Health Promotion International Advance Access originally published online on March 23, 2005
Health Promotion International 2005 20(3):285-295; doi:10.1093/heapro/dai003
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PERSPECTIVES |
Building capacity for health promotion—a case study from China
1Formerly Australian Centre for Health Promotion, The University of Sydney, 2College of Health Sciences, The University of Sydney, 3Division of Non-communicable Diseases, Chinese Ministry of Health, 4Chinese Center for Disease Control and Prevention and 5Division of Non-communicable Diseases, Chinese Ministry of Health
Address for correspondence: Dr K. C. Tang, Department of Chronic Diseases and Health Promotion, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland E-mail: tangkc{at}who.int
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SUMMARY |
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 TOP SUMMARY INTRODUCTIONA MODEL FOR BUILDING...THE PROJECT INPUT: EDUCATION...RESULTSDISCUSSIONREFERENCES |
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During the period 1997–2000 a technical assistance project to build capacity for community-based health promotion was implemented in seven cities and one province in China. The technical assistance project formed part of a much larger World Bank supported program to improve disease prevention capabilities in China, commonly known as Health VII. The technical assistance project was funded by the Australian Agency for International Development. It was designed to develop capacity within the Ministry of Health (MOH) and the cities and province in the management of community-based health promotion projects, as well as supporting institutional development and public health policy reform. There are some relatively unique features of this technical assistance which helped shape its implementation and impact. It sought to provide the Chinese MOH and the cities and province with an introduction to comprehensive health promotion strategies, in contrast to the more limited information, education and communication strategies. The project was provided on a continuing basis over 3 years through a single institution, rather than as a series of ad hoc consultancies by individuals. Teaching and learning processes were developmental, leading progressively to a greater degree of local Chinese input and management to ensure sustainability and maintenance of technical support for the project. Based on this experience, this paper presents a model for capacity building projects of this type. It describes the education, training and planning activities that were the key inputs to the project, as well as the limited available evidence on the impact of the project. It describes how the project evolved over time to meet the changing needs of the participants, specifically how the content of the project shifted from a risk-factor orientation to a settings-based focus, and the delivery of the project moved from an expert-led approach to a more participatory, problem based learning approach. In terms of impact, marked differences before and after the implementation of the training activities were identified in key areas for reform, in addition to the self reported positive change in knowledge, and a high level of participant satisfaction. Key lessons are summarized. Technical assistance projects of this kind benefit from continuity and a high level of coordination, the provision of culturally and linguistically appropriate teaching, and a clear understanding of the need to match workforce development with organizational/institutional development.
Key words: capacity building; health promotion; organizational capacity
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INTRODUCTION |
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TOPSUMMARYINTRODUCTIONA MODEL FOR BUILDING...THE PROJECT INPUT: EDUCATION...RESULTSDISCUSSIONREFERENCES |
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Increasing recognition by many countries that health promotion offers a cost-effective strategy for preventing communicable and non-communicable diseases, has led to close attention being given to the development of a public health infrastructure (IUHPE, 1995
; Nutbeam and Wise, 2002). The term ‘infrastructure’ is defined as the different components that are required to direct and support actions to promote and protect population health. These components include national and local policies, monitoring and surveillance systems, research and evaluation capability, a skilled workforce, and program delivery mechanisms (NHMRC, 1997). Building the capacity of countries to develop and operate this infrastructure for health promotion has become a key strategy for international aid programs supported by the World Bank and country donor agencies such as AusAID. This aid is usually in the form of education and training activities designed to develop workforce and institutional capacity. This paper reports on one such project in China. The World Bank has offered assistance to China through a series of development projects over the past 20 years. The technical assistance project reported here forms part of a much larger World Bank supported program to improve disease prevention capabilities in China, commonly known as World Bank Health VII. The larger program was originally planned to run between 1996 and 2000, and was subsequently extended to 2003. The program operated in seven cities (Beijing, Shanghai, Tianjin, Chengdu, Luoyang, Liuzhou and Weihai) and one province (Yunnan). Within the Yunnan province, its capital city, Kunming, was selected as the targeted city. These cities were chosen as pilot cities by the Chinese Ministry of Health and the World Bank to reflect a mix of size and geographic spread. In these cities, problems associated with a rise in non-communicable diseases or HIV/AIDS were also apparent.
