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

2. 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

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

4. 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”

5. 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

6. 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

7. 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

8. 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

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

10. 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

11. 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”