HealthNet TPO Strategy Paper - ANBI · Strategy HealthNet TPO 2011-2015 4 2. Introduction HealthNet TPO develops a new 5 year strategy in the midst of discussion about the future

HealthNet TPO

Strategy Paper

2011-2015

12/1/2010

Strategy HealthNet TPO 2011-2015 2

Contents

1. Summary ....................................................................................................... 3 2. Introduction .................................................................................................... 4

1.1 Mission, vision & strategy ............................................................................ 4 1.2 General approach ....................................................................................... 5 1.3 Results 2005-2010 as compared with previous strategic plan .......................... 6

2 The position of HealthNet TPO: context analysis .................................................. 8 2.1 Health challenges in the coming years .......................................................... 8 2.2 The working environment: fragile states and excluded populations ................. 10 2.3 Trends in the donor world ......................................................................... 11

2.3.1 National governments ........................................................................ 11 2.3.2 International agencies ........................................................................ 11 2.3.3 The public ......................................................................................... 12 2.3.4 Corporate support .............................................................................. 12

3 HealthNet TPO towards 2015 .......................................................................... 13 3.1 Operations & Support ............................................................................... 16

3.1.1 Contract Management ........................................................................ 17 3.1.2 Public Health and Community Mobilization/Reflection ............................. 18 3.1.3 Human Resource Management ............................................................ 22 3.1.4 Finance ............................................................................................. 23

3.2 Research, strategy and fund development ................................................... 23 3.2.1 Strategy and risk ............................................................................... 23 3.2.2 Knowledge management & network ..................................................... 23 3.2.3 Branding and fund development: from Charity to Social Entrepreneur ...... 24

3.2.3.1 Branding strategy ........................................................................ 24 3.2.3.2 The financial need of HealthNet TPO ............................................... 25 3.2.3.3 Project funds ............................................................................... 25 3.2.3.4 Coverage of indirect costs ............................................................. 25 3.2.3.5 The business-model ..................................................................... 26

3.2.4 Research and development ................................................................. 28 3.2.5 Development ..................................................................................... 30

4 Budget ......................................................................................................... 31


1. Summary

In 2015 HealthNet TPO is a medium sized aid agency, with an annual turnover of € 20-30

million, some 30 ongoing projects in at least 10 different countries at any given time, and a

headquarter support staff of about 45 Fte’s. Funds will be drawn from institutional donors, and

indirect costs will be covered through a combination of corporate funding and income generated

through a for-profit foundation that is linked with HealthNet TPO.

in 2015, HealthNet TPO has strengthened its organizational and financial organisation, and

strengthened its capacity to produce evidence based intervention models. Key issues in the

coming five years will be:

1. A robust financial and administrative organization;

2. A functional knowledge network;

3. A HRM system that responds to organizational needs and is able to contribute to capacity

building in project sites;

4. Development of a research portfolio according to a new research agenda where

‘collective trauma’ is a central concept;

5. Relation building with institutional donors following a documented donor strategy;

6. A proper balance in coverage of indirect costs.

At the heart of this Strategy Paper 2011-2015 is the identity of HealthNet TPO which consists of

improving access to quality health care for excluded populations in fragile states, through the

development of evidence based interventions.

Four important pointers are:

1. The expertise of HealthNet TPO in specific areas (disease control, mental health, health

finance models, and psychosocial community work) will be continued and extended – but

also needs to be embedded in a coherent approach that contributes to the development

of systems of care.

2. HealthNet TPO aims to improve access to health through integrating public and private

sector health care delivery, based on a contracting approach.

3. HealthNet TPO accepts the ‘basic health care package’ approach as a necessary step

towards building functional systems of service delivery, but also continues to address

broader issues such as women’s health, the role of violence, the position of mental

health and issues of psychosocial suffering.

4. HealthNet TPO will develop a partner-policy that is specifically responding to instable

situations in fragile states where basic capacity is lacking. This includes a

remuneration package for local staff that leads to sustainable development of a

functional civil society agents.


2. Introduction

HealthNet TPO develops a new 5 year strategy in the midst of discussion about the future of

international development cooperation, a global economic crisis and the formation of a new

government in the Netherlands; An interesting time to think about the future. In this era of

change it is important to be very clear about the added value of HealthNet TPO. What role do

we want to play, and what do we need to do in the coming years to be able to play it?

HealthNet TPO is not a classical development agency that works primarily with partners in low

income countries to alleviate poverty. Nor is it a neutral, impartial and independent

humanitarian agency that aims to deliver services paid by funds generated from the general

public. HealthNet TPO’s overall aim is to produce evidence based interventions that help

populations who are excluded from access to quality health care to manage their own health. In

order to achieve that, HealthNet TPO implements projects with these populations, very often in

fragile states, but sometimes for excluded groups in more stable states. These projects

contribute to development of sustainable health services. When possible HealthNet TPO works

closely with governments and always with representatives of local populations, in order to build

local capacity and self-reliance.

This agenda brings HealthNet TPO in the midst of discussions about equity in access to health:

about private and public health care providers; about cultural values and action to reduce

domestic violence; about clarifying the difference between respected traditions and war-bred

habits. In order to do this HealthNet TPO tenders for project funds from institutional donors,

while lobbying actively and sometimes successfully to influence their agenda’s. HealthNet TPO’s

idea of independence is in the successful participation in these debates. The agency has no

funds to call itself independent from institutional donors in a financial way. HealthNet TPO is not

a faith-based organization, and does not shy away from political and ethical questions about

motivation and justification of our work.

In short, HealthNet TPO needs to define it position vis-à-vis a range of strategies most common

in the world of international cooperation such as emergency relief, rehabilitation, structural

poverty reduction, economic sustainable economic growth or civil society contributions to

(global) production of public goods. In this strategy document, this position is defined, the

necessary actions to reach and maintain that position are described, and a sketch of the

outcomes we aim for is given.

1.1 Mission, vision & strategy

Mission

HealthNet TPO develops evidence-based interventions to reach better health for all. The mission

is to enhance the ability of communities in fragile states to better manage their own health and

to build health systems with communities that are excluded from functioning health care by

combining international public health expertise with local tradition.

Vision

HealthNet TPO enters fragile communities using ‘health’ as a universal goal to unite people.

HealthNet TPO aims to rebuild community structures and trust after warfare by building

functional health services, thus uses ‘health’ as a means.

HealthNet TPO starts from local resources and local strengths, and mobilizes communities to

become active stakeholders in health and development.

Throughout the programs HealthNet TPO is sensitive to gender inequity and violence in

relations on all levels.


Strategy

HealthNet TPO gains in-depth understanding of local resources, capacities, beliefs and needs

through action research.

It develops and implements new interventions to support health and sustainable health care

in close collaboration with relevant stakeholders.

Among these stakeholders HealthNet TPO selects effective and sustainable implementers

and/or partners in the field of health care and relevant cross-sectoral interventions to

strengthen health.

By monitoring the effect and applying academic research, HealthNet TPO builds the evidence

base to disseminate successful models.

1.2 General approach

HealthNet TPO develops evidence-based interventions to strengthen the health of populations in

distress. HealthNet TPO aims to contribute to the overall health situation, by developing

systems for the provision of health care and by contributing to community reflection as a

conditional necessity in populations recovering from long-time warfare. The overall health of a

population is more than the sum of its parts, while concurrently it is evident that individuals

cannot heal in a sick society. ‘Health’ is defined by different factors and interventions are

undertaken from various sides. The HealthNet TPO approach can be summarized as follows:

HealthNet TPO works on the structural rehabilitation of health care systems in conflict

affected areas worldwide. It aims at improving the health condition of populations at risk by

understanding, supporting and strengthening coping mechanisms that help communities

recover from decades of warfare, conflict, disaster.

In collaboration with the local population and stakeholders HealthNet TPO focuses on the

implementation, development, reconstruction and improvement of sustainable and

accessible health care systems. It trains and encourages the local population to carry out

initiatives that combat disease, provide psychosocial care, restore infrastructure and

strengthen organizational systems. The aim is to rebuild both individual and family lives as

well as society, and to contribute to the design and installation of functional health care

delivery systems.

A scientific knowledge base is essential to back up the programme interventions, resulting in

higher and sustained impact. HealthNet TPO offers innovative and unconventional solutions

that foster self-reliance and promote sustainable health care accessible to all.

The identity of HealthNet TPO is thus rooted in three ways: 1) building public health systems, 2)

working with excluded populations and in fragile states, and 3) academic work and attitude.

We consider the following to be our core values: to be outspoken, scientific, professional,

improvement oriented, and passionate. The objectives, mission and vision of HealthNet TPO

have been redefined in 2010.

In the five-year period covered in this strategy paper (2011-2015), HealthNet TPO aims:

in general: to consolidate its portfolio volume, strengthen its organizational set-up and financial

basis, and strengthen its capacity to produce evidence based intervention models that enable

people in distress to cope better with their health situation. The strategy to achieve this is a

combination of fund development, knowledge management and applied intervention logic.

more specific: HealthNet TPO will develop a comprehensive approach based on the experience

gained in the last 18 years. The work done on health systems strengthening, disease control,

integration of mental health care, and the development of interventions to address psychosocial

suffering will continue to be developed within a framework that responds to overall challenges

in global health developments. The outcomes of the different interventions will be focused


towards the development of community owned mechanisms that allow communities to take an

active role in the design and management and of health services. The core of this approach is

summarized below. The approach has been leading in the proposals for funding as they have

been forwarded to the Netherlands government (MFS II), the World Bank (in collaboration with

PharmAccess), and the Nationale Postcode Loterij.

In order to achieve this, HealthNet TPO will:

install and manage a knowledge network;

update its human resource management systems;

finalize the review of financial and administrative systems;

implement research, directly and in partnerships, according to a new research agenda;

build sustainable relations with institutional donors following a documented donor strategy;

Create a basis for coverage of indirect costs in balancing income from project activities, free

funds from third parties, and participation in fund-raising actions.