The China Health VII program provided financial assistance to the pilot cities to enable them to modernize and re-orient their public health systems in order to strengthen capacity for disease surveillance and public health interventions. As a part of this program, the Australian Agency for International Development (AusAID) supported a technical assistance project that comprised a series of education, training and planning activities over three years. This project aimed to improve the knowledge and skills of policy-makers, public health managers and practitioners to recognize the potential and to implement community-based interventions to address the major risks for non-communicable diseases and STD/HIV/AIDS in China. In the case of Kunming, special assistance was required to build capacity for the application of health promotion strategies to prevent the spread of HIV/AIDS. This capacity-building project within the Health VII program was executed by the World Bank with an AusAID grant and delivered by an Australian consortium led by the Australian Centre for Health Promotion (ACHP), the Chinese Ministry of Health and the Chinese Academy of Preventive Medicine (CAPM). Members of the Consortium were the SMEC, the New South Wales Health Department and the Albion Street Centre.
This paper describes the development and execution of the project, providing available data on the impact of the technical assistance project, and reflects upon the general lessons learned which may be useful in the execution of similar technical assistance in the future.
The experience reported here will be useful in the design, implementation and evaluation of capacity building activities supported by government and non government aid agencies (Crisp et al., 2000; Tang et al., 2001).
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A MODEL FOR BUILDING HEALTH PROMOTION CAPACITY |
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TOPSUMMARYINTRODUCTIONA MODEL FOR BUILDING...THE PROJECT INPUT: EDUCATION...RESULTSDISCUSSIONREFERENCES |
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Figure 1 provides a summary of the technical assistance project structure, inputs and activities described below. It illustrates the equal attention given to workforce development and organizational/institutional development. In the past, greatest attention has been given to the development of skills and capacity among individual practitioners—those responsible for delivering programs and services to local communities. By contrast, the development of institutional capacity has been relatively neglected (NSW Health Department, 2000
; Crisp et al., 2000; Tang et al., 2001; Goodman et al., 1993). This model explicitly recognizes that improved community-based interventions often require changes to local policies, commitment of resources, and agreement to different ways of working. These organizational changes will often depend upon support from local political leaders and senior managers. The technical assistance project was organized in such a way as to support capacity development at the individual and institutional levels, involving practitioners, managers and political leaders. Figure 1 also summarizes the basic intervention approaches that evolved during the life of the project, and indicates the target populations and key objectives for the capacity building project.
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The intention of this technical assistance project was to increase the capacity to promote health at the individual practitioners' and organizational levels in the selected project cities in the five content areas specified by the Chinese MOH and the World Bank:
- develop public health policy;
- improve public health surveillance and monitoring;
- support the development of staff;
- develop and deliver community based health interventions;
- create a supportive organizational environment and structure.
The inputs and outcomes of all but one component mentioned above are described below, as the technical assistance in the surveillance component was undertaken by the Centres for Disease Control and Prevention in the United States.
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THE PROJECT INPUT: EDUCATION AND TRAINING ACTIVITIES |
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TOPSUMMARYINTRODUCTIONA MODEL FOR BUILDING...THE PROJECT INPUT: EDUCATION...RESULTSDISCUSSIONREFERENCES |
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The education and training activities were organized and delivered by the Australian consortium in collaboration with the Foreign Loan Office and the Department of Disease Control of the Chinese Ministry of Health. Specific education and training activities were identified and discussed in detail in annual planning missions between the ACHP and representatives of these partnership organizations.
