Holistic Development: An Emerging Development Approach

The term “development” is used to describe any positive change or an improvement from one stage to another. Development is a continuous process; it is neither a commodity that can be weighed or measured nor a physical infrastructure that can be counted (Clark 1991). However, at an early stage of development thinking, development was regarded as economic growth that could be monitored or measured in economic terms (Pieterse 2001).

The concept of development started with mercantilism – the collection of gold and silver through international trade – in the 16^th century, which eventually led to the concept of colonisation (Gomes 2003). Then, in the 17^th and 18^th centuries, the perspective of development changed to economic growth with increasing per capita income in a country. This led to industrialisation and establishment of economic development, also called growth theory or the theory of modernisation (Pieterse 2001; Willis 2005). However, the term development has been most widely used since the end of the Second World War (Thomas 2000). After the Second World War, the growth theory continued to be popularised. However, other development theories such as dependency theory, alternative development and human development emerged as alternatives to the growth theory that seemed to be failing due to continued poverty in large parts of the world (Willis 2005). The concept of human development and sustainable development emerged with the focus on developing human capital and standard of living that included empowerment and human development (Clark 1991). However, continued environmental degradation caused by industrial growth has led to the distortion of natural resources and adverse impact on human life. Therefore, the concept of sustainable development emerged, a concept that promotes human development and equity without disrupting natural resources (WCED 1987). However, there is discrimination, exclusion and injustice in large parts of the world particularly in the political arena and the delivery of services. Exclusions and injustice have led to poor participation of needy people and unfair distribution of services. And so, in the light of poor outcomes of conventional ‘development’ a new paradigm, holistic development, has arisen. This is a development approach that confirms equity and social justice by removing exclusions and empowering people.

There are different terms used to describe holistic development that include holistic mission, integral mission, holistic transformation or holistic change. Tearfund (2005) describes holistic as combining different aspects so that they work together, bringing a ‘wholeness’ about development in people and community (see link below). Holistic development simply means human development with equity and social justice. It is a development that is integral and refers to physical, socio-economical, emotional and spiritual growth. It is also called integral mission which implies holistic transformation of individuals and communities to fulfill their potential. The concept of holistic development is relatively new in the modern development discourse. The term ‘integral mission’ is also found to be used in holistic development referring to bring the social and evangelical work together.

Micah network declaration[1] on integral mission states:

“It is not simply that evangelism and social involvement are to be done alongside each other. Rather, in integral mission our proclamation has social consequences as we call people to love and repentance in all areas of life. And our social involvement has evangelistic consequences as we bear witness to the transforming grace of Jesus Christ. If we ignore the world we betray the word of God, which sends us out to serve the world. If we ignore the word of God we have nothing to bring to the world. Justice and justification by faith, worship and political action, the spiritual and the material, personal change and structural change belong together. As in the life of Jesus, being, doing and saying are at the heart of our integral task.” Micah Network (2001)

Relief welfare and development programmes are important in serving the poor. Transformation of values, empowerment of communities, equity and social justice and inclusions are the core of the holistic development. Henwood and Henwood (2011) state that the underlying assumptions about development are different among Christian and secular development agencies. Christian development perspectives pursue the total transformation of human being, whereas the basis of secular development perspectives is humanity and materialistic.

Many secular development agencies focus on the physical wellbeing of people but ignore the peace and happiness of individuals, families and societies. Christian agencies focus on biblical perspectives on development, e.g., life of Jesus Christ and His teachings; and believe that personal submission to Jesus Christ is essential for wholeness (Henwood and Henwood 2011). It is also quite common that churches are primarily addressing the evangelical and pastoral needs of people without taking care of their physical needs. Within the Christian institutions and churches as well, some emphasise evangelism and personal salvation, while others integrate the social change and good works into their evangelical gospel sharing work (Woolnough 2011). “Faith without works is dead” (The Bible, James 2:26). In order to be able to demonstrate the faith, there must be work. Hence, the idea of holistic mission emerged to address both social and evangelical aspects of development.

Since the 1960s, there has been significant growth of Christian NGOs with direct responsibility for relief and development. In the past, their role was to tackle the needs of the poor and victims of wars and disaster around the world. Most recently, the Christian NGOs are seeking for partnerships with local churches to integrate the work of the relief and development with Christian Gospel preaching. Woolnough (2011) claims that the earlier model of Christian NGOs and institutions working independently, to “do good to the poor”, has changed over the years. These institutions are increasingly willing to cooperate with local churches to tackle the local needs wholistically through the integral mission approach. Integral or holistic mission attempts to address people’s physical and social needs, and proclaim Jesus as their Lord (Henwood and Henwood 2011).