Below we will look at the last five years in order to check our course over time. Then we will

briefly explain the integrated HealthNet TPO approach, and finally we will translate this into

strategic planning.

1.3 Results 2005-2010 as compared with previous strategic plan

In the 5 year strategy plan adopted in 2005, HealthNet TPO aimed to become a an innovative

international health organization, well known among donors, peers, and health policy

developers for specific areas of expertise such as mental health, psychosocial care, disease

control and financially sustainable post-conflict health systems development by 2010. The idea

was that HealthNet TPO should be implementing intervention models as developed in its

projects.

Organization-wise, HealthNet TPO would have a functioning variety of implementation models to

contribute to building sustainable health for people in crisis. The volume of the organisation

would ensure that managerial bureaucracy would not hinder innovative work, while a well-

managed portfolio volume should secure continuity. There should be a decentralized

management structure that allows local specification in implementation, based on universally

applicable management tools; and we would have furthered our contribution to building an

‘evidence based approach’.

In terms of volume, HealthNet TPO was expected to manage a portfolio of € 10-12 million

annually by 2010, of which some 15-20% would be applied research-related; the headquarters

(‘overhead’) occupation should be a maximum of 15 Fte’s, and the indirect cost percentage

maximum 12%.

We have achieved al of these goals – with one exception. The goal not reached is to manage an

annual turnover of 10-12 m annually with only 15 Fte’s. In 2009, turnover was some 14 million,

and Fte’s amounted to around 20.

New interventions have been developed, tested and published. Research has been done to

support this, and publications are listed in each annual report. Examples of new interventions

include the CTP programme, the community based health insurance scheme, and experience

with results based financing.

Overall strategy as developed over last five years

Over the last five years HealthNet TPO has formulated the overall strategy for its project work

in a more coherent way. In its projects, HealthNet TPO aims to come to an integrated, self-

supported continuity of care. Enabling people to take responsibility for their own health and

health care requires people that are able to function at a minimal level. Given the distortion of


warfare on individual and societal levels, the functionality and capability of people is at stake.

For many individuals, rehabilitation through psychosocial care is a necessary first step. For

communities, community reflection is often a first necessary step to create a situation that

allows for effective change. Access to proper primary health care is another condition for

rehabilitation. It takes healthy people to (re)build a society.

The first step is to help those people that need it overcome their fear and trauma. That is done

by drawing on the strength and resilience of others in the community. The community approach

is essential, not only because individual psychological work is not feasible and may not be

culturally relevant, but because of the numbers of people and lack of resources, and the

positive extra effects of working with the whole community. The psychosocial programme (A)

thus helps to bring people together. Not only are those that need help most sought out and

helped, others in the community that can act as resources but often lack the courage in the

light of recent violence are helped to overcome this fear and take on their former, or new, role.

Thus communities are re-created, and also find new roles. Beginnings are made with ‘bottom-

up dialogues’ towards confidence building. Women are involved in conflict-preventive initiatives

and peace building. Initiatives are thought out to help supporting formal peace processes by

planning informal dialogues, building the necessary capacity and influencing the participants in

the official peace process. Exclusion of specific members of society is addressed, and links are

created with peace building activities that promote reconciliation, truth-seeking and transitional

justice. HealthNet TPO has learned that a too strong focus on health in this phase can lead to a

‘tunnel-view’ in which every problematic aspect of daily life is translated as a psychosocial

problems that would need a psychosocial care or health care response. By starting out with the

more neutral term ‘community reflection’ it is possible to bridge to other sectors more easily to

connect resources to needs – which in itself is the most important aspect of psychosocial work.

The second step is to actually ensure access to quality health care: access especially for those

that have (to) overcome fear and trauma, and for the poorest and most vulnerable part of the

population. The most severe health problems are killer diseases such as malaria, tuberculosis

and HIV/AIDS. Overall, mother and child and reproductive health are essential elements of

health care for populations recovering from warfare or natural disaster. Building a basic,

general, primary health care structure is a necessary condition for creating access to any

specific care.

As stated above, the creation of a system that is – at least partly – owned, managed and used

by people is part of a process of building mutual trust and a return to normalcy. Governments

are not expected to contribute much in terms of public services in the process of recovery and

rehabilitation. Making use of all resources available, including user fees, helps to extend the

coverage of services as well as the sense of ownership in the population. The contracting

approach, where performance-based incentives are key to generate both necessary additional

income for health staff and higher quality care for clients, has proven its validity in DR Congo,

Rwanda, Cambodia and Afghanistan. The approach is applies whenever possible.

The third step is in supporting the actual process of restoring local government and the fabric of

society. This may require conflict resolution, mediation processes and anthropologically

informed processes of recovery at community level. Often these processes are conditional to

reaching effects with local government.

Local government is always partner in the installation of primary care services. Even when

material input, trained staff, and political goodwill to establish basic services is lacking, the

additional value of the local government is the potential to embed services into a sustainable

system, as much as provide various levels of government with practical, evidence based ideas

for health reform.

The social fabric of society is addressed in community reflection efforts. The specific focus for

HealthNet TPO is on health services. The effect of working towards a shared goal cannot be


overestimated in the process of bringing people back together again. As a complementary

process to the often top-down defined ‘peace and reconciliation’ process, villagers begin to think

out local strategies. The goals they set are often more modest (not reconciliation, but being

able to live together) and are close to interventions in the psychosocial domain. E.g. self help

groups of veterans, specific, culturally appropriate interventions to work with child soldiers,

raped women, perpetrators in the wider sense of the word, produce very valuable information

and intervention ideas for active prevention of conflict and peace-building). The relations

between conflict resolution and prevention, human rights monitoring, psychosocial and public

healthcare services, and peace-building activities require further underpinning and elaboration

of clear relationships. This will constitute part of the ongoing research agenda and increase the

organisations’ understanding.

Capacity building and training are always central. Training is based on the participatory

development of culturally informed and locally sustainable interventions, in all fields from

human resource development, organisational development and institutional growth.

2 The position of HealthNet TPO: context analysis

2.1 Health challenges in the coming years

In a globalizing world health cannot be seen as a local issue. Health risks are closely related to

issues of poverty and exclusion, to political developments related to the agenda of state

security and the complementary concept of human security, and to new insights in health risks

that have to do with ecological developments as well as a new balance between the traditional

communicable ‘killer diseases’ to non-communicable disease. The challenges ahead should not

take away attention from the problems that are still enormous and that have defined the

agenda of HealthNet TPO: disease control in fragile states, mental health problems and

psychosocial suffering in (the aftermath of) war. But new insights lead to more emphasis on the

interrelated elements of a health system.1

There is growing consensus on the importance of health systems, such as the need for equity in

access, the need to contribute to rebuilding and/or strengthening health systems taking into

account the importance of all health system’s building blocks, the need to find ways to include

both public and private stakeholders, and the challenges of the introduction of results-based

financing.

The expertise of HealthNet TPO in specific areas needs to be continued and extended –

but also needs to be embedded in a coherent approach that contributes to the

development of systems of care.

More emphasis on health systems also has to do with the growing criticism on Official

Development Assistance (ODA). Enormous investments in health have not led to sustainable

development of functional health systems. The focus on the public sector is an important factor

in this failure. Most low income countries that have a functional public sector at all, find it

overburdened and insufficiently equipped to deliver the required quality health services. As a

result the rich benefit more from (donor-) funded public health care than the poor.2 3 This

causes inequalities and inequity, translated in a high proportion of out-of-pocket health

expenditure (>50%). The health providers that operate outside of the public sector remain

invisible, because they do not fit in the pattern that believes that the government should

provide health care.

1 http://www.globalhealth.org/health_systems/ 2 Preker AS, Langenbrunner JC et al, Spending wisely, buying health services for the poor, World Bank, Washington,

D.C.: 2005. 3 Castro-Leal F, Dayton J, Demery L and Mehra K, Public spending on health care in Africa: do the poor benefit? Bulletin of the World

Health Organization, 78(1): 66-74, 2000.

http://www.globalhealth.org/health_systems/


Governments need to take responsibility, but when necessary preconditions to install a public

health system are not met - the availability of the budget to pay for health care for all -

alternatives need to be found. These funds should be brought in through the collection of taxes,

as a means to enforce income solidarity and in the end deliver the services. An increase in

public healthcare spending through donor financing does not fundamentally alleviate the

problem, as it draws private finance (and as a consequence consumers) away from the private

healthcare providers to the public ones, potentially even leaving the sector worse off – the so-

called crowding out effect. The health sector in low income countries is thus stuck in a vicious

circle of low supply and low demand for health care.

HealthNet TPO wants to respond to this problem by integrating public and private sector health

care delivery, through a contracting approach. Proposals have been prepared in 2010 in

partnership with PharmAccess, and submitted to the Netherlands Government and the World

Bank.

Technical expertise that is partly in-house already and needs to be further extended includes:

Relevant skills and know-how on establishing and implementing smaller and larger private

and public health insurance schemes: the design of risk pools, insurance packages, systems

for premium collection, design of risk equalization mechanisms and raising funding for

implementation, administrative systems for risk pooling such as identification of patients and

related administrative processes, design of a clearing house, selection and contracting of

health administrators and insurance agents;

Design and implementation of equity and debt funds for investments in the health care

delivery system, in assuring quality in health care provision (development of an international

system for accreditation/certification) and involving the private (for profit and not for profit)

sector in the delivery of basic health services and primary health care, including sub-

contracting:

Design and implementation of Health Equity Funds that provide a solid base for inclusion of

the poorest groups until they can be included in an equitable RBF health care delivery

system;

Design and management of large scale disease control programs (Malaria, TB, Aids, Kala

Azar, etc.) that replace disease control models used by governments prior to the conflict,

adapt and modernize an approach that holds in an instable environment and introduce these

adapted models in new health governance structures;

Design of a variety of organizational models for health care provision, e.g. the design of

appropriate approaches to health service delivery for remote and difficult-to-reach target

groups including for HIV/AIDS control interventions such as hill tribes in Southeast Asia,

nomads in Sudan;

Integration of basic psychiatry in national health systems, including psychosocial care that

supports health service delivery;

Socio-economic analysis of determinants of health that lead to ‘bottom-up’ involvement of

civil society in health systems strengthening, community participation, and (community

based) programs providing tailor-made psychosocial support to specific target groups and

broader assistance to strengthen community engagement and community ownership in

fragile states;


Conducting of impact analyses through operational research, measuring medical and financial

effects of programs at various levels (from individual through household and community to

national levels).

