

‘Elementary/beginning stage of Capacity that implies the start of any project’

2nd stage

At this stage, the input (sowing the seed) has produced a small result (the seedling), which may grow into something much bigger if the necessary care continues to be given. Without this care, the eventual dream (the tree) may not come to be. In this stage, caregivers are focused on this small result in order to keep it viable and to move towards the eventual dream.

‘2nd stage of capacity status is the possibility of achieving the future dream’

3rd stage

Through significant efforts over the time, the possibility of reaching the dream becomes more and more visible. At this point, the probability of the intended result has also sharply increased, and it becomes less vulnerable to destructive external factors. Caregivers begin to look at the growth of the tree within a broader perspective.

‘ The growing-up stage gives hope for a greater future’

4th stage

At this point, a series of mechanisms of inputs (roots and branches) result in increased strength and the likelihood of the eventual dream (the tree). As it matures through these systems, there is less of a significant threat for sustainability. Furthermore, all of the efforts and mechanisms that contribute to the growth of the dream become well-functioning and viable.

‘Significant results are in place in order to realize the eventual dream’

5th stage

The dream is realized through the commitment and continuous efforts of caregivers. The permanent changes and results have taken place. In the same way that a mature tree bears fruit, at this stage caregivers and people fully benefit from the results, and the tree, or the outcome, provides continuous benefits. Most importantly, there is very little possibility of the outcome ending. ‘The final stage of capacity is like a fruit- bearing tree that spreads the outcomes

and continues by itself with its own maturity’

Annex III. Capacity Assessment tool Human Resource Development Definition:

Human Resource Development is improving the competence of the staff by supporting their professional development skills through need-based training and other assistance, and making staff diligent in their work through regular appraisal, in order to improve the quality of health services

Potential Statements:

There is system for human resource development o Need-based training is being provided at various stages o Staff’s work-skill/efficiency increased through training o Institutional process of staff appraisal exists

Staff in service delivery position demonstrate appropriate skills Likert Scale

Sub-indicators First Stage Second Stage Third Stage Fourth Stage Fifth Stage Capacity building of staffs

There is no adequate staff’ training system in the Municipal health section

Municipal health section realizes the importance of staff training for providing quality health service

Municipal health section has taken the initiative to assess the training needs of the health staff by introducing assessment format, assessment system, and designated person to conduct assessment.

Municipal health section provides basic training on different subjects (EPI, Health Promotion, etc.) based on assessed needs

The Municipal health section provides almost all the training (Participatory M&E, TBA refresher, etc.) needed by its staff

Institutional process of appraisal

There is no staff appraisal process in the municipal health section

Municipal health section realizes the importance of the existence of staff appraisal process

Municipal health section has introduced the staff appraisal process through informal/ verbal & un-written evaluation procedures

Municipal health section conducts staff appraisal though formal evaluation procedure (written, checklist & format, evaluation indicators etc.)

The effective system of staff appraisal exists in municipal health section: from evaluation to reward and corrective measures

Supervision No supervision for the service delivery staffs

Municipal health section realizes the importance of having an appropriate supervision system

Basic supervision (e.g., target – achievement supervisory system) is in practice

Supportive supervision (coaching to improve quality of services) is in practice

Supportive supervision using standards of care (using check list, format, etc.) to assess staff

Quality assurance No culture of quality at the institutional or individual staff level

The municipal health section is starting to emphasize the importance of quality in the delivery of health services

Supervision is being instituted as a practice of the municipal health section, in order to emphasize quality

Staff skills meet standards for service delivery position

Quality assurance systems are developed and in place to maintain the quality of service delivery

Leadership

Definition:

Leadership in municipal health department means that cabinet members as well as managers are visionary, skilled, responsible, dutiful, and able to take appropriate decision relying as much as possible on participatory techniques. Alternative leaders in the organization demonstrate the capability to lead the proper implementation of the planned programs in absence of the leader.

Potential Statements:

Skilled and decisive leadership has been established Accountability is being ensured through determined and proactive actions from management Participatory decision making processes exist In absence of the leader, alternative leaders step in and play their role to ensure effective implementation of the planned activities

Sub-indicators First Stage Second Stage Third Stage Fourth Stage Fifth Stage

Cabinet members’ motivation

/sense of vision of purpose

Health is not a priority agenda for the municipality. Health staffs are involved in other activities such as tax collection.

