Securing National Ownership through Dialogue Capacity Building in the Health Sector, Nicaragua Case: Obstetric Nurses Programme

Programme based on previous experiences - and failures... Started in the 1980s as an NGO initiative Teachers/trainers where trained Approx. 200 Obstetric Nurses (OB’s) where trained Ownership at NGO level and university

Positive outcome of the project Institutional twinning Nicaragua-Sweden Technically successful project Enthusiasm and innovation Personal commitment

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”

So in the end... Project ended NGO commitment decreased Enthusiasm + personal commitment faded Trained capacities where not used Only a handful work today as OB’s

New initiative based on dialogue Sida received an informal request in 2001 from NGO and Managua University Feasibilty and appraisal missions with Swedish OB’s plus + communicator Interviews including all stakeholders LFA-seminars with key stakeholders

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

Sida’s 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

cont. Sida’s role(s) as donor... Inclusion of communication components in programme design and budget

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

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”