This expertise is to be developed in a more systematic way than was done up to now. A

knowledge management system will be operational as from 2011 to organise development of

expertise. Below is a brief description of this knowledge management network.

2.2 The working environment: fragile states and excluded populations

‘Fragile states’ are those complex emergencies that include a risk as potential safe havens for

terrorists. The state security approach that has largely taken over de agenda of international

collaboration since ‘9/11’ focuses on these fragile states, and this focus has shifted attention

away from the traditional agenda on erasing poverty. On the one hand, this has put the work of

HealthNet TPO much more central stage – there is more attention now for the gap between

relief and development than ever before. HealthNet TPO has always sought attention and

support for this ‘gap’, and now seems to be the time to be active in responding to this growing

attention.

On the other hand there is a keen interest from governments in an international agenda where

aid and military pressure are much more linked. NATO and governments put pressure on the

re-development of old counterinsurgency skills, and countries like the Netherlands want to

move ahead in improving the ‘3D’ approach. Close collaboration between military and civil input

in fragile states is a political choice that still needs to prove to be effective in its outcomes in

peace-enforcing operations, but definitely changes the ‘humanitarian space’. This comes with

EU ideas to set up groups of civilian volunteers on a European scale who should provide the

‘civil’ element in international interventions. All this creates a new environment, in which NGOs

need to be more competitive in showing what their added value is.

In terms of health policy and health systems development, fragile states offer opportunities for

leaps forward in design and implementation of health systems that can often not be made in

countries where hampering aspects of legislation, tradition and elites are still functional. This is

a harsh truth, but the only advantage to be found in an instable situation that leads to

insecurity, lack of governmental protection or civil rights such as fragile states are, is in the

relative absence of rules and regulations that limit innovative interventions. There are often

little or no restrictions on methods or ideas applied in projects in a lawless environment. One

has the opportunity to convince law- and policymakers of specific approaches once national

health policies are developed and implemented on a national level. The experience gained in

pilot projects is invaluable here.

The ethical questions are obvious: does a lack of law- and policymakers not also imply a void in

control of basic principles, ranging from general ‘do-no-harm’ principles in project design to

peer review of the quality of services? HealthNet TPO has chosen to address this problem

through the combination of implementing projects on institutional donor funds and academic

input. The institutional donors require high standards of planning, transparency and reporting.

This is offers a first line of accountability: HealthNet TPO is always fully accountable, not only

for the funds it spends, but also for the way in which these funds are spend – up to the

technical-medical details. The second extra line of accountability is in the academic perspective

in base-line assessments, epidemiological surveys and effect-studies. Outcomes, reports and

publications are shared and submitted for peer review.

Whereas HealthNet TPO accepts the ‘basic health care package’ approach as a necessary

step towards building functional systems of service delivery, HealthNet TPO will continue

to address broader issues such as women’s health, the role of violence, the position of

mental health and issues of psychosocial suffering.


The development of evidence-based interventions that contribute to health systems in fragile

states is thus the core business of HealthNet TPO. HealthNet TPO has contributed to an advice

to the Netherlands government, “Strategy for Dutch engagement in health recovery processes

in fragile states: Building on contemporary policies, practice and science”.4 It was – of course –

recommended that health should be given more attention in policy design for fragile states, and

the approach to ‘basic health care packages’ was seen as helpful for increased access and

equity. It was also noted that maternal health and sexual and gender based violence, as well as

mental health services are not included in the packages as developed in some countries where

the needs are greatest in these field.

2.3 Trends in the donor world

2.3.1 National governments

The present day climate is hostile towards ODA. The new Netherlands government reduced –

for the first time in decades – the 0.8% of GNI for ODA to 0.7%. It has also installed the MSF II

methodology that forces civil society organisation to organise themselves in consortia.

HealthNet TPO is part of the ‘Dutch Consortium for Rehabilitation’, and will work closely with

Care NL, Save the Children NL, and ZOA in the coming five years – provided that the submitted

proposal is accepted. This basically means that funds diminish, while obligations in terms of

accountability and inter-agency coordination grow substantially. This trend in the Netherlands is

not isolated. ODA is criticized worldwide. It seems thus clear that ODA will become a scarcer

commodity than it already is.

The Netherlands government is expected to make choices for ODA for the coming years. The

idea is that there should be a focus on a limited number of themes and countries. The report of

the WRR (Less Pretension, More Ambition) is leading. Health and education sections in the

report have not been well received, but the important issue for HealthNet TPO is that the idea of

working in an innovative way with different players in the field, including the private sector, and

using the added value of specific expertise in the Netherlands (mother and child health, micro-

finance products such as health insurance) offer productive avenues for collaboration with the

Ministry of Foreign Affairs.

2.3.2 International agencies

UN agencies and especially the World Bank, public-private partnerships such as the Global

Fund, the GAVI alliance, and private funds such as the Gates Foundation are important funders

for international health. In line with what is mentioned above, the governmental contributions

to these institutes are expected to diminish with the reduced ODA.

There is a trend starting in the US where very wealthy civilians press their peers to donate more

(the “Giving Pledge”: Gates and Buffet proposed to 40 of their peers to give away half of their

fortunes. which would amount to some 125 billion USD), and in general private funds are

becoming more important in setting agenda’s. Most of these donors fund the international

agencies such as Global Fund or Gavi, and it does not look like a new type of money is

becoming available.

It is important to note that there is maneuvering space in working with the World Bank, and

especially with Global Fund and GAVI funds. The agencies are under pressure to deliver and are

interested in unorthodox options. This maneuvering space can be used to negotiate better

coverage of indirect costs and more efficient ways of managing (clusters of) projects.

4 Netherlands Platform for Global Health Policy and Health Systems Research, June 2009


2.3.3 The public

Since the Netherlands government changed the subsidy regulations some 4 years ago there has

been, as predicted, fierce competition in the Development branch over the public’s attention.

Initiatives range from sponsoring individuals who participate in sports events to radio-shows

and links with companies. There is no visible change in real interest in the underlying issues,

however. Fundraising attempts towards the general public remain costly, and are difficult to

combine with awareness campaigns about the actual situation people live in. The emotional

factor is still predominant, and as such HealthNet TPO still finds it difficult to see how the

continuity that we strive for in a respectful and realistic approach that avoids victimization can

be combined with successful development of fundraising towards the general public.

The market for public fundraising is not only extremely competitive, but also conservative if not

to say extremely old-fashioned in its replication of asymmetric relations between the ‘emotion

of charity’ and a rights-based approach towards development. Some agencies manage to raise

enough funds from the general public to work without institutional donor funds. This position is

tempting in terms of freedom of action (‘anything’ can be done with free funds) and simple

accounting methods (requirements as given by institutional donors are not present). There is

however danger in lack of accountability as well as lack of discipline in achieving and showing

results.

A selected group of the public consists of entrepreneurs or retired businessmen who are

interested in the problems of poverty and exclusion. These are often people with a sincere and

active interest. A clear trend here is personal involvement. This involvement is concrete and

direct: people want to be involved in planning and execution of projects; they want to visit

project sites, organize different support lines, sometimes to the point where the agency is seen

as a facilitator of personal contact between the donor and the people he or she wants to work

with. These initiatives of individuals or groups of individuals is often based on specific capacities

people have, and their perception on how thee can be made of use in poverty alleviation or

other acts of solidarity.5 This assumption is that international cooperation is in essence nothing

more than the application of a specific set of technical skills in other surroundings: the same

assumption that has limited the effect of ODA investment in health for decades. The lack of a

systematic approach and the emphasis on personal relations weakens the effect of this

involvement, whereas relationships of this kind can easily strain the organization that is seen as

the interlocutor.

2.3.4 Corporate support

Sometimes a similar assumption governs the involvement of business, companies that want to

shape their effort in Corporate Social Responsibility (CSR) through active involvement in

international collaboration. The technical skills that a corporation can offer open possibilities

that can go beyond individual project contributions. HealthNet TPO has a long term relation

(since 2004) with the cooperative insurance company Achmea/Eureko, and is beginning to

develop a similar partnership with the cooperative Rabobank. Both companies were

instrumental in the development of a community based micro health insurance scheme, which is

now starting up. There is interesting dynamics in the development of different views on CSR,

but at the same time it is not difficult to see where the problem is. No company can be

expected to become a structural donor; most companies lack the necessary international

expertise in low-income countries, especially those ‘under stress’ now labeled fragile states; as

long as the interest is limited to CSR agenda’s there is no real commitment. More interesting,

not only for companies but for potential beneficiaries, is an attitude that emphasizes ‘return on

investment’. HealthNet TPO is stimulating potential partners to broaden the view on exchange

of knowledge and experience. The challenge for HealthNet TPO is to help partners think about

what that return should be, and how that can be materialized.

5 See description of ‘particulier initiatief’ in De anatomie van het PI: Resultaten van vijf jaar onderzoek naar Particuliere Initiatieven op

het terrein van ontwikkelingssamenwerking. Lau Schulpen, CIDIN, 2010.