Cabinet members understand the importance of the protection of mother and child health, and the role of health department in improving the health services.

There is an effective communication between cabinet members and health staffs in developing shared vision across the health department. Cabinet members explain the purpose and importance of quality in the delivery of health services to the health staffs. Cabinet members with the assistance from health staffs lead the formation of WHC.

Cabinet members are involved in many activities relating to health, such as day observation, developing network with the like minded organisations, mobilising local resources, leading WHC, active participation in MESPCC, etc.

Health is one of the most important agendas for the municipality. Political accountability has established between municipality and community. Budgetary allocation for health has increased significantly. Municipality is now the learning Center for the other neighbouring municipalities.

Decisive management

Leaders (Mid-level managers: coordinators / supervisors) are not clear about their individual responsibilities and how those relate with the responsibilities of the Management Leadership. For example, staffs are not sure where to turn to for effective decisions and advise.

Leaders have inadequate idea about their own responsibilities and how those relate with the responsibilities of the Management Leadership.

Leaders are aware about their own responsibilities and how those relate with the responsibilities of the Management Leadership.

Leaders are aware about their responsibilities, and can articulate clearly their own responsibilities and that of their peers.

Leaders are aware about their responsibilities. Staffs are also aware about responsibilities of leaders. Staffs are confident about the Management Leadership skills of their leaders. For example, staffs know who to turn to for difficult decisions and advise

Accountability Leaders do not believe in introducing accountability and transparency for quality leadership.

The accountability and transparency process has started. But roles are not clear, and avoidance strategies and blame shifting are common when problems occur

The aspects of accountability and transparency in leadership have strengthened. Managers are reporting on progress on tasks through appropriate and open media (staff meeting, status reports, etc.)

Accountability and transparency strengthening the relationship between leaders and staffs. Staffs feel they can share implementation and performance problems in order to find team solutions and remedies, rather than hide them.

Accountability and transparency in every aspect of leadership has institutionalised. Now Managers take responsibility for problems, particularly when their staffs are faced with difficulties.

Acceptance of disagreement and new ideas

Leaders implement various Programs of the health department with their own decisions and own way. They do not accept disagreement; do not go for team discussions; and do not open to new ideas.

Sometimes leaders are making decision in consultation with one or two persons.

In most cases leaders are making decision in consultation with one or two persons.

In most cases leaders are making decision in consultation with almost all relevant staffs.

Participatory decision making process through proper leadership exists

Development of alternative leadership

There is no alternative leader and leaders do not like the idea of introducing alternative leadership

Presence of alternative leader exists but leaders are reluctant to give them any responsibility

The senior management pursues active steps to promote and advance alternative leaders. The alternative leaders are being delegated to various jobs/tasks but they are reluctant to take responsibility.

Alternative leaders are taking the responsibilities due to proper encouragement from all levels of Municipal Health System. However, they are yet to develop their expertise in doing their jobs.

The role of alternative leader is active (he/she is capable of dealing/handling the health related issues in absence of the leader)

Participation Definition:

Participation means that individuals are solicited and take part spontaneously in all activities to achieve the objectives.Beyond the Municipality members of like-minded organizations (men and women) show mutual trust, cooperation, respect, and share in both successes and failures.

Potential Statements:

People have high expectations towards receiving health services The health workers and other associates (CHV,TBAs) providing services with sincerity The relation is respectful of both professionals and clients Ward commissioners/ cabinet members are playing active role in improving quality of services Health staffs have high level of participation in regular interdepartmental monthly meeting and in decision making process The target population has increased its participation in receiving health services (Vaccine, ANC, PNC, ARI, Diarrhea )

Sub-indicators First Stage Second Stage Third Stage Fourth Stage Fifth StageRegular meeting within Municipal health section

Municipal health section rarely sits/does not sit for inter departmental monthly/ weekly meeting.

Municipal health section sometimes calls for meeting but the presence of health workers in the meeting is discouraging.

Municipal health section has successfully conducted around 75% of their targeted meeting. Presence of health workers in the meeting is also promising, around 75%. Most of the meetings are used mainly as a forum of information dissemination. Often, meeting are also used to blame the workers for failure. Health workers do not get opportunity to participate in issue based discussion and in any decision making process.