What was taught, how it was taught and for whom
The project consisted of three types of activity: intensive training courses of six weeks' duration held at the University of Sydney, two week study tours which were usually based in Sydney but on two occasions involved visits to locations other than Sydney, and four day workshops conducted in China. The short courses usually included 6–8 participants, the study tours would generally include up to 12 participants, and the workshops in China which were intended to reach a much larger number of practitioners, often involved more than 50 participants.
Table 1 provides an overview of the activities held during this period. At the beginning of the project, the expressed needs in China were highly goal-directed, emphasizing the need for improved technical skills and capacity in risk factor control (e.g. tobacco control, dietary modification). With experience and discussions based on monitoring and feedback, the emphasis of the program shifted from the specific to more generic skills development (e.g. in planning and evaluation), and from a risk-factor orientation to a settings-based approach to health promotion (e.g. in schools, workplaces and local neighbourhoods).
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The participants in the short courses comprised mainly mid level managers and academics from the Chinese Academy of Preventive Medicine (CAPM), the Health Education Institutes at national and city levels, the anti-epidemic stations (now renamed as centres for disease control and prevention) at the city level, the relevant departments of the Chinese MOH and of the Bureaus of Health of the project cities. These courses were taught in Chinese with the assistance of an interpreter, and were tailor-made for the participants. Where appropriate, units of study from the Sydney University Master of Public Health Program were used. This group were regarded as leading practitioners who would have responsibility in China to provide technical expertise for the implementation of the health promotion activities operating in the project cities.
This component of the technical assistance was acknowledged to be very demanding. Within a period of 6 weeks, in addition to the 30 6–8 hour teaching and visiting days, participants were required to submit an assignment, which consisted of a written proposal and an oral presentation, for assessment. After the assessment, a grade was given which was included on the certificate of participation received by all students. When they returned to China, the written proposals were presented, published and disseminated as models of good practice.
The participants in the 2-week study tours generally consisted of more senior managers and community leaders. These included Health Department/Bureau directors, senior Chinese Ministry of Health officials, senior academics, and political leaders such as Deputy Mayors responsible for health in a pilot city. The 2-week study tours had a less formal and rigorous educational component, and tended to be more strategic and experiential in orientation—intended to inspire and to win the commitment of senior managers and leaders to the health promotion programs at the city and local levels in China.
Participants in the workshops consisted of a mix of mid-level managers who had participated in the Sydney short courses, and a large number of lower level project managers who were generally responsible for the delivery of the health promotion activities on a day to day basis in the pilot cities.
Through this structure a simple cascade model of education and communication operated. Senior officials and community leaders were engaged to win their support, mid-level managers had the opportunity to develop their knowledge and skills through intensive training to guide the development and management of activities, and more junior staff also had opportunities to take part in training activities involving international and local experts.
Educational design and content
The content and approach to teaching and learning evolved over the life of the project. As indicated in Table 1, in the first year of the project, the Ministry and project cities were most concerned to ensure that the staff working on the projects had essential skills to address specific health risks. By 1999, the technical support had moved away entirely from specific risk focussed subject matter (tobacco, HIV) to generic technical skills and program strategy. Thus in 1999 training activities focussed exclusively on different settings for health promotion such as schools, worksites and health care settings.
Similarly, the approach to teaching and learning evolved as the project developed. The 1997 and 1998 activities were essentially teaching oriented. Participants were provided with knowledge of and skills in planning, implementation and evaluation in accordance with models of good practice, and were exposed to a wide range of theories which are used to guide health promotion practice. This was in accordance with the contract for technical assistance, and in line with the expectations of the Chinese Ministry and project cities.
To ensure that the participants could understand the application of theories, knowledge and skills, case illustrations were extensively used. In retrospect, it is clear that the relevance of some of those cases was limited in the context of China, especially in relation to HIV prevention, and to some extent in policy development and implementation. Not surprisingly, some participants had difficulties in the application of the teaching.