Given this brief tour on trends in the donor world, there are conclusions to be drawn and

choices to be made for HealthNet TPO. They are listed under heading ‘branding and fund

development’ below (3.2.2).

3 HealthNet TPO towards 2015

Amidst growing competition over scarce funds for international collaboration, scepticism about

the use of international collaboration, and more and more politicized international agenda,

HealthNet TPO has set a number of aims for the coming five years.

Points of departure are

that HealthNet TPO is not

about service delivery in

itself, but about developing

new, evidence based

intervention models. We

therefore need to be

keenly aware of the role of

civil society in international

change in health policies,

define the added value of

HealthNet TPO in this

perspective, and organize

HealthNet TPO to deliver

this value.

The role of civil society is

changing, as described

above: governments in low income countries have failed to take on the responsibility for health

service delivery, and governments in the high income countries are shying away from real

investment in global health. The ‘market’ is expected to play an increasing role in service

delivery in high income countries, but the private sector is ignored in development of health

systems. In other words, there are openings on all sides for an active civil society, and within

that, agencies that do not automatically expect their activities to be subsidized. This is not to

say that government has become less relevant for finding lasting solutions for lack of services,

but a realistic assessment of the shift in initiative and leadership.

The challenge is in funding the activities of an agency that accepts the diminishing role of state

subsidies. The mix of activities in this respect is under heading ‘fund development’ in this paper.

The potential success of that mix depends first of all on a clear vision, a clear message, a clear

added value.

There is no doubt about what should constitute the added value of HealthNet TPO. The

combination of direct implementation of projects in combination with research to develop new

interventions in health in fragile states is a unique agenda. HealthNet TPO’s added value is

accepted and respected in this field, recognized as it is by WHO, World Bank and national

governments.

Special targets for the coming 5 years are the following:

The establishment of a functional knowledge management network;

A clear research agenda that covers the activities of HNTPO and links with the academic

world;

New tools for new type of field operations (performance based contracts for field staff,

contracted relations within HNTPO);

A fund development and communication system that is ahead of charity models and

manages to link interests between companies, government and CSOs.

HealthNet TPO at a glance:

What: The goal is always related to improved health for populations

excluded from health care How: The means to reach this goal vary from straightforward public

health programming to social rehabilitation of specific target groups or communities (community reflection)

Modus operandi: HealthNet TPO works though a mix of self-managed projects funded through grants in instable settings,

advisory tasks for partners paid by consultancy fees, subcontracted technical support, tendered health system strengthening projects, research grants

Research: These means are applied as much as possible in a research context that leads to evidence based interventions

Communication: These interventions are disseminated through

peer reviewed journals but also in ‘grey literature’, and through

other media that prove to be effective. Communication is continuous in relating to target populations as beneficiaries and benefactors alike.


There is continuity in the following strategic choices:

Working towards complementary modes of interventions in every region/country. The

integrated approach where health systems are built with special attention for mental

health and psychosocial care, health financing, and disease control – as argued for

above.

Strive towards a more balanced geographical spread, where the strength of experience

can be used in clusters of projects and programmes.

Activities of HealthNet TPO include a range of themes…

community reflection activities to prepare for change

disease control = HIV/Aids, malaria, TB, onchocerciasis, kala azar etc

mental health and psychosocial care = integrated psychiatry in primary health care,

psychosocial care, psycho-trauma work

health systems development = district health development, health financing, public-

private mix

…and a range of contexts

Programmes that aim at strengthening local capacity to deal with public health needs of

populations excluded from (or limited) access to primary care in:

Complex emergencies;

Countries that have come out of complex emergencies;

Situations where people are excluded from health care.

Thematic choices are based on the most immediate needs of people challenged by the need to

rebuild their lives and society. We have come to see how important psychosocial care, health

systems development, and peace building are as themes. Within these, HealthNet TPO has

chosen to build special expertise in mental health, disease control and health finance in

rehabilitation. A special focus on mother and child health and HIV/AIDS are natural outcomes of

this choice. But there are other indicators:

Social development, human rights, self-determination and capacity building: these issues

are essential for health – and essential for project funding.

Is there conflict, post conflict, chronic conflict, or exclusion?

Is there sufficient manoeuvring space for developmental activities?

Are potential local partners present, and if not, is there some capacity to relate to in the

local population? And vice-versa, if sufficient local capacity is present, how do we translate

that in our role (partners instead of independent implementers), and are we necessary at

all?

For whom do we work: local government, national government, ‘the population’, a local

organisation?

What is our position vis-à-vis the powers that be – cooperative, avoiding, negotiating, etc?

Do we distinguish between local, regional and national government/authorities, and how

does that effect planning?

Other themes that are close to what we do and sometimes overlap with, include peace building,

human rights work, child protection and gender programmes. Programme activities should be

linked to other sectors when relevant. HealthNet TPO will seek partnership and alliances with

agencies that excel in these fields, rather than ‘do it alone’. There is clear task here that is

related to the knowledge management as relevant in the public health & research department.

Where

HealthNet TPO is currently active in Asia, Africa and Europe. The number of countries where we

work has slowly diminished over the past years. HealthNet TPO has left Eritrea, Ethiopia,

Georgia, Uganda, Bosnia, Rumania, East Timor and Indonesia over the past years. We have a

very modest beginning in Sierra Leone, but overall it proves very difficult to get started in new

countries. At the same time, the project portfolio has grown in financial volume. This


concentration has to do with the growing budgets for programmes where the basic health care

package is to be delivered, rather than the one-issue projects in the past.

It is important to follow a double strategy. The core of

the HealthNet TPO approach is to develop new models.

One needs time to develop these, and the required

project volume depends fully on the type of intervention

at hand. The implementation of the basic health care

package in combination with a health financing model

that requires financial input from the population or

another agent is not something that can be developed in

isolation – a certain minimal coverage is needed.

Coverage is less important when it comes to

interventions that depend more in depth understanding

of specific issues – a community reflection strategy can

be developed in a relatively small area, as long as it

remains possible to test the approach in a wider area –

which can also be done by offering the intervention

technique to partners. The best working situation is one

where a certain volume allows for an input in national

policy debates, while offering a protective environment

for more specialist interventions.The work field is given in

the present clusters of programmes and projects: the

African Great Lakes area (Burundi, DRC, Rwanda,

Uganda, Sudan) in Africa, and Afghanistan, Pakistan,

Nepal, Cambodia and Sri Lanka in Asia. Extension to

areas where there is an obvious need will be sought in

the coming years: North Sudan, Central Africa, Somalia,

West Africa, but also the countries surrounding

Afghanistan, as well as Birma, Indonesia and Laos in East

Asia.

We are interested in consolidation and extension of our

activities in these areas – but we are by no means limited

to these. We can work anywhere where there is a group

of people excluded form access to minimal quality health.

Modes of working

There is a variety of implementation strategies:

The continuation of a set of activities that started in an emergency (projects handed over

to us by other agencies;

Programmes started by HealthNet TPO in areas where there is a clear need for external

assistance in organising access to health, whereas no other presence can fulfil this need

(projects formulated after an initial assessment on or own initiative, or on request from

others;

Programmes developed in response to a call for proposals (be it grants, tenders or

other);

Collaborative work with any other type of agency (as subcontractor, partner, researcher,

in joint venture, partner in a consortium);

As provider of technical assistance to an existing organisation.

Linking skills is a matter of ‘knowledge management’. In HealthNet TPO projects,

‘international knowledge’ is applied locally. We channel the information that is available

in academic institutions or other centres of excellence to the field, where there is a dire

need for this knowledge. Applying this knowledge locally yields new knowledge that

should be channelled back to the international level. Linking local needs with

internationally available expertise is something we will keep doing until the link can be

organised in other ways.

Guidelines for proposal

development

Protocols for the formulation of new proposals as well as for the extension of existing projects need guidelines: Decisions concerning extension will

be taken 6 months for donor-money expires. Decisions are taken in management team.

Donor mapping is done in Amsterdam and the field, in accordance with available capacity.

A final proposal is ready one month

before donor deadline. Proposal writing is seen as a team

effort, with the input of relevant staff. One person will be assigned to take the lead and is responsible for timely production.

Budgets are initially developed

according to standard HealthNet TPO format, later to be adapted to requirements of the foreseen donor (adaptation of the present

HealthNet TPO standard to meet new requirements is done as soon

as possible). Project proposals will circulate

among the relevant staff for comments and final check.

The final version of the project proposal will be submitted to donors only after endorsement by management team.


Bridging in time means that the task of HealthNet TPO comes to an end when there is

local capacity available to do the work. The exit strategy is always closely connected to

the installation of local capacity. This capacity may be supported by newly created links

with the (inter)national world. This local capacity should be able to take on the task of

organising health HealthNet TPO for the target population. It can be organised in a

variety of ways: in a governmental institution, in the private sector, as a local

organisation of any shape.

Organisation of the agency headquarters

The organisation of HealthNet TPO is constantly reviewed and updated. Structure follows

strategy, and in 2008-2009 the organisation transformed from an agency with 16 staff in

Amsterdam to an agency with 34 staff and a double portfolio volume. The project ‘Ready for the

Future’ was started in 2009 and continues until at least end of 2011, with the aim to update the

agency in terms of organisation to the demands of a new size as well as a new environment. At

the moment of writing, the outline of the structure at the Amsterdam office is best summarized

in a scheme like this:

(Project Implementation)

Field

HNTPO organisation

Liaison

Officer

Operational Support Team

Implementation &

OrganizationMT

Knowledge Management

Strategy & Risk

Communication & Funds

Development

Research &

Acquisition

Finance

Officer

Research &

Development

P&O

Officer

Technical

Officer

Two parallel ‘streams’ support and guide the projects, from complementary perspectives:

‘Operations & Support’ organises management support to deliver quality work in contracted

projects, and ‘Strategy and Research’ provides development support in translating outcomes

into better input in strategies, projects and dissemination of end results.

