From “filling deficits” to “working politically”
When most people talk about capacity, they actually mean either “stuff” – resources and equipment – or hard skills in some technical discipline. This is the obvious starting point: without proper medical facilities or trained staff, how can a local health clinic do its job? Which is probably why so many capacity building programs try to fill deficits by giving stuff and providing technical training. But often the real problems confronting service providers have nothing to do with what's available in a tangible or technical sense – this might be a symptom, but it's not the root of the problem. So what do we then do in terms of thinking about capacity?
At ODI, I work on a research program in Sierra Leone that is concerned with the state's capacity to prevent malnutrition. Our approach is informed by some conceptual work just published by the SLRC, which is in turn informed by some excellent research from the European Centre for Development Policy Management. The big message: capacity is a relational concept. That is, capacities are developed through social relationships, and the nature of those relationships has profound consequences for the ability of an agent, an organization or a system to get things done. As soon as you look at capacity in this way, you immediately open up a load of interesting – and difficult – questions about gender, power, politics, incentives, and systems (a little more on this last one towards the end). We should not shy away from these tough questions, because they really matter: lots of good work being carried out at ODI and elsewhere is demonstrating exactly why, if we care about things like state capacity for service delivery, we should also care about things like “who can get what done” and “how that happens.”
So what does a relational approach actually look like? Some examples from Sierra Leone
I'm recently back from Freetown where I presented our phase 1 Sierra Leone findings on what the current state of capacity support to the nutrition sector looks like. What came out quite strongly during that discussion was the importance of looking beyond the “capacity as training” approach – which really dominates much of the programming – towards a more relational, political way of thinking. The need for this is clear at three different scales.
The national level is where the core coalitions of support for particular issues, such as preventing malnutrition, are usually built. This is all about reaching beyond the obvious individuals and organizations – for example, those sitting in the Food and Nutrition Directorate – and winning over those for whom nutrition (and issues of reproductive economic activity more generally) is not a priority. We know from recent research that forging alliances between actors across different sectors is necessary for making progress against malnutrition. Of course, the tangible stuff still matters here: how can other ministries be expected to devote time to nutrition if staff time isn't budgeted for? But really this is about the capability of specific individuals to maneuver politically and build support.
The relational dimensions of capacity are also apparent at the community level. We have just finished data collection for our second phase of research in Sierra Leone, which involved visiting three sites in one district to better understand 1) the social conditions that reproduce malnutrition, and 2) the relationships between communities and service providers. There have been moves to deter people's use of traditional healers and birth attendants in rural Sierra Leone, which generally seem to have been quite successful. However, our research uncovered cases where community members have become alienated by past experiences of visiting the health clinics. Many took issue with the attitudes of clinic staff, perceiving that the quality of treatment provided depended on a patient's status or wealth. Others reported having to pay for services that should be covered under the government’s Free Health Care Initiative. These experiences can discourage future clinic attendance. So, in thinking about capacity to deliver services at the community level, we should be thinking not just about the medical knowledge of clinic staff, but also about:
- The way they deal with community members. Findings from SLRC's cross-country baseline surveys suggest that someone's tangible experience with certain aspects of a service (how long they had to wait on their last visit, whether they thought enough qualified staff were present) can sometimes affect their wider perception of not only that service but also of the state. We also find some strong links between perceptions of the state and how participatory a service is (for example, whether users are consulted about services, whether accountability or grievance mechanisms are in place). So, if we care about effectiveness coverage – about the capacity of a provider to not only reach but to also offer a quality service to its catchment population over time – then the way in which that provider relates to their users matters.
- The way state service providers deal with non-state service providers. In Sierra Leone, we found that people's health-seeking behavior wasn't necessarily based on a competitive “either / or” approach – health clinics and traditional healers were often both used, to the extent that in some places a kind of informal referral system exists between those two sets of providers.
Taking systems seriously
Thinking relationally about capacity means seeing capacity as a systems issue. You might have the best-trained staff and the most well-equipped organizations, but without understanding what’s going on between them (information sharing, coordination, planning, delivery chains, feedback loops, the informal governance of decision-making and action), you’re going to miss out on how stuff really works. A lot of the thinking about capacity within our field is reductive. Thinking relationally, and getting to grips with how systems function, is how we start interpreting and managing capacity problems in a way that takes us way beyond technical skills and tangible stuff.