National Institute for Medical Research, Mwanza Centre, P,O Box 1462, Mwanza, Tanzania.
Health Res Policy Syst. 2010 May 13;8:12. doi: 10.1186/1478-4505-8-12.
Little is known about how to implement promising small-scale projects to reduce reproductive ill health and HIV vulnerability in young people on a large scale. This evaluation documents and explains how a partnership between a non-governmental organization (NGO) and local government authorities (LGAs) influenced the LGA-led scale-up of an innovative NGO programme in the wider context of a new national multisectoral AIDS strategy.
Four rounds of semi-structured interviews with 82 key informants, 8 group discussions with 49 district trainers and supervisors (DTS), 8 participatory workshops involving 52 DTS, and participant observations of 80% of LGA-led and 100% of NGO-led meetings were conducted, to ascertain views on project components, flow of communication and decision-making and amount of time DTS utilized undertaking project activities.
Despite a successful ten-fold scale-up of intervention activities in three years, full integration into LGA systems did not materialize. LGAs contributed significant human resources but limited finances; the NGO retained control over finances and decision-making and LGAs largely continued to view activities as NGO driven. Embedding of technical assistants (TAs) in the LGAs contributed to capacity building among district implementers, but may paradoxically have hindered project integration, because TAs were unable to effectively transition from an implementing to a facilitating role. Operation of NGO administration and financial mechanisms also hindered integration into district systems.
Sustainable intervention scale-up requires operational, financial and psychological integration into local government mechanisms. This must include substantial time for district systems to try out implementation with only minimal NGO support and modest output targets. It must therefore go beyond the typical three- to four-year project cycles. Scale-up of NGO pilot projects of this nature also need NGOs to be flexible enough to adapt to local government planning cycles and ongoing evaluation is needed to ensure strategies employed to do so really do achieve full intervention integration.
对于如何将有前途的小规模项目推广到大规模，以减少年轻人的生殖健康不良和艾滋病毒易感性，人们知之甚少。本评估报告记录并解释了非政府组织（NGO）与地方政府当局（LGA）之间的合作如何在新的国家多部门艾滋病战略的更广泛背景下，影响到由 LGA 主导的创新 NGO 项目的扩大规模。
对 82 名主要知情人进行了四轮半结构化访谈，对 49 名地区培训师和主管（DTS）进行了 8 次小组讨论，对 52 名 DTS 进行了 8 次参与式研讨会，并对 80%的 LGA 主导和 100%的 NGO 主导会议进行了参与观察，以确定对项目组成部分、沟通和决策流程以及 DTS 用于开展项目活动的时间的看法。
尽管干预活动在三年内成功扩大了十倍，但并未完全融入 LGA 系统。LGAs 提供了大量的人力资源，但财力有限；NGO 保留了对财务和决策的控制权，而 LGAs 基本上仍然将活动视为 NGO 推动的。技术助理（TA）在 LGAs 的嵌入有助于提高地区执行者的能力，但可能会阻碍项目的整合，因为 TA 无法有效地从执行角色过渡到促进角色。NGO 行政和财务机制的运作也阻碍了其融入地区系统。
可持续的干预措施扩大规模需要在地方政府机制中实现运营、财务和心理上的整合。这必须包括为地区系统留出足够的时间，在没有 NGO 大量支持和适度产出目标的情况下尝试实施。因此，它必须超越典型的三到四年项目周期。这种性质的 NGO 试点项目的扩大规模还需要 NGO 有足够的灵活性，以适应地方政府的规划周期，并需要进行持续评估，以确保所采用的策略确实实现了全面的干预整合。
