Opinion: Reimagining technical assistance to shift power

The global development community is converging around a vision of a new global health system — one in which local entities and experts set the agenda, coordinate their own programming, and ensure that funding decisions respond to locally identified needs. This requires that donors and implementers invest in trust-building with partner governments and civil society, leverage local resources and expertise, and adhere to mutual understanding and responsibility. This system — grounded in continuous learning, adaptation, innovation, and accountability — will strengthen local entities and partners to build more resilient health systems around the world and ultimately achieve more equitable, robust, and sustainable health outcomes.

This vision depends on radically new approaches to technical assistance, or TA, that value existing capability and accomplishment and help strengthen national and community capacity to sustainably design, manage, and adapt health systems. We need to replace the entrenched TA methods that do little to build on success and strengthen long-term capacity — and often perpetuate the disparities we seek to diminish.

In 2018, JSI — an NGO that has provided TA in 107 countries through 2,600 projects — launched an initiative aptly named Reimagining Technical Assistance, or RTA, at the request of the Bill & Melinda Gates Foundation. Our goal was to create a road map to the new global health system we all envision. As JSI’s new president and CEO, I am honored to offer our evolving insights to the larger conversation about local capacity enhancement and strengthening.

A human-centered approach to design a human-centered system

We began the work in 2018 in the Democratic Republic of the Congo and Nigeria, with our partners at Sonder Design and later Global Change Labs. We convened coalitions of individuals involved at every level of health delivery to delve into how they experience TA and how they want to engage with funders and implementers going forward. The result was a series of workshops and 68 interviews with government representatives, local and international NGOs, and TA funders and recipients.  

We later expanded our conversations to include representatives from an additional 13 countries and experts from the Gates Foundation, the U.S. Agency for International Development, and the World Bank. These open, honest, and sometimes difficult discussions produced a framework of nine critical shifts — the systemic reforms needed for stronger, more sustainable, and equitable health outcomes for all.  

The shifts redefine relationships among funders, national governments, local and international implementing organizations, communities, and individuals. They are divided into three major themes to guide our work at each step: enabling local entities to set the agenda; leveraging local leadership and expertise to support sustainable capacity; and prioritizing equity.  

Critical shifts 1-3: Ensuring that local leaders and organizations set the agenda

The first three shifts move us from funder-focused agendas to country-driven priorities and sustainability. They challenge the power structures that drive the distribution of funding and define a complementary supportive role for funders to listen, build trust, and promote buy-in from the beginning. Future TA approaches will enhance sustainability by understanding what is needed, relying and building on local expertise, and promoting accountability from all involved.

Critical shifts 4-7: Leveraging and reinforcing local expertise for the long term

The second set of shifts delineates strategies for coordinated and contextualized programming aligned with governments, civil society, and community priorities. These reforms move us away from siloed, short-term efforts toward sustained collaboration within and across initiatives that are holistic and person-centered. They are shifts from rigidity and compliance toward adaptation and iteration in response to emerging needs and expectations.  

To achieve this, collaborators need to mobilize resources to meet the true cost of providing person-centered services and coordinate seamless transitions between funding cycles. Rather than simply presuming gaps in capacity, these shifts recognize the existing leadership in countries where we work and the need to build synergistically on this capacity for sustainable impact.

Critical shifts 8-9: Promoting equity and addressing power asymmetries

The final set of shifts underscores that long-lasting outcomes depend on elevating community voices and putting gender and power equity at the forefront of our work. Unless we acknowledge power imbalances and promote equity, we may strengthen the very hierarchies of power and privilege that perpetuate health disparities.

The last critical shift, essentially a culmination of the first eight, calls for promoting feedback, learning, and action between communities and funders. This also means enabling all partners — not just those with funding power — to contribute to decisions and evaluations.

Forging a new path toward a common goal

At JSI, we are using the RTA framework and assessment tool to reflect on our own role and operating principles, measure our progress, and articulate how we will achieve our mission of better health outcomes for all. We are committed to contributing our own learnings, successes, and failures. We hope that RTA can provide a foundation of shared language and objectives to align global health partners, inform strategies, and increase accountability.  

Our TA models must move beyond the structures of individual projects and organizations. We need to provide TA that our clients want and need, prioritize contextual knowledge and expertise, and shift power and resources to local stewards. The result will be more fully strengthened and resilient health systems around the world.

Visit JSI.com/RTA to learn more about our tools and resources and sign up to receive updates on this initiative.