Most secular development agencies are active in relief and development around the world. They supply the needed resources and skills to achieve short-term physical benefit which is tangible. However, they often lack the less tangible emotional and spiritual domains. Christians claim that happiness and peace that come from faith; faith comes from hearing of gospel; and hearing necessitates evangelism and preaching work. Hence, when Christian development agencies and churches work together, they can bring holistic change in people’s lives – “fullness of life” (The Bible, John 10:10). However, there are a number of challenges in adopting the model of holistic development. Churches may focus only on spiritual issues; social/development work may ignore spiritual issues; and development workers become narrowly specialized in just one area of work. Local churches in the resource-poor countries are not usually involved in development; instead social wings are set up and are given the responsibility of carrying out development programmes. Similarly, many Christian organisations run holistic development programmes that do not involve the church (Tearfund 2005). Thus, it is crucial to integrate social programmes and evangelical work together to achieve the anticipated mission of holistic transformation that brings salvation, justice, equity, peace and happiness in people lives.

References and Links

• Clark, J. (1991). Democratising development: The role of voluntary organisations.  London: Earthscan Publications Ltd.
• Gomes, L. (2003). The economics and ideology of free trade: An historical overview. Cheltenham: Edward Elgar Publishing Ltd.
• Henwood, N. and Henwood, R. (2011). Changed agents: Nine years in Nepal. Guildford: Grosvenor House Publishing Ltd.
• Micah Network (2001). Micah network declaration on integral mission. URL: http://www.micahnetwork.org/sites/default/files/doc/page/mn_integral_mission_declaration_en.pdf
• Pieterse, J.N. (2001). Development theory: Deconstructions/Reconstructions. London:  Sage Publications.
• Tearfund (2005). Holistic change in our communities. Footsteps 53.  URL: http://tilz.tearfund.org/Publications/Footsteps+51-60/Footsteps+53/Holistic+Change+in+our+Communities.htm
• Thomas, A. (2000). Poverty and the ‘end of development’. In: Poverty and development into the 21^st century. (T. Allen and A. Thomas, eds.). Oxford: Oxford University Press.
• WCED (1987). Our common future. World Commission on Environment and Development. Oxford: Oxford University Press.
• Willis, K. (2005). Theories and practices of development. London and New York: Routdedge.
• Woolnough, B.E. (2011). Christian NGOs in relief and development: One of the church’s arms for holistic mission. Transformation. 28(3):195-205. Sage Publications.

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[1] The Micah Network is a coalition of evangelical churches and agencies from around the world committed to integral mission. Convened by this network, 140 leaders of Christian organisations involved with the poor from 50 countries met in Oxford in September 2001 to listen to God and each other for mutual learning, encouragement and strengthening as we serve the cause of the kingdom of God among the poor.

Strengthening Health Systems in Resource-Poor Countries

Various agencies have been engaged with delivering healthcare services in the resource-poor countries. Generally, the state, the private sector, and the third sector have a role in the delivery of healthcare services. Since both state-driven and market-led approaches have often been ineffective, there has been an emergence of non-governmental organisations (NGOs) that include faith-based institutions to facilitate the delivery of healthcare programmes in resource-poor countries. Over the past several decades, NGOs have become major players in the arena of development and healthcare services in resource-poor countries. There has been a growing interest in the role of NGOs in the field of health and development, as they are frequently considered as more efficient and responsive than the state.

There has been duplication of the roles of the state and international agencies or NGOs in some countries’ health systems. It is noticeable that NGOs are taking greater involvement to help the state to address the objectives and statements made by Alma Ata Declaration and Millennium Development Goals. National health institutions are receiving resources and technical assistance from NGOs and international donor agencies. However, a policy paper of American Public Health Association (APHA), see link below, states that the health systems in the resource-poor countries suffer from insufficient financial resources, poor management and technical capacity, limited institutional framework and infrastructure, weak health information systems, inequity and discrimination in the distribution of available services, poor community participation and lack of transparency and accountability. Due to lack of robust health policy, weak health system and the shortages of capable health professionals, attempts of preventive and curative healthcare services and health promotion programmes have been insufficient and ineffective.

Professor Anne Mills (see link below) asserts that although contracting services to the private sector and NGOs is advocated as a solution to the problems facing governments in managing healthcare services, there is a need for developing the management capacity of governments to contract out service provision to other agencies. She further mentions that strengthening health systems is a long-term process that requires enhanced capacity of government institutions and local personnel. Hence, countries or governments need to identify the areas for improvements and develop policies and programmes to accommodate inputs or assistance from the private sector and NGOs. From the sustainability point of view, governments must develop institutional frameworks and policies, so that external agencies find their role as assisting the existing government policies and programmes. 

