Strengthening of Public Health Associations (SOPHA) Evaluation

By: Dr. Paul Freeman

For 25 years the Canadian Public Health Association, with support from the American Public Health Association, has been facilitating ongoing processes to establish and/or strengthen Public Health Associations in developing countries. In November 2011, SOPHA has organized a mission to evaluate its program through field visits to three countries currently receiving assistance and through the results of a questionnaire answered in 5 other country partner Associations. Omar Khan and I were part of this evaluation process through field visits to Nicaragua, Mozambique and Congo Brazzaville. I accompanied Drs Henri Delatour and Deo Sekimpi to the Congo. It was inspiring to see how enthusiastic the members of the local Public Health Association – L’Association Congolese Pour La Santé Publique et Communautaire (ACSPC) – were. In the midst of poverty they devoted a lot of their own time to establish their association and to conduct ongoing activities that established the credibility of their organization with the community and government.

We huddle to discuss Public Health Association business. Photo credit: Paul Freeman.

The SOPHA program has resulted in both individual and group capacity strengthening and knowledge sharing.  Formal training was given in key aspects of strategic planning and project planning, implementation, monitoring and evaluation. SOPHA support of participation in international conferences and networking improved the profile of the organization and led to learning through sharing. In 2008 and 2010 ACSPC organized scientific conferences where different stakeholders participated. ACSPC members have built both personal and institutional capacity by attended many international meetings.  ACSPC also collaborated with municipal and national health authorities, thus contributing to strengthening the health system at those levels.  The projects contributed to public health capacity building across many health programs, such as sanitation, immunization, road safety, TB control, HIV/AIDS control and malaria control.

They appreciate what can be achieved through association. Photo credit: Paul Freeman.

Institutional capacities were adequately strengthened and they are sufficient to ensure sustainability in the short term, but better fund raising activities are needed for the mid to long term. The ACSPC staff were trained on results based management (RBM) tools which were applied in the development of project plans.   New knowledge was applied in financial management to prepare annual, midterm and final financial reports to CPHA, and strategic planning was used to prepare the strategic plan 2012-2016. Funding is not sufficient; the association is using the skills and tools acquired with the SOPHA program to look for other donors and prepare projects.

Supplying latrines and clean water to schools, a typical project. Photo credit: Paul Freeman

There were several key lessons learned. SOPHA capacity building contributes to increase the confidence and the credibility of the association. Advocacy needs to be undertaken to increase the involvement of other health professionals (doctors, nurses) and government officials in the association and develop their interest for public health issues. The main challenge and issue for project implementation was that the multi-disciplinary and multi-sectoral dimension of public health is not yet understood by many stakeholders and decision makers and, partly as a consequence of this, there are few doctors, nurses, or government (Ministry of Health and local health authority) members in ACSPC.

We talked for hours, often by gaslight in small rooms – their offices – in just adequate private housing, that we reached through dirt streets awash with water from recent rain. It was heartening to see what had been achieved and how these pioneer members, with only a few trained health professionals amongst their numbers, had established and barely kept afloat, their own Public Health Associations. Perhaps we could establish links with them for solidarity and to support their growing skill and knowledge base.

Paul Freeman is a physician with advanced training in tropical disease control and general public health, health personnel education, and health program management and evaluation. He has over two and a half decades of experience in capacity building and the design, planning, implementation, monitoring and evaluation of primary health care, child survival and malaria control programs in developing countries and for deprived rural indigenous populations in developed countries. He is a Clinical Assistant Professor at the University of Washington School of Global Health and the Chair-Elect of the International Health Section.

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