3.1 Operations & Support

The Operations & Support department combines all tasks related to ongoing projects. Finance,

contract management, public health support and human resource management is organized in

country teams. ‘Country teams’ are in fact the central platform where relations between

projects and HQ are managed. A country team meets regularly to check on ongoing issues and

decide what type of support is needed. Portfolio managers function as secretaries and

coordinators to the country teams, which are made up of representatives of all relevant

departments.


3.1.1 Contract Management

Contract management relates to all contracted activities both in the field and in the

Netherlands. The portfolio of HealthNet TPO will be much bigger in 2010 as compared to 2009 –

but will most probably shrink back to a more structural volume of around 18-20 million euro’s

on an annual basis for the longer term.

HealthNet TPO works through contracted projects, and submits proposals for funding to

institutional donors. The tendency towards tender procedures is growing. In the context of

HealthNet TPO work there is discussion about this approach: the competitive element is not

always easy to combine with a needs based approach. The challenge is in negotiating

acceptable terms with the donors. So far HealthNet TPO has had moderate success in this.

Contract management is the core of the Operations & Support department. Projects are

supervised and supported, while relations with donors are maintained, all in order to provide

quality project implementation.

In the period 2011-2015 the liaison between HQ and the projects needs to be developed

further. It has been noticed that capacity building poses extra challenges in the environment of

fragile states. Not only in the fragile states, but also in the Amsterdam HQ! The relation

between the Amsterdam HQ and the projects depends on capacity on both ends. This has

implications for notions of partnership.

An important question that needs to be answered in the coming years is whether

partners are available and how they qualify; and if not, how HealthNet TPO strikes a

balance between implementing projects to assist the population and building

partnership capacity?

Independence in the field, the way to offer guidance and supervision, the danger of dependence

through salaried positions rather than performance-based positions, the location of ownership

and policy development, and the very notion of partnership itself are important concepts that

need to be updated in a new environment.

Independence Afghanistan projects

A strong, Afghan and independent public health agency is needed in Afghan civil society for the

future, and HealthNet TPO should prepare its exit as an international NGO in favour of a

national agency. The process will take some years, and the current situation in Afghanistan is of

course not one in which long term predictions can be made.

The Afghanistan the portfolio and the general position of the Afghan national program

management team is ready for an exit strategy of HealthNet TPO. There is no rush to get out of

Afghanistan, but the situation requires a well-planned road towards an independent agency in

Afghanistan that can function as a partner organization. This is a complex process, and needs to

be managed very carefully.

In 2009, a meeting was held in Dubai (November) to mark the first steps in the process. The

O&S department is in charge of guiding this process. The first step is to improve the

management capacity of the Afghanistan Management Board (AMB) of HealthNet TPO

Afghanistan towards the management of an Afghan independent Non-Governmental

Organization (NGO).

A committee is formed at the beginning of 2010, and this committee will organize the process –

both the planning and monitoring of the process itself, as the organization, funding and

implementation of the necessary HRM steps to be taken. It is foreseen that this process will

take several years.

MFS II and challenges to work in a consortium


In November 2010 the Netherlands Ministry of International Cooperation decided that the Dutch

Consortium for Rehabilitation (CARE NL, Save the Children NL, ZOA refugee care and HealthNet

TPO) will be funded with 71 million euro’s for the period 2011-2015. This consortium aims to

improve rehabilitation programming by creating synergy between the different sectors that are

represented: community development, good governance, education and livelihood. Next to the

projects in South Sudan, DR Congo and Burundi, HealthNet TPO is to manage the knowledge

network for this consortium. Developing the above mentioned synergy is an interesting

challenge that will force HealthNet TPO to think beyond the public health spectrum. The

management of this package of activities has proven to be difficult under MFS I and the

previous TMF program. The challenge is more complex now since the consortium approach so

far has produced complex compromises but no clear set management standards. Nevertheless,

the opportunity to learn lessons in collaborating with others is useful.

South Sudan and DR Congo

Growth is aimed for in South Sudan and DR Congo. After the referendum in South Sudan

HealthNet TPO should move forward and start using the opportunities of the different funding

mechanism, as has been done in the set up of HIV/Aids programmes with the World Bank in

2010. The most important lessons to be learnt from the experience in Afghanistan is to avoid

setting up an overhead structure in Sudan and DR Congo itself that hinders rather than enables

strong local organizational capacity building. As said above in the section on HRM, building a

strong organisation without creating a non-sustainable salary structure is important. In

Afghanistan, HealthNet TPO has created a very heavy structure, with an enormous staff. This is

a burden on project development that is hardly realized as long as the budgets remain available

with donors, but even while it lasts it puts too much pressure on the organisation. Management

is more focused on internal problems than on project development. This must be avoided in

South Sudan.

Countries like Afghanistan, Sudan and DR Congo are at the receiving end of different funding

mechanisms (see study on the funding gap in post-conflict situations as commissioned by the

Fragile States Network). The strategy in Sudan and DR Congo must be to make use of the

available funds in a sensible way. The strategy department should provide guidance in finding

the right match between donors that provide complementary funds.

3.1.2 Public Health and Community Mobilization/Reflection

Developments in public health in fragile states point towards a growing focus on health systems

development. HealthNet TPO has already worked towards a more comprehensive approach

since the MSF I projects started. This will be continued and intensified. The point of departure is

to build upon the present evidence base in health care development in fragile states –

acknowledging that more evidence is needed, but also acknowledging that clear choices need to

be made to reach effect.

HealthNet TPO has proven that the introduction of performance based incentives in combination

with smart use of user fees contributes to tangible poverty reduction6. The development and

enhancement of pre-payment systems for health care is expected to bring more beneficial

effects on poverty reduction strategies. Prepayment systems may directly support the poor, by

avoiding catastrophic unpredictable and high out-of-pocket expenditure. A strong program focus

on improving geographical and financial access to quality basic health care, including essential

emergency (obstetric and other) care is expected to lead to improved utilization of essential

health services. HealthNet TPO has been developing Community Based Health Insurance (CBHI)

Schemes on a cooperative basis in fragile states. This is done in collaboration with Achmea and

Rabobank, on the basis of extensive experience in building health systems in the aftermath of

war.

6 Benjamin Loevinsohn, April Harding, “Buying results: Contracting for health services in developing countries” Lancet 2005; 366: 676-81

and “Achieving the twin objectives of efficiency and equity: contracting health services in Cambodia” ERD Policy Brief Series no 6. Asian

Development Bank, March 2002.


The results of this approach extend beyond the function of an insurance scheme as such.

Extra’s are:

Access to health is created for the poor;

Poverty reduction is reached through economizing on out-of-pocket health expenditure;

Applying the association philosophy helps repair the fabric of social life that is often

destroyed by decades of warfare;

And governments are presented with role models that help them take their responsibility

in enabling cost-effective public health care.

Building civil society

Building civil society is an explicit strategy in this approach. In the fragile post-conflict states

the program works on community reflection aimed at supporting vulnerable groups to

reintegrate in society and to strengthen - in a bottom-up manner - specific and diverse

community groups. Community reflection aims to contribute to building sustainable health care

systems. One of the strengths of the program is the combination of a) concrete economic,

organizational and public health experience in rebuilding functional health systems, with b)

experience in the field of activating and ‘mobilizing’ traumatized communities through

psychosocial interventions. In stable countries, the program works with and builds capacity of

existing institutions (public and private health care providers; patient organizations;

performance-based finance (PBF) committees; private health insurers; other national partners).

Partnerships and the promotion of ‘ownership’, amongst others by effectively transferring

knowledge and skills, is an essential feature of the program.

Influencing policy

Developing innovative and responsive models of health care implies supporting and empowering

clients and community organizations to express their needs and to facilitate their participation

in health care planning and management. At the local level, this impacts on power relations

between local health providers, health financers, clients and local government. Therefore, the

program is instrumental in health policy development at the local level. Further, the program is

strongly involved in policy development at national and global levels; field experiences on

innovative models for health care are analyzed in an in-depth manner, discussed in relevant

forums and published in international peer-reviewed journals7. Policy issues around the

following themes are directly addressed: sustainable economic development; HIV/AIDS; health

system development; human rights; good governance. Overall, the program is in line with

broader development objectives and strategies. The Millennium Development Goals 1, 4, 5 and

6 are directly addressed and the focus of the Health Access Consortium program on influencing

development of national health policies is most relevant for the Paris Agenda which promotes

results based management as a guiding principle of engagement.

The public health group in the Operation & Support department provides technical support to

projects in the field based on this approach.

Community Mobilization/Reflection

Communities in post-conflict areas have specific characteristics. The social fabric is often

destroyed by man-made, sometimes natural disasters; families are scattered, community

members mistrust each other, institutions, political and legal systems designed to protect and

support people malfunction or disappear. Frequently, conflict causes an increase in social

tension as well as damage to the (health) infrastructure and destruction of economic capital,

resulting in an increase in poverty. Cultural notions and practices are under pressure and

families lose their function as a safety net and support system.

For example, sexual and gender based violence in East Congo has dramatically changed ideas

and practice of sexuality with ever-younger girls there. Child soldiers in Uganda and Sudan have

lost the knowledge of a community’s cultural rules; they only know the army rules and

practices. Uprooting of large groups of people in Sudan or Cambodia has destroyed traditional

7 For example: http://content.healthaffairs.org/cgi/content/abstract/28/6/1799


family support systems. These specific aspects of post-conflict situations frequently create a

shift in power relations at all levels of a society; power relations are always gendered and often

related to ethnicity and/or class. Shifts in gender relations provoke a continuation of violence,

often narrowing down within families and communities (e.g. domestic violence). Because the

communal destruction of cultural identity manifests in physical, psychological and social

aspects, these situations can be considered as collective trauma. If we want to properly analyse

and use an effective approach to these problems we need to adopt a holistic view.