In response to these experiences, the teaching and learning methods used in the latter part of the 1998 and for the 1999 activities were changed to be far more learner-oriented. Chinese experts as well as the participants of the short courses and workshops took increasing responsibility for the teaching activities and learning experiences, and were given considerable opportunities to participate in the planning, implementation and evaluation of the extended technical assistance project. This not only ensured greater relevance, it also helped ensure that there was increased experience and capacity in China to undertake health promotion education and training activities at the end of the formal project. The role of the Australian technical advisors increasingly became one of facilitation rather than direction and management.
Problem-based learning was progressively introduced, especially through the Sydney-based 6-week intensive training courses. Participants in these courses were asked to submit real-life health promotion project planning and implementation problems that they encountered in their project cities as cases for development. All participants were required to develop a project response to the problem, and to present their proposal for peer review.
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RESULTS |
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TOPSUMMARYINTRODUCTIONA MODEL FOR BUILDING...THE PROJECT INPUT: EDUCATION...RESULTSDISCUSSIONREFERENCES |
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Evaluation of this type of technical assistance project is complex, in part because of the diffuse nature of the inputs, but mainly because of the difficulty in ascribing causation to subsequent observable actions. This section describes some of the changes in public health policy and practice that were observed during and after the technical assistance project, as well as summarizing data collected from evaluative studies performed within the project.
Evidence of workforce development
The project was delivered according to plan and timetable. Quantitative feedback from the participants at all levels as regards the different types of activities, particularly the short courses, was very positive. Each of the short courses was separately assessed using pre- and post-course questionnaires, and all indicated a very high level of satisfaction with the organization of the technical assistance, and considerable self-reported increased knowledge. The positive changes were also confirmed through formal evaluation sessions and informal feedback from officials and participants, as specified in some 40 project reports to the funding bodies over the 3 years, including planning mission, training activity, project quarterly and completion reports.
Although such findings are difficult to verify and may reflect a culture of respect among the participants, these findings are consistent with the conclusions drawn by the annual supervision sessions of the project team of the World Bank, as well as two independent assessments of the technical assistance commissioned by the World Bank in 1999, with one conducted by a consultant from overseas and the other by the Beijing Medical University.
Practical evidence of changes in knowledge and skills could be observed in the improvement to the annual plans, project proposals, implementation and evaluation reports over the period of 3 years. More tangible evidence of improved knowledge and skills can be found in the large volume of health promotion technical reports, casebooks, manuals and guidelines that were produced during the technical assistance project, for example, the ‘Collection of Reports by the Trainees of Overseas Short-term Training Volume I (The Health VII Project National Office, 1998), the ‘Health Promotion Intervention Methods and Applications’ in 1999 (Yang, 1999) and the four guidelines for promoting health in schools, hospitals, the workplace and community in 2003. Articles were also published in professional journals in China and internationally (Chen, 1999; Wang et al., 2000; Wang, 2000).
Evidence of organizational development
Since the implementation of the extended Technical Assistance in 1999, practitioners and academics of the Ministry and the project cities recognize the importance of obtaining organizational support for health promotion. To ascertain whether or not organizational support had increased over the 3-year period of technical assistance, and to identify ways of obtaining further support, a structured questionnaire was developed. This examined participants' perceptions of changes in organizational support and capacity in eight dimensions, namely leadership, expertise, structure, reward, helpful mechanisms, relationships, purpose and attitude to change.
The focus of each of the eight dimensions to which the questions referred is highlighted in Table 2.