The meeting of the Municipal health section is mostly regular (meeting hardly not held owing to special reason). Almost all the health workers attend the meetings. Apart from information dissemination, they participate actively on issue based discussion. They also discuss the reasons of success and failure of any activity, but do not participate in any decision making process.

The meeting of the Municipal health section is mostly regular. Active participation of most of the health workers is visible in the meeting. There exist mutual trust, participatory decision making process, and sharing responsibility of successes and failures. People find attending the meeting as a learning opportunity.

Participation of Ward Commissioners/ Cabinet members

Cabinet members do not put any health agenda in cabinet meeting and also do not participate in activities relating health.

Cabinet members put health agenda in cabinet meeting and raised discussion in the meeting.

Cabinet members put health agenda in cabinet meeting and raised discussion in the meeting. Cabinet members regularly attend WHC meetings.

Health is a priority agenda in cabinet meeting. They participate in WHC meetings and health activities (e.g., day observation), and campaigns (e.g., Vitamin A) organised by WHC and health department.

Cabinet members attend almost all the MESPCC meetings, and take lead role in coordinating the activities of the other service providers.

Participation of women (key target group)

Nobody thinks about the issue of motivating women for increasing their interest and ensuring participation in receiving health services

A motivation process is in place to enhance women’s interest and participation in receiving health services

Along with the motivation, health workers are sincerely continuing their effort to provide good/ quality services to increase women’s interest and participation in receiving health services

Women’s physical presence in receiving health services is visible. Health workers are very sincere and women’s are very appreciative about the service of health workers.

Health workers are one of the important institutions to the community, especially women. Beneficiaries (women who have already received support) are also motivating the other women in receiving health services.

Participation of the other stakeholders

There is no functional relationship between health workers and the other stakeholders such as TBA, volunteers, teachers, etc. Health workers work in an isolated way.

Importance of developing a functional relationship between health workers and the other stakeholders has acknowledged increasing the participation of women in receiving health services.

Initiatives have been taken to develop a functional relationship between health workers and the other stakeholders to increase the participation of women in receiving health services.

Health workers communicate with the other stakeholders on regular basis. Provides need based training to the relevant stakeholders, e.g. TBA, CHV.

Stakeholders are motivating women in receiving health services.

Local Resource Mobilization Definition:

Resource Mobilization means optimal utilization of financial, material (including facilities) and human resources through active participation of the Municipality and all concerned persons, organizations and establishments, towards smooth implementation of the health activities for the welfare of designated beneficiaries.

Potential Statements:

The health department has list of all material (school, club) and non-material (persons/people) local resources Necessary communication and coordination among the local resources is being done under leadership of health department for achieving the objectives The volunteer, midwife, school teacher, Imam, rural doctor, and various voluntary organizations and other organizations actively participate in proving Municipal health care services

for people’s welfare and admit to share the achieved results Sub-indicators First Stage Second Stage Third Stage Fourth Stage Fifth StageInventory of local resources

Municipal health department has no idea about local resources. They do not think that identification and proper utilisation of local resources is important for ensuring quality health services.

Municipal health department has lack of knowledge about local resources. Inventory of local resources is not available.

Municipality health department has an incomplete inventory of resources that can be leveraged.

Municipality health department has the list of all financial, material (school, club) and non-material (persons) local resources (especially those who are involved with activities related to health services).

Municipality cabinet, service providing institutions, ward health committees, and the other relevant institutions are aware of this inventory of local resources and they have access to this list.

Effective networking

Others service providing institutions (MCWC, CS office, NSDP, FPAB, Marie Stopes, RMP, Imama, TBA, Teachers, WHC, CHV, Club, etc.) have less idea about leadership and services of Municipality health department

Municipal health department has taken initiative for building rapport with the local service providing formal and informal institutions

Municipality health department has established a network amongst the identified local service providing formal and informal institutions. A regular communication process is in place.

There is an effective communication with some local institutions, mainly CS office, MCWC, WHC, CHV, and TBA. Network members occasionally share information related to financial, material and human resources.

The Municipal health department has effective communication with various local institutions. Regular and systematic information sharing of all types of resources based on a clear inventory of what is available.