The omnipresence of social problems justifies the introduction of community

mobilization/reflection (CMR) —an essential prerequisite for establishing and strengthening

social fabric, networks and services. CMR is an essential component of the HealthNet TPO

intervention strategy, which emphasizes demand-based, sustainable well-being/health. But it

goes beyond; CMR creates a condition in which poor health of individuals does not become an

extra burden on the community. The final outcome is that people of communities in fragile

states are able to better manage their own well-being and health and participate in the

management of their own health care.

Community Mobilization and ‘reflection’: action research in order to develop evidence-

based programmes

CMR is an essential action in post-conflict settings to achieve a level where one can contribute

to the sustainable development of services. HealthNet TPO considers CMR as an integral

component of health programmes and critical in the (re-) establishment of functional health

systems. However, HNTPO also considers CMR as a concept / an approach that goes beyond / is

more than a ‘health programme’. CMR can have an effect on health without the interference of

formal health care; its focus is to improve well-being in the broadest sense. It is about

empowering people to restore social cohesion and build their capacity to take charge of their

own health and well-being; this refers to people’s ability to ‘bounce back’ and to manage the

difficulties they face. Without ignoring or underestimating the importance of professional

(mental) health care and health-related psychosocial support for populations at risk, a much

more socially oriented action should and can be undertaken by local people within the

communities where they live or are forced to live.

CMR describes and analyses the individual and collective mechanisms (which can differ from

community to community) that ensure or hinder the sustainable development of services that

might contribute to a better health and well-being. CMR not only emphasises social

determinants of health, but also food security and livelihoods, education, income, social justice,

shelter and peace which are essential preconditions that need to be addressed to ensure the

development of sustainable health care delivery.

At the very moment of this description and analysis, a crucial intervention occurs. Discovering,

together with the population in crisis or stressful situations, what is most needed and how this

might be obtained not only provides invaluable information about further intervention strategies

but also revitalises skills and (helping) attitudes that as a result of the event or disaster are no

longer utilised. By obtaining an in-depth understanding of local resources, capacities, beliefs

and needs through immediate action and by monitoring the effects, followed by academic and /

or operational research as a next stage, HealthNet TPO aims to build the evidence base to

disseminate successful models.

The entrance is the community; CMR is socially oriented and focuses on enhancing genuine

community engagement in all aspects from planning to on-the-ground actions. Mobilizing people

to undertake action will only be possible by involving community members, institutions and

organisations in decision-making processes, establishing a common ground (values), and

describing and agreeing on everyone's rights and responsibilities in the process. This is import

because people who draw up ideas, norms, rules and resources of social structures (re)produce

society.


CMR is a means to a goal. It is an approach aimed at repairing or strengthening community life,

which is a necessary condition to rebuild life in the aftermath of man-made or natural disasters.

CMR is an umbrella for other interventions; it is underlying our health programmes and

interventions, but it is also underlying the programmes of other organisations, e.g. our partners

in the Dutch Consortium for Rehabilitation (DCR). CMR is thus an intervention strategy that

works at different levels.

In itself, CMR contributes to reconstruct the social fabric of society, to enhancing empowerment

and to help communities define their own agenda. The actual mobilisation takes place through a

wide range of activities that have their own dynamics: from projects that aim at reducing

gender violence, to the creation of health associations and health insurance systems, to socio-

therapy, livelihood and educational programmes and models to improve community

governance.

Putting community reflection into practice

CMR requires community-based approaches that acknowledge and build on existing structures,

practices, traditions and protection mechanisms within the cultural context. As mentioned, CMR

actively promotes community member participation, as well as participation by local

organisations, government and other relevant stakeholders.

Considering CMR as an essential part of HealthNet TPO’s intervention strategies has practical

consequences. First, it requires that in the starting up of a project or programme more time

should be reserved to conduct a proper context analysis and to perform more specific needs

assessments. CMR requires specific staff qualities: people who conduct such assessments need

to be well perceived by other community members, should have the required skills and be

sensitive toward the concerns, feelings and needs of these members. Assessments should

include relevant questions about specific intervention areas; the data to be collected can vary

depending of what is already known, done or on the specific characteristics of an area (related

to tribes, customs, environmental issues, such as land pressure etc.). Since not all problems

can be solved within a limited timeframe, needs must be prioritized and organisations, groups

and/or key persons to work with should be identified.

This ‘community mapping’ will provide invaluable information about the right ‘entry point’ within

specific communities and is needed to create a structure where (local) organisations and

governmental institutions can work together and take responsibility. Only when there is

cohesion among community structures and organisations and government institutions, can

genuine and meaningful capacity building occur; it is a process of direct empowerment through

cooperative participation by which people are invited to take responsibilities from the very start.

Only after analysis of the obtained data, can specific interventions be designed in close

cooperation with all stakeholders. Interventions are not pre-designed, but depend on the needs,

gaps, existing or lacking resources and contextual factors that have been identified during

community mapping.

The relationship between community reflection and ‘standard’ HealthNet TPO’s

activities

The overall purpose of HealthNet TPO is to improve the health status and well being of the

target population by:

1. Understanding, supporting and strengthening coping mechanisms that help communities

to recover from decades of conflict and rebuild their lives and society;

2. To the design and (re-)establishment and / or strengthening of functional health systems

that guarantee access to basic health services.

Ad1) CMR is a strategy aimed at understanding local problems and identifying and

understanding available local resources to address needs. The action research approach used to

collect information at the start of a programme provides the basis to determine the focus of the

interventions. The range of interventions is limited to the definition of the programme: a

malaria control programme will look at context factors such as local health beliefs and


explanatory models, ecological contexts, socio-economic indicators for vulnerability,

acceptability of specific preventive measures and drug resistance. A general health systems

strengthening programme will also consider the socio-cultural, economic and historical context

in which determinants of health are embedded.

Action research will in itself provide the first steps of community mobilisation: in organising the

response from the community, information is gathered about the community itself and

mobilisation starts with the first group discussions. CMR in its ‘underlying function’ can be used

to ‘connect’ the different thematic or specific projects of HealthNet TPO and will help to bring

the so-called ‘multi sectoral approach’ into practice. Given that the mandate and expertise of

HealthNet TPO is focused on specific aspects, interventions will not address all perceived needs

and gaps directly. However, CMR can contribute to connecting the service delivery requirements

with intervention strategies implemented in other projects by other organisations (for example,

for the DCR – see below).

Ad 2) Frequently used concepts within HealthNet TPO are Health System Strengthening with a

specific focus on Mental Health and Psychosocial Support.

Health System Strengthening refers to the design and (re-)establishment of a functional

health system and includes all aspects that accompany the various functions of a health

system (see building blocks annex 3).

Delivery of Mental Health services is an essential and integral component of basic and

essential hospital service delivery, reflected in developed policies and strategies as well

as in health sector plans. HealthNet TPO has an extensive track record in the

development and implementation of psychosocial programmes. CMR should facilitate

expanding the potentially narrow focus on specific mental health concepts (e.g.

psychological trauma) to include a focus on the social context which is vital to well-being

and ensuring that family and community are fully integrated in assessing needs and

interventions.

Providing psychosocial support can vary from the follow-up of patients with mental disorders, to

individual counselling and group work with adults or children in order to prevent more serious

problems (CTP, support groups etc) or psycho-education and awareness-raising to inform the

population at large.

3.1.3 Human Resource Management

The most important challenges for the coming years cover two areas: a clear and competitive

HRD policy for people that work with HealthNet TPO, and a clear and realistic vision on how to

install HRM skills in the field. This division is important and is present in each of the separate fields where action will be taken:

3.1.6.1. New ways to work with regional expatriates and local staff.

As we see in most of the operations there is a very fast increase in salaries for local staff in

management positions overall. HealthNet TPO has so far seen no other option than to follow the

trend or lose the best field staff available. The implications of this trend are bleak: when large

donor commitments will fade away, the new elite that has been groomed by NGOs in countries

such as Afghanistan, Burundi and DR Congo, will have to make a choice to continue their work

on a much lower remuneration base or to seek other options. Many will leave, and the outcome of years of work can be severely damaged.

By 2015, HealthNet TPO will have developed and installed a system where remuneration of local

staff is based on performance, commitment and ownership. We will no longer simply offer

salary contracts. In contributing to the development of an accountable and sustainable civil

society we need to work towards the establishment of local organisations that offer a future for


their staff that goes beyond donor contracts as they exist in the emergency or recovery phase. The solution is in applying insights from the private sector, be it for-profit or not-for-profit.

3.1.6.2. Human Resource Development: for whom?

There are at present no clear ideas about the idea behind human resource development – there

is an ad hoc policy that depends on requests from the field. By 2015 HealthNet TPO has a

strategy that clearly separates the HRD for its own staff from the HRD that should be part of

projects. Building the capacity of staff that is foreseen to play key roles in the long-term should

be part of project implementation. Human resource development will be closely linked to an

overall approach on capacity development, but in the implementation we shall be more clear on

the division between the needs of HealthNet TPO as an international agency and the needs of

he projects. These may of course overlap, and this should also be explicit in formulating an

integrated approach to capacity development (using opportunities such as the LWT with PSO) throughout the organisation.

3.1.4 Finance

The financial department is a new entity. The roles, staff and responsibilities need to be decided

upon at the time of writing. There are some essential tasks that shall be included:

It will provide high quality and timely management information to the MT;

It will make up budgets for program proposals, and ensure that minimal requirements

are met in terms of project implementation and organizational needs;

It will check the quality of financial reports from the field, and prepare these to be send

to the donors;

Upon this basis, it will notice lack of financial-administrative skills in the field, and then

be responsible to build capacity in the field in terms of financial administration and

reporting;

It should therefore be able to either provide or organize admin-finance training in the

field - so there is need for didactic skills.

