HC Link has been helping build the capacity of people, groups and communities working to build healthy communities for eight years. The three organizations that now make up HC Link – Health Nexus, Parent Actions on Drugs, and Ontario Healthy Communities Coalition- have been involved in capacity building for decades. The term “capacity building” is often seen as jargon — as nebulous as the terms “health promotion” or “healthy communities”. What does it really mean to build capacity? How important is capacity building in health promotion and healthy communities work? Does it really make a difference? These are questions we often get— and that we often ask ourselves. Answering them has not always been easy.
My long-time colleague, Kim Bergeron, and her colleagues at Public Health Ontario (PHO) have recently published an excellent article on this very topic. The article summarizes a systematic review that PHO conducted to identify the underlying theories, models and frameworks that inform capacity building interventions in the published literature.
What does it really mean to build capacity?
The WHO defines capacity building as the development of knowledge, skills, commitment, structures, systems, and leadership to enable effective health promotion. In other words, we are building all of the components necessary for health promotion to affect the health of our communities. To do this effectively, we need to work at three levels: individual, organizational and community. Importantly, like with many things, there is no “silver bullet” in capacity building; no one thing that will build capacity on its own. A range of approaches is needed across a number of dimensions. Typically, services that build capacity include consultations, webinars, training workshops, and knowledge products and resources (precisely the services that HC Link provides).
Theories, Models and Frameworks for Capacity Building
The purpose of the systematic review conducted by PHO was to identify underlying theories, models and frameworks used to support capacity building interventions relevant to public health practice. Twenty-eight different theories, models and frameworks were identified. Of this number, five were most frequently cited:
- Two were theories: Diffusion of Innovations and Transformational Learning;
- Two were models: Ecological and Interactive Systems Framework for Dissemination and Implementation; and
- One was a framework: Bloom’s Taxonomy of Learning.
How important is capacity building in health promotion and healthy communities work?
Well, that’s a good question. Clearly, HC Link believes this is critical work! We are not the only ones, however: the Bangkok Charter for Health Promotion, Canada’s past Chief Public Health Officer Dr David Butler Jones, and Ontario’s strategic plan “Make No Little Plans” all refer to the importance of capacity building. In the late 1990s, the Ontario Government established a system of capacity building resource centers. That system, the Ontario Health Promotion Resource System (OHPRS), developed a framework to show the relationship between the services that its 22 members provided and the health of Ontarians. By building the capacity of health promoters, the framework proposes, the quality of health promotion programs will be enhanced, which will ultimately improve health outcomes at the individual and community level.
Does it really make a difference?
It has often been a struggle to show tangible outcomes from capacity building interventions, beyond satisfaction and short-term change. In 2004, the OHPRS conducted a literature review to establish the link between health promotion capacity building and positive health outcomes at the population level. While a causal pathway (below) was inferred from the literature review and research conducted, direct evidence to support the link between capacity building amongst health promoters and positive health outcomes is difficult.
Tina Sahay, 2004. A Review of the Literature on the Links between Health Promotion Capacity Building and Health Outcomes
Conclusions and Implications for Practice
That is why the work that Public Health Ontario has undertaken is so important. The article concludes that there is a need for the use of theories, models and frameworks to be intentionally used to develop capacity building interventions, and importantly, to be explicitly referenced.
The findings presented in the article can be used to better design capacity building interventions (e.g., consultation, technical assistance, training, coaching, web-based and/or facilitated learning opportunities, knowledge products and resources). They can also help to guide implementation practice by encouraging practitioners to consider, explicitly identify, and clearly define which theories, models and frameworks were used during various stages of the capacity building process.