Effective use of resources

Municipality health department is unable to utilize the existing facilities of the organizations and establishments, so Municipality is observing the especial days by themselves.

Municipality health department realises/ understands the importance of the effective use of local resources to observe the especial days in more colourful ways, to attract more people in the rally, to increase participation of the community.

Municipality health department has developed a network and is taking initiatives to get the network members such as NGOs, clubs, persons (elite), etc., together for observing the especial days.

Along with day observations, network members occasionally share material and human resources (providing space for EPI Centers, sending Scouts for awareness raising Program, etc.) through effective assessment of needs and coordination.

Regular, systematic and institutionalised sharing of all types of resources based on a clear inventory of what is available and effective assessment of needs through coordination. The Municipal health department has ensured optimum utilization of the volunteers, midwives, teachers, Imams, rural doctors and other organizations and establishments for improving health services.

Resource management

Municipal health department has no idea about resource management. There are no guideline for resource management, no system of reviewing stock of resources, and no utilisation plan of resources.

Municipality health department realises/ understands the importance of the effective management of available local resources.

Municipality health department has initiated a process of resource management. Example, health department is now preparing resource management guideline. Development of the utilisation plan of the existing resources is in progress.

Municipality health department has established the system. All guidelines are in place. Short and long term plans for resource using have developed.

Resource management system is running properly. There exists a proper guideline, and the department is using the guideline. There exists a regular review mechanism of the stock of existing resources.

Monitoring and Evaluation Definition:

Monitoring & Evaluation is the regular assessment of the progress of the activities of the health department as per plan, disseminating among the people, taking necessary steps for achieving next target and the final process of assessing the achievements at the end of a specific period.

Potential Statements:

Municipal health department has staff trained and skilled in running an established monitoring and evaluation system Achievements are presented regularly at the municipal assembly and municipal health committee meeting for assisting health program for management decision For ensuring people’s participation, the results of the health program are reviewed annually at the community level with the people

Sub-indicators First Stage Second Stage Third Stage Fourth Stage Fifth StageM&E Staff Municipal health

department do not think that there is a need to have a specific person responsible for M&E.

Municipal health department understands the need to have a specific person responsible for M&E. However, the department is giving responsibility on M&E to different workers on different occasions/ at different point of time.

A person from health department has given responsibility on M&E. However, the designated person does not have enough skill to perform their task.

To enhance the skill, the designated person has been provided with the relevant capacity building activities, such as trainings, coaching, etc. The designated person is providing efficient support to municipal health department.

M&E has been institutionalised. Everybody is clear about the role of M&E staff. Everybody sees the benefit of having an M&E staff. Alternative M&E resource person exists in the health department.

Data collection and preservation

Based on the requirement, Municipal health department collects information in a scattered manner. There is no information preservation system.

Based on the requirement, Municipal health department collects information in a scattered manner. However, the department understands the importance of information collection on a regular basis. Occasionally they also preserve some important information in a disorganized way.

To regularise the information collection and preservation system, municipal health department is working on developing an integrated Health Management Information System in collaboration with the other stakeholders/ service providers.

Municipal health department has introduced integrated Health Management Information System. The other stakeholders/ service providers are clear about the purpose of introducing this new system. They cordially assist the health department in collecting information. However, the heath department does not have the required skill in preserving this regular flow of information in an organised way.

There exists a regular information flow system. To enhance the information preservation skill, the staffs of health departments have been provided with the relevant capacity building activities. Now, the health department is preserving all information of different sources in an efficient way. The preservation system is well organized (there is specific file for specific subject, naming of the files are appropriate).

Data analysis and information dissemination

Generally municipal health department do not give the collected information to anybody (except any special reason). There is no skill &/or system in analysing and sharing information.

Municipal health department understands the importance of data analysis and information dissemination on a regular basis.

Municipal health department poorly analyses the collected data in irregular fashion. Staffs do not have skill for the in depth analysis of data. They occasionally present/share only those data in different forums and seminars which mainly focus on the successes/ positive achievements of the department.

To enhance the analytical skill, the staffs of health departments have been provided with the relevant capacity building activities. Quality of data analysis has improved significantly. Health department presents/shares all kinds of data (success and failures) in different forums and seminars.