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Thirty practitioners in each of the eight project cities were selected as respondents to the assessment. The questionnaire assessment was coordinated by the Chinese Academy of Preventive Medicine (CAPM) and was administered by the Project Office in each of the project cities in April 2000. The respondents to the assessment were asked to fill in two sets of identical questionnaires. The questionnaires were in Chinese and the face validity was assessed and found satisfactory. In the first questionnaire they were required to register their perception, on a six-point scale, of the support in early 1997 or at the time they joined the organization. In the second one, they were asked to provide assessment of the situation in April 1999. Completed questionnaires were returned to the CAPM through the Project Office in their city. Altogether 219 questionnaires were completed and returned to the Project Offices. The completed questionnaires were sent to the Australian Centre for Health Promotion for coding and analysis in batches. In this analysis, 182 questionnaires are considered. The remaining questionnaires (37) were excluded because they contained incomplete information.
Positive changes have been found in all eight dimensions. The pre- and post-scores of the different dimensions are (the higher the score, the better is the support):
Interpretation of the findings of this assessment needs to be cautious, as a convenience sample was used and there might also be recall biases. Moreover, there might also be variation in the administration of the questionnaire assessment among the project cities. These results are consistent with the external reviews of the project, and indicate positive changes in perceived organizational support during the period of the technical assistance.
Evidence of improved community-based project management
Feedback from members of the national experts group as well as from project reports to the World Bank reveal the increased sophistication and effectiveness of planned community-based interventions. These improvements in intervention method include:
- improved planning of the interventions;
- the adoption of a setting-based approach, ensuring better integration of interventions;
- the conscientious involvement of people in the community by the practitioners; and
- the introduction of supportive policies.
Based in part on the experience of this project, the Chinese MOH launched model NCD programs in 30 provinces (Kreuter, 2003).
Overall, the evidence available from annual World Bank inspection reports, as well as anecdotal evidence from senior officials in China, provide a consistent picture. Health promotion projects in the project cities are now in general well planned, properly implemented and more rigorously evaluated. Planning guidelines developed through technical assistance projects are widely used. The need to develop interventions based on theories and the assessment of the fit between an intervention and its objectives is now understood and practised. In implementation, combinations of strategies are used, replacing more basic media and education campaigns that were a feature of the past. Field testing of interventions has also become increasingly common. Evaluation is often conducted at both process and impact levels and the methodology has become more rigorous.
Evidence of policy, strategy and guideline development
The Health VII Project Offices at the central and city levels are required to write and submit their annual reports on progress with the implementation of their interventions. An analysis of these annual reports from the project cities during the 1997–2000 period indicates that a range of policies and guidelines in six content areas have been developed where none existed previously. Although it is difficult to attribute these changes directly to the ideas and inputs from the technical assistance project, the changes are completely consistent with the advice and practical support provided during the 3-year project. These include policies and guidelines on:
- tobacco control
- smoke free schools
- restricted sale of cigarettes to minors
- banning of tobacco advertising in the streets
- smoke free schools
- prevention of road injuries
- first aid training for learner drivers
- promotion of wearing helmet by motor-cyclists and passengers
- first aid training for learner drivers
- HIV/AIDS prevention and control
- patient's right to remain anonymous when seeking treatment
- integration of HIV/AIDS education in secondary school and university curriculum
- guidelines for diagnosis and treatment
- patient's right to remain anonymous when seeking treatment
- balanced diet
- dietary guidelines for primary and high school students
- designated manufacturers of nutritious food for school students
- citywide dietary guidelines
- dietary guidelines for primary and high school students
- high blood pressure prevention and control
- compulsory testing of first time patients aged 35 and above
- guidelines for hospital physicians to test patients for hypertension
- compulsory testing of first time patients aged 35 and above
- coordination and capacity building/human resource development
- health promotion training for health professionals
- integrated government approach to health promotion
- health promotion training for health professionals
All project cities recognize the contributions of these policies, strategies and guidelines in achieving population health. While some policies, strategies and guidelines have been introduced and delivered satisfactorily, implementation has not been consistently achieved in regard to some others (such as restricted sales of cigarette to minors). This is due to a combination of factors including lack of funding, ineffective intersectoral cooperation/ambiguous departmental responsibility, lack of community support and lack of technical expertise. Effort is currently being made in China to ensure more effective implementation by addressing these impediments.
