How RTI International boosts local capacity in Asia-Pacific

The Gerona Birthing Center in Tarlac, Philippines is one of the first participating clinics in the RTI-led Wireless Access to Health project designed to improve public health and patient records. Photo by: RTI International

Efforts to engage local partners in campaigns to eradicate poverty and boost development aren’t new. But to truly make a difference, it is crucial to develop long-term relationships with government officials, local NGOs and private companies that help to build local capacity and increase community ownership of development even after foreign assistance dries up and aid groups move on to other projects.

That’s precisely what RTI International, a U.S.-based nonprofit focused on research and technology-driven technical assistance, is doing in the Asia-Pacific region, where poverty remains high despite soaring economic growth and — even more importantly for RTI — there is a huge demand for guidance on how to achieve sustainable development while avoiding the so-called “middle-income trap.”

How has RTI been able to nurture the deep and long-standing relationships with local partners that reduces poverty and advances opportunity for all?

Take the case of the Wireless Access for Health project in Tarlac, Philippines. When RTI staff members visited the province in 2008, an official from the governor’s office pitched them the idea of setting up a computer-based system to address the challenge of manual public health reporting and patient records systems across the whole province. RTI not only secured funding from the U.S. Agency for International Development and technical expertise from semiconductor giant Qualcomm to buy computers, develop software and train doctors, nurses and technicians, but it also convinced local officials to commit future funds and other resources to make sure the project would continue under local leadership after those initial investments. Six years later, WAH is being used by almost all of Tarlac’s municipalities and is considered a model for the whole country by the Philippine Department of Health, which would like to replicate it in other provinces to improve care and the collection of public health data.

Key to this initiative’s success so far has been the strong case RTI has made to local officials that this was not a handout but an initiative that truly addresses residents’ needs, and that it could be run without foreign assistance soon enough, according to Alex Herrin, chief of party for RTI’s broader LuzonHealth project in the Philippines.

“We didn’t want it to be an international project,” he said, adding that it was important to get local officials “to a point where they want [the project], they will support it, put in their own resources, and be proud that they own it.”

‘Ahead of the game’

The LuzonHealth project, which started just last year, followed a larger nationwide project also directed by Herrin called HealthGov that was carried out from 2006 to 2013 and was supported by USAID. Under HealthGov, RTI provided technical training and services to health and other officials from local government units as well as the Department of Health’s Center for Health Development.

It’s important to note here that although the country fully decentralized its public health system in 1991, implementation of this policy has always been challenging — precisely because the national government transferred responsibilities to LGUs without ensuring that they had the resources and skills to deliver basic health services. The Department of Health’s regional Center for Health Development were designed to provide this support.

“Decentralizing health service delivery responsibility is a great thing because it allows a stronger local voice in deciding what services are important and how they are managed but at the same time it fragments the health system,” said Catherine Fort, director of RTI’s Asia programs. “The Department of Health now plays more of a stewardship role, rather than a direct implementer.”

Under a cooperative agreement with USAID, RTI was hired to fill the skills gap, strengthening the delivery of health care across 26 provinces and in more than 600 LGUs by improving health management, budgeting, planning, finance, local policies, logistics systems and health service quality in reproductive health, family planning as well as maternal and child health. The NGO also helped LGUs and local people advocate for reproductive health and family planning, topics that have long been taboo in the Philippines where the Catholic Church remains extremely influential (especially in its opposition to any form of artificial contraception).

The project’s goal, according to Fort, was to first help improve the health system in order to improve health outcomes, in partnership with local and regional health authorities — and then to assure its sustainability. By the end of HealthGov in 2013, RTI had 17 subcontracts with local organizations which provided many of the project’s technical services directly to LGUs. This allowed the nonprofit to expand its reach despite only employing about 60 full-time staff members, while ensuring that project services would be available to LGUs as they were needed longer-term.

“For us, it made sense to work with local organizations and help them help us so they would take these skill sets and apply them beyond the end of the project,” Fort said, noting that RTI’s push to engage local stakeholders predates the USAID Forward reform agenda and supports its goals and objectives, including the ongoing push to expand local partnerships and build capacity.

“USAID really appreciated that model,” Fort said. “We were kind of ahead of the game.”

Grassroots governance

RTI can look back at an even longer-standing relationship with its local partners in Indonesia, where the organization has one of its flagship projects: Kinerja.

Kinerja (“performance”) is a four-and-a-half year program funded by USAID to strengthen local governance and, in particular, the delivery of public services in five provinces and 24 districts. Kinerja partnered with local organizations, providing technical assistance to local governments on how to improve public services in areas like health, education and business licensing.

The Kinerja team quickly identified several areas of improvement, said Jana Hertz, a senior policy and governance specialist with RTI.