There exists a regular and efficient data analysis system. Information dissemination system targets not only different forums and seminars but also community. The health department informs the community and different stakeholders every year about the results of its Programs. Health department promotes discussion of different stakeholders on the results of the Programs.

M&E data inform decision

M&E data inform decision system does not exist.

Irregular but municipal health department has started answering the questions (raised from the analysed M&E data) relating to health services in cabinet, departmental and MESPCC meetings.

Municipal health department has started answering the questions (raised from the analysed M&E data) relating to health services in cabinet, departmental and MESPCC meetings on regular basis. Health departments listens different options and accepts recommendations to improve the quality of services.

Based on the recommendations, the health department makes its action plan to overcome failure/ to increase effectiveness of the Program. They share the plan in the appropriate meetings (cabinet/ departmental/ MESPCC), and if necessary re-plan on the basis of the feedback.

M&E system is institutionalised. Municipal health department presents the final plan in the cabinet and MESPCC meetings for ensuring the effective management decision. Decision is being taken after analyzing the information and steps are being taken accordingly.

External Coordination

Definition:

External Coordination means the establishment of friendly and effective relations amongst the various persons, government and non-government organizations in the municipal area through inter-department communication for implementing planned programs of the health department

Potential Statements:

There is coordination between government and non-government organizations under the leadership of municipality There is understanding towards mitigating misunderstandings through coordinated programs All the government and non-government organizations have friendly/cordial relation and people from all sections of the society are spontaneously participating the programs of health department MESPCC is playing active role in improving quality of services The program of the municipality is successful in achieving target having overall efforts from all

Sub-indicators First Stage Second Stage Third Stage Fourth Stage Fifth Stage Understanding external coordination

Staffs of municipal health department do not have clear understanding about the importance of external coordination. They also do not know how to develop external coordination.

Municipal health department understands the need to develop external coordination to improve the quality of health services.

To enhance the skill, the department has been provided with the relevant capacity building activities. The health team has clear understanding about the importance of external coordination, more specifically how to do it and its necessities.

A person from health department has been designated as a focal person of external coordination. Municipal cabinet members have been provided with orientation on the importance of external coordination.

Municipal cabinet members are supporting health department in improving the external coordination by using their personal influence, reputation and network.

Cordial and meaningful relation

Municipal health department does not have any cordial and meaningful relationship with various government and non-government health service providing organizations.

Municipality health department has taken initiative in developing cordial and meaningful relationship with various organizations though personal and written correspondence.

The health department has established a formal relationship with many different organizations. Based on official invitation letter, organisations attend different meetings organised by the health department. They share information but do not commit for sharing resources.

The health department has established a meaningful formal relationship (sharing of financial, material and human resources) with many different organizations.

The health department has meaningful and cordial relationship with all/ most of the organizations. Partners take pro-active role in passing valuable information to the health department. For example, Health department usually comes to know about important meetings (e.g., NGO coordination meeting of DC) at very late stage and hence they fail to send representative. Ministries often send the theme of the day observation at very late stage to the municipality, and hence the department does not get chance to prepare for the day observation as per theme. Cordial relationship and pro-active roles of partners help the health department in receiving information well in advance.

Functional coordination with MESPCC

MESPCC exists in paper but not in practice. People can hardly remember any functional/ successful meeting of MESPCC.

Participation of the organisational representatives in MESPCC is not active (Decision makers do not attend. Lower level staffs attend physically who hardly participate in any discussion)

Participation of the representatives in MESPCC has improved (Decision makers of some organisations attend physically, participate actively on issue based discussion but do not take any important decision and do not share responsibility, success and failures)

Participation of the representatives of the organization in MESPCC is quite active (Decision makers of many organisations attend physically on regular basis, participate actively on issue based discussion, facilitate to take some important decisions but do not share responsibility related to failure.

Active participation of key actors is visible in MESPCC meeting. There exist mutual trust, participatory decision making process, and sharing responsibility of successes and failures. People find attending MESPCC meeting as a learning opportunity.

Planning Definition:

Planning means the determining and prioritizing of monthly, quarterly, and yearly activities on the basis of ensuring maximum utilization of existing local resources.