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DISCUSSION |
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TOPSUMMARYINTRODUCTIONA MODEL FOR BUILDING...THE PROJECT INPUT: EDUCATION...RESULTSDISCUSSIONREFERENCES |
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The results of the technical assistance were very encouraging and there were many factors that led to this success: the good planning and execution of the technical assistance, the high quality of the participants and their positive attitude towards the technical assistance and learning styles, particularly, the short course participants as well as the political support built during the 3-year technical assistance period.
The overwhelming majority of the course participants were experienced practitioners and had considerable capacity to absorb and use knowledge. They took the training very seriously. They were keen to learn and worked hard. Different from the participants of other similar courses from China, the great majority of them were open and assertive. They were responsive to questions and also willing to ask questions. The use of Chinese as a medium of teaching, the unpatronising attitude of the Consultants and the work that was done to develop a trustworthy and mutually respectful working relationship contributed to the responsiveness. Upon completion of their training, most participants returned to their own work units and assumed either a managerial or technical role in health promotion.
The success was also due to the positive support given to the technical assistance by the senior executives of the Chinese MOH and their counterparts at the city level throughout the 3 years. Increase in the funding for chronic disease control was noted in most of the project cities, particularly in Beijing, Shanghai, Chengdu and Liuzhou. The support was forthcoming partly because of the efforts that were made by the consultants in building trust, respect and mutual understanding. Upon completion of the technical assistance in mid 2001, the support was sustained for at least two reasons—the recognition of the usefulness and contribution of health promotion to achieving health and the synergy from the overall Health VII Program which continued until the end of 2004.
Although the broad content areas of the education and training activities of the projects were specified in the original contract for technical assistance, the detailed development of the project was the responsibility of the Consultants in collaboration with the Chinese Ministry of Health. There was no working model of good practice in capacity building for health promotion in developing countries, and our experience may be useful as a guide for the development of future technical assistance in health promotion.
Continuity and coordination
The impact of a one-off consultancy will always be limited. It is unlikely that any individual consultant alone is able to meet the wide range of educational and training needs of effective health promotion practice. These needs can only be met by a team of consultants. It is our experience that technical assistance will be more cost-effective if managed through a single institution which is able to mobilize, in a coordinated manner, a team of consultants with expertise in different disciplines and with a balanced mix of academics and field practitioners. Furthermore, this technical assistance project ran over 3 years. It was able to offer a series of progressive and mutually reinforcing education and training activities.
This long-term coordinated approach to the technical assistance helped to ensure that duplications and gaps were avoided, consistency in standards maintained, and core messages reinforced. Confusion and conflicting views on effective health promotion among consultants were also minimized.
Building trust, respect and mutual understanding
A respectful working relationship between the Chinese MOH and the consultant contributed to a great extent to the success of the project. In addition to the education and training activities, there were regular planning missions and evaluation sessions. Through these missions and sessions, the Consultants took time to listen and share views with Chinese colleagues. The views and expectations of the consultants and the Chinese MOH were communicated. Differences in the interpretation of health promotion concepts were clarified. Local cultural values and practices were introduced. The strengths and limitations of both parties were acknowledged.
The mutual respect and trust which evolved over a 3-year period through these planning missions was crucial to the development of appropriate education and training activities and the sustainability of the technical assistance. This approach allowed the two parties to have a genuine dialogue, provide frank and insightful input and make joint decisions so as to improve the quality of the assistance.
The informal relationship that was developed outside the meeting and teaching rooms through social activities has proven to be helpful to promoting understanding, which in turn led to mutual respect, and the development of a trustworthy working relationship between the Chinese MOH, the participants and the consultants.
