Securing National Ownership through Dialogue

1
Securing National Ownership through Dialogue

• Capacity Building in the Health Sector, Nicaragua
• Case Obstetric Nurses Programme

2
Programme based on previous experiences - and
failures...

• Started in the 1980s as an NGO initiative
• Teachers/trainers where trained
• Approx. 200 Obstetric Nurses (OBs) where trained
• Ownership at NGO level and university

3
Positive outcome of the project

• Institutional twinning Nicaragua-Sweden
• Technically successful project
• Enthusiasm and innovation
• Personal commitment

4
But what about sustainability?

• National health authority absent
• Financial sustainability insecure
• Local health authorities unaware
• No dissemination in local communities
• Professional groups not on board

5
So in the end...

• Project ended
• NGO commitment decreased
• Enthusiasm personal commitment faded
• Trained capacities where not used
• Only a handful work today as OBs

6
New initiative based on dialogue

• Sida received an informal request in 2001 from
  NGO and Managua University
• Feasibilty and appraisal missions with Swedish
  OBs plus communicator
• Interviews including all stakeholders
• LFA-seminars with key stakeholders

7
Securing national ownership

• Negotiations with key professional groups
• Discussions with Minsitry of Health (MoH)
• Formation of a programme Core Group
• Technical design phase in dialogue with national
  health authorities on all levels

8
Sidas role(s) as donor/partner

• Offering technical assistance in design
• Securing initial support from MoH
• Involving and informing donor community
• Promoting national dialogue, esp. local level
• Liasing with other related donor inititives

9
cont. Sidas role(s) as donor...

• Inclusion of communication components in
  programme design and budget

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Strategic communication in the design phase

• Communication exercise with Core Group in the
  design phase
• Professional support in communication
• Focus on communication opportunities with each
  target group, connected overall objectives

11
What about sustainabilty now?

• Building on National Health Strategy
• Included in Health Sector SWAp
• Included in PRSP (as means to reduce maternal and
  infant mortality)
• Institutional twinning arrangements
• Long-term investment that requires donor
  patience