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Part 2: Opening the Umbrella of Primary Care to Include HIV Services in Namibia—Organizational Capacity Assessments

In part one of this blog, I provided background on why IntraHealth Namibia is working to help our local partners—faith-based hospitals—build capacity to integrate HIV/AIDS programs and staff into their primary care services. To get started, we identified the Organizational Capacity Assessment tool (OCA) in Pact’s Organizational Development Toolkit as a tool to help us provide our partners with a baseline assessment of how prepared they are to integrate services, and we organized OCA workshops to conduct the assessments. I found these workshops so valuable that I want to share our experiences, especially since I know that others will also need to eventually support integrating programs and staff.

Capacity assessments by nature reveal weaknesses and gaps that have the potential to make participants feel vulnerable. Recognizing this, we held introductory meetings with the program and facility management teams of our partners—Catholic Health Services, Lutheran Medical Services, and Anglican Medical Services—to explain the process and get their buy-in. Some of our partners were a bit apprehensive, sharing concerns such as not being able to find the resources to implement activities that might be proposed and the fear that the assessments might lead to IntraHealth’s staff dictating needed changes. We spent more time talking with smaller groups of managers to better address their concerns. In the end, the time was well-spent: we had strong buy-in for the process. 

The logistics for each workshop were challenging, but we began by compiling a list of representatives to participate that included clinical and administrative staff representing all cadres and administrative departments of the organization. We used external facilitators trained in conducting the OCA to ensure objectivity and to give our partners the opportunity to see the OCA as a learning process as well as an exercise in identifying gaps.

Revealing Gaps and Having Fun

In the end, the OCA workshops were a lot of fun. Creative group activities introduced each area to be assessed (such as monitoring and evaluation, human resources, etc.) and allowed participants to rate their organization. The activities included candy voting, a bull’s eye with different sticky dots, voting tables, and radar maps. I found this to be the best part of the OCA as it supported cross-learning and allowed administrative staff to learn how health programs and services are designed while allowing clinical staff to learn more about administrative processes. It brought the different program areas together, facilitated dialogue about how different services can be combined, and provided an opportunity for staff to share successful practices. Participants also completed individual assessments.

On day two, facilitators shared the results and identified the strengths and weaknesses for each capacity area. This included an overview depicting each area’s average rating as well as the degree to which participants were in consensus with their ratings. The group then further explored the findings and developed an Institutional Strengthening Plan—the roadmap for organizational development work. 


I loved to see how program staff members working in different service delivery areas gained a deeper understanding and appreciation for each other’s work and how they eventually realized their common purpose. While providing a road map for longer-term change, the OCA workshops also led to immediate changes in organizational decisions and individual perspectives.

For example, the medical superintendent at Onandjokwe District Hospital (under the auspices of the Lutheran Medical Services) made a decision to develop a department of HIV/AIDS integrated into the hospital’s structure rather than maintaining the HIV/AIDS unit as a separate program. 

One HIV/AIDS nurse, who initially had concerns about the salary implications of being absorbed, said, “I can now see that we are part of the same organization.”

We have conducted OCA workshops with the Lutheran Medical Services, Catholic Health Services, the HIV Clinicians Society, and Anglican Health Services and look forward to supporting their institutional strengthening plans. Organizational development is about facilitating—not dictating—change.

If anyone is interested in learning more about our experience, leave a comment below, and I’d be happy to get in touch with you.