Potential Statements:

Health staff are capable in prioritizing activities (according to the necessity and importance of locality) with proper reflection in the plan. Health department prepares plan in a participatory way by involving all relevant stakeholders. Health department reviews plan regularly and re-plan, if necessary, based on recommendations. Health department implement activities according to the plan by proper utilizing of local resources.

Sub-indicators First Stage Second Stage Third Stage Fourth Stage Fifth StagePreparing activity plan

Municipal health department does not have experience in preparing the activity plan. The department is doing whichever activities are appearing before them, i.e., the activities are not pre-planned.

The health team has taken initiative to develop plan. To enhance the skill, the department has been provided with the relevant capacity building activities, such as participatory planning, priority setting, need assessment, etc.

There is a written plan of the department. The activity plan is prepared on the basis of the experiences of health staffs with active support from Concern.

There is a written plan of the department. The activity plan is prepared on the basis of the experiences of health staffs as well as in consultation with the other stakeholders and community. Plan reflects the demand of the locality, such as, cleanliness, EPI, ANC, PNC, Delivery, Health Education, Day Observation, and sanitation. Concern provided limited support in preparing plan.

There is a written plan of the department. Municipality health department prepare activity plan by ensuring participation of all relevant stakeholders and community. The department does not take any support from Concern in preparing the plan.

Implementation of activity plan

Health department does not have any written plan. The department is implementing whichever activities are appearing before them.

Department has prepared a plan and 25% of the plan is being implemented in the year.

50% of the prepared plan is being implemented in the year.

75% of the prepared plan is being implemented in the year.

Almost all the activities in the plan are being implemented.

Review of activity plan

There is no system in reviewing plan as there is no written plan in the health department.

Health department does not give priority of reviewing activity plan in the monthly meeting. Often this issue completely untouched in the meeting.

Irregular but health department reviews the activity plan in the monthly meeting. Take some on the spot decisions if there is any failure related to implementing planned activities.

Activity plan and decisions taken in the previous meeting are reviewed regularly at the monthly meeting. The department takes appropriate steps/ re-plans based on the review.

Activity plan and decisions taken in the previous meeting are reviewed regularly at the monthly meeting. Inform stakeholders, cabinet and community about all the important decisions and changes in the plan. After informing/ discussing, the department takes appropriate steps/ re-plans based on the review.

Organisational Viability Indicators Trust among partners Explanation/ Situation:

Activities of MHPP should not be politically biased. Role and responsibility of Concern as partner and the goals of all MHPP should be explained very clearly to Program partners. WHC members need to be oriented very clearly about the goal and activities of WHC. WHC can contribute in developing political accountability but the activities of WHC should not

be politically biased. Leaders from all political parties should have participation in the WHC activities. Besides, professional group like teacher, private practitioner, and imam should be free from political biasness while running the activities of WHCs.

WHC fund management must be transparent to all the relevant stakeholders. Sub-indicators First Stage Second Stage Third Stage Fourth Stage Fifth Stage Politically unbiased activities of MHPP

Cabinet members and the municipal health department do not have any idea about the goals of MHPP as well as Concern.

The cabinet members and the municipal health department have some idea about MHPP through informal interaction with Concern staffs. Concern needs to make it clear to the cabinet and health department that the activities of MHPP are not politically biased. The department also did not receive any formal orientation about the roles and responsibilities of Concern.

Cabinet members have already gone through the formal orientation Program. Cabinet members are clear about the goal of MHPP as well as the broader role of the other Concern Programs. They know that the activities of Concern are not politically biased.

Cabinet members and the staffs of health department have gone through the orientation Program. Cabinet members can articulate the goals of MHPP and Concern to the staffs of health department and to the relevant stakeholders of the community. Cabinet members have made it clear to the health department and to the community that the activities of Concern are not politically biased.

Concern organises orientation Program on regular basis (yearly) for the cabinet members and health department. It is helpful for the new members/staffs to get orientation. It also acts as a refresher for the existing staffs and cabinet members. Cabinet member, staffs and community know very clearly that the activities of Concern are not politically biased.

No political involvement of WHC

WHC formation process has ensured the involvement of people from different socio-economic, professional, and political groups of the community.

A series of formal and informal meetings and discussions has been held with the ward commissioners and with the other local political leaders to clarify the roles and responsibilities of WHC. This initiative has made it clear to them that WHC is not a political forum. Rather, this is a forum where people from different political background can equally participate and can contribute in improving the mother and child health.