The very first and absolutely most urgent task for the financial department is in providing

correct and smart management information.

3.2 Research, strategy and fund development

3.2.1 Strategy and risk

The strategy unit will work on overall strategies:

• Country strategies, cross sectoral relations, linking health policies, fragile states,

military-civil relations, links with business and private sector;

• Donor policies, new opportunities in donor country policies and institutional funds;

linking the variety of policies and different types of donors;

• A controllers role vis-à-vis the financial department and financial strategies.

3.2.2 Knowledge management & network

HealthNet TPO is a knowledge-intensive8 organisation. Knowledge is generated for and

disseminated internally to improve project implementation and externally to a market of

multiple stakeholders: academic institutes, INGOs, funding agencies, donors (bi-lateral and

multi-lateral), media, governments, forums and panels. Building upon field experience in

programme and project implementation as well as scientific and applied research, HealthNet

TPO is now developing a uniform system to measure effects, record outcomes and create

“added value” in terms of knowledge quantified as data and documented as information in

reports, documents and publications in external journals, other publications and media.

8 Knowledge intensity is the increasing importance of knowledge for socio-economic activity and for the workforce, resulting in

“knowledge workers” taking on greater prominence within organisations.


HealthNet TPO is responsible for the organisation and maintenance of the knowledge network in

the MFS II consortium for the five years of its implementing work starting January 2011.9

HealthNet TPOs role as a knowledge organisation needs to be reassessed or audited regularly to

stay ahead in a global market where in provision of cutting-edge development services NGOs

need to add to, and at times compete with, academic, commercial and military sectors.

Increasingly, activities are undertaken under a corporate social responsibility mandate or a civil-

military ‘3-D’agenda. These activities at times combine a high level of professional skills with

limited contextual sensitivity in terms of development theory.

HealthNet TPO has a track record of scientific publications, but is weak in documenting concrete

experience in project implementation. The production of ‘grey literature’ needs to be improved,

given that this is the first and most effective line of dissemination of knowledge and experience

towards counterparts in civil society.

HealthNet TPO is developing a phased knowledge management development plan. The initial

development plan starts in the fall of 2010 as a project within the organisation, and will be

tested towards its quality assurance prior to it being made structural to the organisation. Thus

in the coming years development of knowledge management strategies, indicators and specific

time bound actions will be undertaken.

The knowledge network is financed by contributions from project grants. At the outset, as form

2011, thee are funds available from PSO and MFS II. Over time, knowledge network activities

will be budgeted for in all projects eligible.

3.2.3 Branding and fund development: from Charity to Social Entrepreneur

3.2.3.1 Branding strategy

Every day, communications strategies unfold all around us. In this age of unparalleled choice,

communications is committed above all to the principle of broadcasting differences: formulating

the added value and competitive advantages. Here is what separates our findings from all the

others. Here is what makes our approach and our organisation unique.

While it may be easier to think about communications in terms of products or services, it is

more constructive to think in terms of an ongoing and iterative process. A communications

strategy is not the glue between different communications products: it is a means of elaborating

how we network, participate, and interact with relevant target groups. Good communications

reflect a two-way dialogue, where we listen to what our stakeholders expect, design and deliver

audience-informed strategies, and then gather feedback to assess higher impact. But before

proceeding with any form of communication planning, it is necessary to develop the guidelines

for a ‘brand’. Brand marketing is the art of making the right impression on relevant

stakeholders. It is the active process of discovering, developing and bringing the right image or

identity of HealthNet TPO towards different target groups and stakeholders, although consistent

at all times.

Two opposing forces work when it comes to formulating the principles for such an ambitious

plan. First, the knowledge that attention should be paid to the careful choice of strategies,

making choices about focus and setting priorities in imaging, the shape of a professional device

that is sufficiently equipped to perform tasks properly. In short, investing time, resources and

people is a primary step. Secondly, the urgency to gain (fundraising) results in the short term is

evident. The coherence of the various components is described in the matrix below. Although

four different fields (marketing, communications, partnership marketing and fundraising)

basically have their own objectives, there is a question of priorities between the various parts.

9 See appendix “Knowledge Network of the Dutch Consortium Rehabilitation”.


MARKETING

COMMUNICATIONS

PARTNERSHIPS

FUNDRAISING

INTERNAL EXTERNAL

STRATEGIC LEVEL (3 to 5 years)

MARKETING PLAN o 4 P’s o SWOT analysis o Product definition o Product – market

combination o Target Groups o IDENTITY / IMAGE

BRAND STRATEGY o Triangle Website, Intranet, Newsletters o Media and target groups o News and press strategy o HOUSE STYLE

IMAGO TRANSFER o Strategy on

partners o Rights o Develop HNTPO

package o Differentiation of

partners

RISC SPREADING o Strategy recourses

Legal entities Individuals

o Brand association o Instrumental choices

TACTICAL LEVEL (annual plan)

Improving formal/ informal comm. flows, aiming cohesive structures at HQ; HQ-Field; Field-Field

Media training Speakers group Communication materials

Plan for Achmea Proposal for Dutch Lottery

o Prepare active

fundraising 2011. o Elaborate

cooperation: PifWOrld Civil Society Lottery

OPERATIONAL LEVEL (monthly)

Intranet

Newsletters

Website

PR

Newsletters

Achmea

Plexus

Online platform PifWorld

Development /submission Lottery proposal 2011-2015

FUNDAMENT: o CRM – database and information management system o G-drive (joint network HQ) o New location (presentation)

3.2.3.2 The financial need of HealthNet TPO

Based on current trends, the volume of ODA for health will not increase – it will probably

decrease. Is that bad? Not necessarily. Funding may not be the biggest challenge to improve

coverage of quality health care. Given the approach developed over the last years, increased

access to health care requires a new paradigm rather than new funding.

What is important for HealthNet TPO is not growth in turnover, but consistency. HealthNet TPO

needs to be able to keep functioning on the current turn-over level of about € 20-25 million on

an annual basis. The turn-over is necessary for sufficient coverage of indirect funds, and for the

implementation of programmes that have sufficient volume to be able to work on health

systems models. Projects that have the ambition to make a difference in creating local,

functional health systems need a minimal volume to be able to cover the necessary elements of

the system – although it is not always necessary to cover all six ‘building blocks’ covered.

3.2.3.3 Project Funds

In order to implement projects in an environment of accountability, of the necessary volume,

and with the opportunity to disseminate the results through effective channels, HealthNet TPO

needs excellent contacts with institutional donors. Relations with EU, national governments,

PPP’s and large private funds need to be strengthened. A new donor strategy will be developed

for these institutional donors in 2011.

3.2.3.4 Coverage of indirect costs

The weakest point in the organisation HealthNet TPO is the acquisition of free funds. These are

needed to cover the indirect costs that are not covered by institutional donors. This amounts to

the difference between the average contribution to these costs (at about 6%) and a realistic

indirect cost percentage (which is some 14%). There are several sources that are explored: a


possible contribution from the Nationale Postcode Loterij, income through projects that are

implemented for market-conform prices, corporate fund development and public fund raising.

The model that HealthNet TPO aims to realize is as follows:

An annual turnover in the range of €20m;

Composed of e.g. 90% regular, institutional donor funded projects, 10% ‘for-profit’ (or

otherwise regular consultancies);

14% admin and development costs should allow for quality management;

Free funds in range of €1m are needed to cover indirect costs (fundraising is not done

for projects).

HealthNet TPO aims at developing a long-term cooperation with some 20 foundations in Europe

and the United States for co-financing large grants and extra activities. HealthNet TPO aims to

secure 14% of its gross turn-over to maintain an operational level. Therefore, we will seek long-

term funding from corporations, ‘professional philanthropists, participation in ‘electronic

fundraising’, and legacies.

In order to realize this, the department of communication and fund development develops a

marketing strategy that positions HealthNet TPO as a modern, business minded NGO vis-à-vis

corporations with an interest in participation in international health development.

A focus on corporate fund development should be seen as a strategy to reach a number of

goals. Participation of companies that have overlapping interests in developing health systems

will be based on sharing knowledge. Direct funding can be an outcome, as we have known

before in the first years of the relationship with Achmea/Eureko. The value of participation in

project development can also be ‘costed’ and counted as contribution in line with funds from

institutional donors.

Another goal is the introduction of HealthNet TPO to the constituency of partnering companies.

This constituency consists of other stakeholders in the trajectory for project development, such

as clients, employees and other partners. HealthNet TPO has started working with PifWorld as

one option to be further developed in this line.

3.2.3.5 The business-model

HealthNet TPO shall develop a ‘BV’ structure to allow us to make more efficient use of the

resources we have. Some of the work done through tenders is better administrated through a

business-model approach. HealthNet TPO therefore aims to establish a specific branch that is

also able to work ‘for profit’, in order to:

1. Be better able to work on the mandate;

2. Bridge the gap between the public and private sectors in health and fund development;

3. Improve its financial independence;

4. Enhance its position in the chari-market.


Ad 1: The mandate and vision of HealthNet TPO imply that improved access to quality health

care is central for the organisation. People living in ‘low-income countries under stress’ are the

traditional target – but as time goes by, new indicators become more important. Inclusion and

sustainability are indicators that bring groups of people forward for whom we increasingly work.

This includes specifics groups of people who lack good governance (or any governance), access

to work and income, political representation and are deprived of public services. They are found

in urban and rural areas in countries where rcisis continues in a variety of forms, ranging from

warfare to everyday-poverty. Most of these settings are non-responsive to a traditional NGO-

funding request. Moreover, effective interventions require a business-like approach to local

contributions and sustainability. “Profitability is the price for sustainability”.