In Aceh, where the 2004 tsunami claimed more than 130,000 lives, a complaint survey of patients in health clinics was conducted for the first time and local health officials published the results. At first they were concerned about the number of complaints, but they soon realized they could use the results to advocate for improved services. These local government and multi-stakeholder fora eventually signed a service charter for joint accountability for improved services.

A particular breakthrough was the decision for local officials to invite public participation and respond to citizens’ input. For example, as a result of the complaint survey and service charter, local health clinics successfully advocated for decentralized authority to procure medicines from the district authorities, resulting in improved availability of needed medicines for patients, Hertz said.

“This is exciting,” Hertz suggested. “It’s governance at the actual grassroots level. Citizens and government officials engage on common problems and find mutually beneficial results.”

Another challenge was convincing teachers to deploy to remote areas, culturally perceived as a demotion. The solution, Hertz recalled, was a combination of social pressure from community groups and citizen journalists as well as local government incentives such as accelerated promotions and extra stipends.

Kinerja, Hertz explained, is a unique project because it delivered technical assistance exclusively through the engagement with local organizations. RTI essentially supported these groups in developing their own expertise with an eye on keeping costs down so that local governments could afford to contract the local organizations directly after program support ended. That worked through a cost-sharing mechanism with local governments and a recognition by local governments of the benefits of technical assistance provided by local organizations.

RTI also built strong local ties through the support of quality local organizations that assisted local governments to successfully reduce red tape on business licensing, which not only reduced corruption in the form of kickbacks but also allowed more women to register their businesses and thus be eligible to get bank loans.

Growing a ‘knowledge sector’

Indonesia, the world’s fifth-most-populous country, still lags behind many of its smaller neighbors when it comes to a robust “knowledge economy.”

The massive Southeast Asian nation’s research institutions and think tanks have struggled to generate the kind of data and analysis necessary to support and inform major public policy decisions. Government ministries, faced with policy decisions that demand rigorous analysis, regularly farm those projects out to international experts instead of looking to their own domestic research groups. While Indonesia-based institutions might carry out pieces of a policy research project — like data collection — government ministries are more apt to entrust the bulk of research design, execution and analysis to proven international institutions like the World Bank, Hertz told Devex.

“If the ministry of public works is going to do a big infrastructure project, are they going to go to the World Bank for analysis, or are they going to go to an Indonesian policy institute?” Hertz asked.

Right now, the answer is too frequently the former. RTI and its partners are working to change that.

Implementing the first phase of a 15-year commitment by the Australian government to aid in the development of Indonesia’s knowledge sector, RTI is looking to boost the supply of high-quality, consistent and usable knowledge products in the country. A major grants program for research organizations is meant to help increase the supply of high-quality data while targeted outreach, legislative reforms and new research networks will seek to improve the “enabling environment” for a robust national knowledge sector.

The long-term goal of Australian Aid’s knowledge-sector initiative is for more and more of Indonesia’s government ministries to see home-grown research institutions as viable partners for big policy decisions so those ministries do not always have to look to — and pay for — foreign expertise.

But ensuring international donors do not overshadow or displace domestic research and analysis while still providing policymakers with the high-quality knowledge products they need is a difficult balance that takes time to nurture.

“If the local research institutes don’t start gaining more responsibility and more experience, then it’s going to be hard to compete,” Hertz said.

Learning along the way

In Indonesia and elsewhere around the world, RTI takes pains to engage communities to advance local solutions rather than trying to force designs crafted half a world away in Washington or elsewhere, said Nicole Barnes, vice president for business strategy and communications.

“Our work in Indonesia evolved over time. We started out with one big opportunistic win in public finance almost 30 years ago,” she told Devex. “Then one thing led to another, and ended up in Kinerja.”

When the country decentralized practically overnight in 1998, RTI found itself in a prime position to deliver USAID-funded technical expertise because the NGO already had a network of local partners in place. Many of the experts RTI had worked with in the past had since moved on to prominent posts within the Indonesian government, which facilitated the NGO’s work.

Initially, the training RTI provided was very hands-on, Barnes said, but over time RTI’s footprint became smaller as government agencies stepped up and priorities were adapted to changing development contexts.

“We want to be building partnerships that are going in the same direction that Indonesia is moving,” Barnes said.

It’s a philosophy RTI puts into practice in all of its work, whether in its cutting-edge research or the innovative solutions to pressing development needs that it pursues with the help of partners.

“We do try to take a long-term view around partnerships,” Barnes said. “We want to keep relationships going, either through our project base that’s funded by clients or through the research we fund ourselves.”

This article was sponsored by RTI International.

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    Carlos Santamaria

    As associate editor for breaking news, Carlos Santamaria supervises Devex's Manila-based news team and the creation of our daily newsletter. Carlos joined Devex after a decade working for international wire services Reuters, AP, Xinhua, EFE and Philippine social news network Rappler in Madrid, Beijing, Manila, New York and Bangkok. During that time, he also covered natural disasters on the ground in Myanmar and Japan.