A series of formal and informal meetings and discussions has been held to clarify the roles and responsibilities of WHC among its members. Ward commissioners and the other local political leaders have clarified to the other members of WHC that the activities of WHC are not going to be politically biased.

Leaders and members of WHC often share with the community about the goal of WHC. At the same time they also make it clear to the community that activities of WHC are not politically biased. WHC does not allow any political discussion in WHC meetings. WHC put notice in the office about the restriction of political discussion in the meeting.

Health department/Concern/ WHC organises orientation Program on regular basis (half yearly/ yearly) for the new members of WHC. It is helpful for the new members to get orientation about the goal of WHC. It also acts as a refresher for the existing members. Leaders and members of WHC and community know very clearly that the activities of WHC are not politically biased.

WHC fund management

WHC does not raise fund, so it is not an issue to the other stakeholders/ Program partners.

WHC has started raising fund on ad hoc basis. There is no guideline for spending money from the fund. WHC spends money based on the decision of the ward commissioners. The health department sees that WHC is spending money for good purposes.

WHC has started raising money on regular basis. There is no guideline for spending money from the fund. WHC spends money based on the decision of the ward commissioners. The health department wants to get clear picture about the raised money (accounts), and the way money had been spent.

WHC has started raising money on regular basis. There is a guideline for spending money. The health department knows about the guideline. Health department knows how WHCs are spending money in different occasions and how they are maintaining accounts.

WHC fund management has institutionalised. Cabinet members and the health department are happy about the WHC fund management system. Community believes that WHC is properly utilising the fund.

Absence of dependency for support and assistance Explanation/ Situation:

Municipality needs to have a well managed vaccine storage system and technician. In absence of storage system, Municipality totally depends on Civil Surgeon/ Upazila health authority to get vaccines. However, they cannot always ensure the supply of vaccine as per the demand of the municipality.

GAVI project is giving financial benefit to 10 CHVs in every municipality, which is negatively affecting the traditional voluntarism attitude of the community people. These CHVs do not want to get involve in other activities without any financial incentives. Other CHVs are also referring it as an example, and asking for financial incentives.

Sub-indicators First Stage Second Stage Third Stage Fourth Stage Fifth StageEnsure effective vaccine administration

Cabinet member s and health department do not put any requisition to the CS office to ensure the supply of necessary amount of vaccines on time. CS Office supplies vaccines to the municipality without any requisition.

Health department is aware about the necessity of timely and enough supply of vaccines. They prepare requisition according to the local demand and send to CS office well in advance.

To ensure effective supply of vaccines and to tackle increasing demand, municipality feels the need to have an own storage system for vaccines. They have taken initiative to get support from GOB for ILR, deep freeze, etc. They have also selected a person to follow up this issue on regular basis. At the same time, they have also taken a staff development plan for proper maintenance of the equipments.

Municipality have established vaccine storage system. Assigned persons have been trained with the support of CS office and Concern.

Municipality have own managed vaccine & storage system. Municipality ensures the availability of vaccines as per requisition of out reach and fixed site Centers. Trained personal of the health department are effectively maintaining the vaccine storage system. Health department is monitoring the ILR regularly. Health department sends the requisition to CS office on time according to demand.

Absence of dependency on external financial support

Municipality health department works in an isolated way.

MHPP is trying to develop a functional relationship between the health department and CHVs. Health department understand that their existing human resources are inadequate to each the target population. Mobilising CHVs is the best way to reach more people.

There exists a functional relationship between the health department and CHVs. Health department has already provided training to some volunteers, who will support the health workers. Health department does not give any financial incentives to the CHVs but acknowledge the contribution of CHVs.

Municipality acknowledge the contribution of CHVs. Municipality understands that social acknowledgement is more powerful than the financial incentive. Municipality offers prizes to best CHVs. Cabinet members give priority to CHVs in fulfilling different vacancies in Municipality.

Municipality accepts financial support from different government and non-government organisations to improve health services. However, municipality rejects the proposal which offer direct financial incentive to the CHVs. Municipality always request other organisations to do something that is sustainable without depending on external resources. Municipality does not allow the destruction of voluntarism in the name of financial incentives.