Ad 2:

In order to reach these people boundaries between so-called public and private sectors of

health need to be crossed. The ADB and World Bank supported ‘contract-approach’, a system of

performance based incentives, has helped achieving just that (Cambodia, Rwanda and other

experience). The logical next step is to initiate quality service delivery through partnerships with

suppliers, clients, and local regulators (ref). This means establishing regulatory bodies that

relate to local and national governments (such as insurance companies); service providers with

adequate clinical and managerial skills; and installation of supervisory skills in governmental

levels. Some of these roles can be played through the NGO set-up, but in other roles a

corporate set-up enables for more effective achievements.

Ad 3:

An example may be the setting where HealthWorks BV bids for the EC tenders that are

exclusively open for for-profit companies, and where one is to organise the spending of EC

funds in a given setting/country. Such contracts are expected to deliver profit, which can be

used to cover indirect costs for the NGO projects of Stichting HealthNet TPO. Furthermore,

other activities may also yield results that add to the free reserve of HealthNet TPO.

HealthWorks BV is legally committed to this goal, as is shown in its constituency, bylaws and

ownership regulations.

Ad 4:

Not only a more stable financial position, but also the entrepreneur-spirit that private sponsors

and ‘professional philanthropists’ are looking for, HealthNet TPO will strengthen its position the

chari-market. Full transparency and accountability in the balance between for-profit activities of

the BV and NGO-programmes of the Stichting HealthNet TPO constitutes a modern framework

for action.

HealthNet TPO wants to establish a subsidiary LLC (BV) under the name of HealthWorks BV. to

execute its market services. Over the years HealthNet TPO has established best practices and a

wealth of experience and knowledge. In ‘HealthWorks BV’ this experience is taken to the

market. The mission of HealthWorks BV is to transform best practices into functional, effective

and sustainable health care systems in low income countries under stress.

Services

The market services of HealthWorks BV are foreseen to consist of:

Project Consultancy: providing knowledge both on specialist topics related to health

system development;

Project Implementation: executing third party projects

Project Development: executing projects initiated by ourselves.

Currently we are developing several business cases. The most detailed are:

Initiating a health care insurance system in Cambodia

Initiating a storage centre and distribution system for medical supplies in Afghanistan

Achmea and Rabobank are already partners, and at the time of writing HealthNet TPO is in

touch with Philips.


HealthWorks BV will be a subsidiary of Stichting HealthNet TPO. As major shareholder of the BV,

Stichting HealthNet TPO is responsible for policy development and the distribution of profits.

The aim is to register the BV at the Chamber of Commerce in Amsterdam by 30 September

2011. The registration of the BV in formation at the Chamber of Commerce is a formality with

no strings attached for Stichting HealthNet TPO. For the legalization of the BV a legal document

is required with Articles of Association in which the relation between the Stichting and the BV is

defined and a business plan with a clear definition of the products, markets and prospects. A

deposit of €18.000 is required to finalize the legalization of HealthWorks BV. The board of

HealthNet TPO will be provided with the required documents before 1st July 2011.

3.2.4 Research and development

Background

Research is necessary to create a better understanding of the underlying mechanisms that

cause the needs and, (health) problems of individuals and communities living in complex

circumstances as fragile states and low income countries. Research in this context needs to be

participative, action and solution oriented to produce the options for action and the evidence for

specific interventions. The production of evidence is only the first step towards the application

and implementation of sound health policies. Research within HealthNet TPO is also used to

develop procedures to translate knowledge in activities that change health policies.

Research

HealthNet TPO defines the development and implementation of evidence-based interventions for

public health in the realm of post-conflict and complex emergency situations as its core

business. Implementing programmes and conducting research are therefore narrowly linked.

The process is best described as a ‘cybernetic loop’ that integrates research outcomes as

feedback into the programmes. Research is part and parcel of basically all HealthNet TPO

activities, as research is implemented to prepare, support and evaluate interventions. Some

research activities are a fully funded integral part of programme implementation. Other

research is funded separately, and is done on the basis of monitoring and evaluation data by us

or in collaboration with academic partners. Research is also undertaken as an individually

funded activity or conducted by partners under the umbrella/aegis of HealthNet TPO or as a

partner in a consortium of research groups and other organizations.

The main objective of research within HealthNet TPO is the focus on development of and

increase effective interventions, knowledge and expertise.

A second objective of research within HealthNet TPO is related to monitoring and evaluation of

the field activities. A consolidated monitoring and evaluation design is part of any proposal for a

field activity and allows implementing the data collection that is required to serve the ongoing

project, enrich future project cycles, and add to a wider set of research questions, like

improvement, quality control and efficiency of the intervention techniques. Last but not least,

HealthNet TPO uses (publications of) research to promote its expertise and position in the field

among other experts and professionals.

HealthNet TPO stresses the importance of both operational and academic research in order to

address the above-mentioned objectives. HealthNet TPO uses methodologies from several

relevant disciplines (eg social sciences, medical sciences/epidemiology and economic sciences).

In doing so we employ a variety of qualitative and quantitative research methods, including (but

not limited to), case studies, process evaluations, treatment efficacy studies, treatment

mechanisms and processes research. The choice of the methodology will be dictated by the

overall goal: the development of effective, evidence based interventions. Some of the

traditional types of research that apply strict scientific procedures have long term or indirect

effects on projects. Other types of research, eg action research can yield effect in a short time

span. Depending on the research subject and the preferred methodology, the ‘loop’ of applying

results in implementation design may take anything between days, weeks, months and years.


We aim to gain in-depth understanding of local resources, capacities, beliefs and needs, as well

as by monitoring the effect and applying academic research, we build the evidence base to

disseminate successful models. Accordingly, HealthNet TPO has lead and participated in

multidisciplinary academic research projects and has performed research within service-oriented

projects and programs.

Research Themes

HealthNet TPO’s present research program covers a range of research activities within the

different operational themes (eg health system development, disease control, health financing,

public health and mental health and psychosocial distress)

The general main objective of the current research program is to link the burden of

disease with biological and social determinants in relation to (development of) interventions,

(cost-) effectiveness and (possibilities of) financing. (see scheme)

Specific objectives are:

Identification of individual and community indicators to describe and define the

relationships between health and context.

Identification of individual and community mechanisms to describe and define health

(status), functioning and wellbeing

Exploring Individual and communities’ perspectives: from health beliefs, help seeking

behavior, to perceptions of what health care should deliver

Implementation of state-of-the-art knowledge in local, culturally informed research

designs and applications

Integration of relevant sectors that promote or sustain health – eg livelihood

empowerment, education, advocacy, health system development and health economics

Exploring and defining interactions of themes from the major domains: health financing,

disease control, mental health and psycho-social well-being, mother and child health

Understanding of mechanisms in the context that explain individual and

community health/functioning/well-being

Health System development

Core Objectives

i. Theory formation

ii. Development/ improvement of care

iii. Development of tools and procedures

iv. Quality control

Health financing PH/Disease

control MHPSD

Existing coping

strategies and resources

Bio –Medical

determinants Socio-Cultural

determinants


In addition, the overall perspective of the research program anticipates on ongoing and future

issues:

Need for quality improvement of current project activities,

Development and implementation of activities within the framework of MFS II

Collaboration with other organizations

Community Mobilization

- Understanding of community mechanisms that contribute to strengthening resilience and

healing

- Exploring existing resources and coping strategies that help communities recover from

warfare and rebuild their lives and society.

- Development of research tools and methods for collection and analyzing of data.

Socio-cultural mechanisms and determinants of health

- Exploring contextual factors of (mental) health and social functioning, including the

erosion of (social) support structures, poverty, violence and structural (gender-based)

injustice

- Exploring connections between and integration of (mental) health and non-health

sectors, including human rights and poverty alleviation.

- Exploring effects of community-based services, resources and processes on individual

and community health.

- Development of research tools and methods for collection and analyzing of data.

Public health and disease control

- Epidemiological research into the occurrence of diseases and risk factors for diseases

- Effectiveness of existing and new health practices and health programs

- Community perceptions related to health problems and health services

Mental health and psychosocial support

- Development and (process) evaluation of implementation, organization and financing of

context-appropriate care packages/ systems for vulnerable populations in fragile states.

- Exploration and evaluation of treatment and support mechanisms and processes for

mental health and psychosocial problems.

- The integration and up-scaling of mental health in primary health care in fragile states

- Exploring mental health status and subsequent risk and protective factors of populations

in post disasters and complex emergencies.

- Long-term preventive effect of resilience-promoting and community-mobilization

interventions

- Evidence building of specific interventions or treatments; i.e. substance abuse

treatment; mother and child care (psychosocial aspects).

Health financing

- Exploring local perceptions and beliefs of health, helpseeking behaviour and explanatory

models of health in public services and health financing models

- Exploring user perspectives in public services and health financing models

- Exploring community/contextual perspectives in public services and health financing

models

- Development of subjective indicators for assessment of impact and effectiveness of

health financing models

3.2.5 Development

Development in HealthNet TPO refers to the implementation, eg dissemination of all types of

knowledge and expertise and research findings, both within and outside the organisation.

The management of knowledge is therefore a key activity for and throughout the whole

organisation. Strengthening knowledge management by the implementation of knowledge

management systems/procedures and knowledge networks are crucial..


Knowledge management takes into account that the dissemination of “knowledge” should fit in

the perspectives of the different stakeholders:

Country-specific:

- clients of health services and individuals and communities in need for health services,

- local program management

- health professionals (HealthNet TPO), donors and others

- governmental agencies

Non-country specific:

- general program management

- (other) organizations/institutes, universities

- (peer reviewed) journals.

4 Budget

The estimated budget development 2011-2015 follows separately.

Documents

HealthNet TPO Strategy Paper - ANBI · Strategy HealthNet TPO 2011-2015 4 2. Introduction HealthNet TPO develops a new 5 year strategy in the midst of discussion about the future