The use of Chinese as a language of teaching
Crucial to the success of this project was the use of Chinese as one of the two languages for communication. The participants of all education and training activities were provided with an interpreting service. The great majority of the presentations and core teaching and reference materials were also translated into Chinese.
The use of Chinese allowed the MOH at the central and city levels to send their core health promotion staff members to take part in the activities regardless of their English proficiency. Participation in the activities was far easier and more likely. This also allowed a large number of frontline practitioners to participate in the great majority of the in-country workshops. Their participation is critical for achieving effective health promotion as they are the ones responsible for the day-to-day implementation of interventions.
All but one of the assignments of the course participants were also written in Chinese and the supervision given to the participants was also conducted in Chinese. This was made possible only because the course coordinator was bilingual. The interpreting and translating services for the courses and tours were provided by qualified interpreters with a high level of proficiency in written Chinese, with assistance from many colleagues of the Chinese MOH at the central and city levels. The language services provided in the workshops were provided by colleagues in China.
The provision of the services required additional cost and accounted for about 3% of the total budget, but there appears to have been significant added value to the project from this investment.
Building political support for health promotion
It is obvious that the increase in knowledge and skill levels of individual practitioners was a key success of this capacity building project. However, the expertise of individual practitioners alone will not lead to effective health promotion practice without strong support from the organization within which they work. For example, improved community-based interventions often require changes to local policies, commitment of resources, and agreement to different ways of working. This cannot be achieved without support from local political leaders and senior managers. The involvement of political leaders and senior managers in the technical assistance project through the study tours and China-based training activities helped to ensure that such support was available. To capitalize on this support, the educational and training activities not only helped participants develop practical skills for local implementation of health promotion projects, but also emphasized the importance of achieving organizational change and development to create a more supportive infrastructure. Capacity building at both individual and organization levels must go hand in hand.
Start where the client is and end up where the client should be
Part of the process of trust building involved the consultant in meeting the MOH's immediate needs and expectations related to the need to address identified risk factors such as diet and smoking, and by utilizing more traditional intervention methods including public education and the use of the mass media. As the working relationship developed, the different components of contemporary health promotion were introduced. This included the introduction of theory-based planning, the use of evidence to guide interventions, the use of different forms of strategy in multiple combinations and so on. Eventually, many of the more radical changes proposed by the consultants were acknowledged and adapted for local application.
These changes in the content of the education and training activity have meant that the Ministry and project cities have greater capacity to apply these skills to a range of public health issues which are beyond the scope of the original project. As a consequence, the generic skills which have been developed through the project have already been applied, for example, to maternal and child health projects, and the promotion of immunization in the poorer regions of China—in both cases they are geographic regions outside the original project areas.
Concluding remarks
It is difficult to capture the complexities and subtleties of a technical assistance project such as the one described above. Most of the evidence that we have reported here suggests that the project was successfully executed, and has produced early results that are consistent with its objectives. We have attempted to summarize the key inputs and outcomes in building capacity for health promotion in a range of cities in China—each with its own distinct characteristics and needs. Some generalizable lessons can be extracted from this experience.
It is clear from this experience that technical assistance projects of this kind benefit from continuity and a high level of coordination, the provision of culturally and linguistically appropriate opportunities for applying classroom teaching to practice, and a clear understanding of the need to match workforce development with organizational/institutional development. The accomplishment of these conditions cannot be achieved in a short period of time but through a series of progressive and mutually reinforcing education and training activities.
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ACKNOWLEDGEMENTS |
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The authors wish to thank the World Bank and AusAID for funding technical assistance and Stephen Law, PhD student of the Department of Statistics and Actuarial Science and Centre of Asian Studies at the University of Hong Kong for applying the statistical procedures to examine the changes in organizational support before and after the technical assistance specified in Table 3.
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TOPSUMMARYINTRODUCTIONA MODEL FOR BUILDING...THE PROJECT INPUT: EDUCATION...RESULTSDISCUSSIONREFERENCES |
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