Absence of financial dependency Explanation/ Situation:

As per government policy, municipality should allocate minimum 1% of its total budget for Health and Conservancy department. Municipality develop its budget based on its prospective revenue collection (core budget) and the Annual Development Plan -ADP (committed by MOLGED). As ADP does not give any allocation in the health sector, ultimately Health and Conservancy department relies on the core budget of the municipality. Budgetary allocation needs to increase to ensure quality health services.

Municipality allocate lump sum for the Health and Conservancy Department. Department spent money as and when necessary. Municipality does not prepare detail budget against specific activities under health department. In the absence of detail budget the money from this poor budget is always under spent. Proper utilisation of money is not possible without preparing detail budget of health department. There does not exist of any budget review mechanism in the municipality.

Sub-indicators First Stage Second Stage Third Stage Fourth Stage Fifth Stage Budgetary allocation

Based on ADP commitment municipality allocates a good amount of money for the health department. In reality, Ministry never gives any allocation for health from ADP money. Using this excuse, municipality usually spends very little money for health activities.

For the budgetary allocation (resource mobilisation) of the Health department, Municipality is now put importance on its own resource (collected revenue). Municipality’s main focus is now 1% money of its own total budget.

Municipality allocate 1% money for health budget as per policy. However, municipality do not allocate this money in different line items based on the priority tasks of the health department. In addition, the total budgetary allocation is not enough to prepare a realistic budget (to address the minimum needs) for the department.

Municipality is allocating more than 1% money for the health department. Health department can address the minimum needs with the allocated money. With the assistance from the health department, municipality can prioritise the area of budgetary allocation, and allocate money accordingly.

Municipality is allocating more than 1% money for health department. Municipality can allocate sufficient money to prepare a realistic budget (WHC and Health Department are happy with the total allocation) to achieve the health goal. Health department can prioritise the community need and can convince the cabinet to reflect the community needs in priority setting for budgetary allocation.

Detail budget Municipality allocate lump sum for the Health and Conservancy Department. They don’t consider with the ratio of total budget and community demand. Department spent money as and when necessary. Municipality does not prepare detail budget plan against specific activities under health department.

Municipality cabinet realises/ understands the need of the development of detail budget. They understand that the detail budget needs to prepare based on their existing resources.

Cabinet members have lack of knowledge in developing detail budget. Despite lack of knowledge, they have initiated a process. Now, they allocate budget for health department in some broad head (e.g., Day observations, WHC, EPI, etc.)

Municipality prepares detail budget for health by involving the health department. Health department has capacity to prepare the detail budget. There exists a format of preparing detail budget.

The system of preparing a detail budget has been institutionalised. Municipality health department is now an integral part in budget preparation. Every year, they help cabinet in preparing budget by using specific format. Community and all relevant stakeholders have access to the budgetary details.

Budget review There is no system of budget review in the municipality. Cabinet members do not consider it as an important task.

Municipality understands the importance of initiating a regular budget review process. Cabinet members understand that the process of budget review helps in establishing accountability of the health department.

Municipality knows the process of budget revision. Occasionally municipality review the overall budget expenditure in some broad head. Municipality has a checklist (plan, deviation and corrective measures) for budget review.

Municipality knows the process of budget revision. They set a cut off date for the revision. Municipality periodically reviews the expenditure against the budget line item and adopt pre-cautionary measure for reducing budget variance.

A system has established and functional. The review process is transparent. Review process highlights priority events. The department re-plan the activities based on the outcome of the budgetary review plan and implement it accordingly.

Annex IV: Facilitators Pool in MHPP

Name Current Designation Program /dept

Dipankar Datta

Partnership and Capacity Building Adviser

Policy Development and Evaluation Directorate Concern Worldwide

Dr. Shamim Jahan Program Manager Municipal Health Partnership Program Concern Worldwide Bangladesh

Kazi Liaquat Ali Senior Project Manager- Operations

Municipal Health Partnership Program Concern Worldwide Bangladesh

Abdul Matin Shardar Senior Project Manager- Operations

Municipal Health Partnership Program Concern Worldwide Bangladesh

Md. Zamal Uddin Senior Monitoring & Evaluation Officer

Municipal Health Partnership Program Concern Worldwide Bangladesh