Aarthi Rao is a Senior Program Associate at the Results for Development Institute, a partner in the Ministerial Leadership Initiative for Global Health (MLI).

Capacity building is undoubtedly a development buzzword.  Many programs contend that they are building the capacity of health systems to deliver improved health outcomes in the long-term, but what does it take to actually build the structure and performance of a health system rather than work around it?  In the MLI experience of supporting ministries of health, it requires patience, mutual trust, flexibility and most importantly, a commitment to local resources.  Recently, I attended a presentation by Fred Rosensweig, the Capacity Building Team Leader for HS2020, to learn about HS2020’s approach to organizational development.  I was struck by the program’s similarities to MLI.

Both programs rely on country-based expertise and tend to focus on strategic units within ministries.  For example, MLI has provided targeted support to the policy and planning units in ministries of health in addition to the reproductive health policy units. HS2020 also emphasizes the importance of functioning processes within all components of health systems. Sound day-to-day processes ensure that policy units can continue to steward the health system under difficult circumstances.  MLI has found that working with the Ministry leaders who are often the Minister’s right hand advisors can help carry policy initiatives forward through leadership transitions and other political challenges.  These leaders stick with ministries and have the needed tenure to retain expertise. Within these groups there are always champions who can promote change and manage the process.  Marty Makinen, a technical advisor for MLI and a former director of HS2020 at Abt Associates, notes that “every ministry needs a brain” – a central mix of talented and committed individuals. Identifying and supporting these change agents is at the heart of MLI.

One outstanding question is whether building up discreet units like policy and planning teams within Ministries or local public health institutions will actually serve as a lever for strengthening a health system.  Scale up and long-term viability are stumbling blocks for many promising development initiatives.  HS2020 will certainly have to address this as it moves into its next phase, and MLI is currently grappling with these issues.  Our mid-term evaluation suggests that there have been tangible changes within our partner health ministries, and in the next year we hope to identify the implications for health systems at large. As the findings around different capacity building initiatives crystallize, it will be helpful for development partners and country governments to come together and ask the big questions—what works well and how can gains be sustained into the future?