APHA claims that heavy involvement of private sector, international agencies and NGOs may have adverse effect on the national health systems in terms of sustainability of the services and capacity building of government health institutions and professionals. It states that government’s national health systems may be deteriorated through international organisations’ project activities by diverting health professionals from the public sector and creating parallel structures to government services. There is duplication in the allocation of resources and the delivery of services, which tend to worsen the isolation of communities from formal health systems in one hand and waste of limited resources on the other. There is also an issue of sustainability, as the support from international NGOs and donors is project-bound and time limited.  Hence, it is sensible that the role of international agencies and NGOs is to enhance the capacity and infrastructure of a state’s health systems, so that the government will be able to deal with meeting health needs of their country. APHA recommends that international NGOs include capacity building and strengthening of national and local health systems in their projects to ensure long-term sustainability after their support terminates. Further, it recommends that international agencies and donors commit support to government’s health sector, so that national workforce and institutions can be strengthened with an adequately trained healthcare professionals and workable national and local health systems in resource-poor countries.

References & Links:

• http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1375
• http://www.dcp2.org/file/83/HRHS_Mills_final.pdf

Capacity Building of Community Based Organisations

Capacity building is one of the most frequently cited jargon word in the present context of development. Many international organisations including multilateral/bilateral development agencies and NGOs have provided capacity building as a part of their programmes of technical cooperation and development to their member and partner organisations. Despite the growth in interest and popularity, development agencies, international and local, have limited understanding of what capacity building entails. Capacity building is a concept developed by international development agencies to address the capacity deficits in the developing countries. It is a process by which individuals and organisations increase their abilities to perform responsibilities and solve problems, in order to deal with their development needs in a sustainable manner. Most literature defines ‘capacity building’ as a process of developing local community-based implementing agencies by providing training and skills from international organisations to implement projects effectively. Hence, capacity building is a process of developing organisational capability by providing skills, resources and technology in order to initiate, plan and implement development projects and fulfil the development needs of the people.

The increasing role of local agencies in the implementation of development projects has raised the issue of building up the capacity of local implementing partners to address the changing paradigm of development. The capacity of any organisation can be considered in three aspects that include intellectual capacity referring to the ability to think, reflect and analyse independently; institutional capacity dealing with how organisations function; and material capacity covering the assets of the organisation.

It is contestable whether local agencies forge increased capacity without reliance on inputs of international organisations. In the main stream development practice, capacity building appears to be a one-way process, with external agencies taking the lead role. Often external agencies think they should be active and the beneficiaries should be passive recipients of ‘development’. The capacity building in community development is a long-term process that requires local ownership and learning by doing approach. Such kind of development process does not follow the time-bound project cycle approach that most funding agencies demand. Hence, external agencies cannot resist the temptation to push a capacity building process forward at their pace and design.

Chris Stalker and Dale Sandberg have written an article on capacity building for advocacy (see link below). According to them, capacity building interventions can be targeted at six levels, including the individual, projects or programmes, organisational, external linkages, creating an enabling environment, and multiple levels. They have also introduced three different types of capacity building interventions: pre-planned – offering support in pre-set areas based on evidence about key factors in effectiveness; structured support – customised framework to respond to a particular set of identified needs and challenges; and fluid approach – looking at and exploring range of opportunities and threats facing organisations or programmes and providing support in thinking through ways to best respond to these issues.

Building the capacity of community-based organisations (CBOs) to make them more effective and sustainable is a focus of many community development programmes. Chris Wardle writes an article about process-based approach to capacity building, consisting of five stages and elements, of village communities to manage the provision of clean drinking water (see link below). The stages/elements include: raising awareness and mobilising communities; creating drinking water users committees; delivering practical training and support; encouraging peer learning; and involving local partners. During the process of capacity building, programmes encountered a range of challenges and problems, including: passivity of community members; political influence and interference; difficulties with the management of the drinking water users committees; conflict of interests among local partners; overcoming resistance to women’s participation; sustainability of water systems; and ownership of water projects.

The article states that capacity building of CBOs is a challenging task. To be successful, capacity building must be treated as a planned process that involves several complementary stages as listed above. Similarly, the clarity on the purpose, use of capacity building methods, and the focus for the sustainability of the programmes are vital for any organisations or programmes that deliver capacity building to CBOs. Hence the capacity of local communities and CBOs can be enhanced by organising themselves, imparting knowledge and skills, sharing management and technical tools and systems, networking with local and outside partners, and building institutional frameworks that help CBOs to function independently in a sustainable manner.

References & Links:

• http://www.intrac.org/data/files/resources/698/Praxis-Paper-25-Capacity-Building-for-Advocacy.pdf
• http://www.intrac.org/data/files/resources/697/Praxis-Note-57-Building-the-Capacity-of-Villages.pdf

Monitoring and Evaluation of Community Health Programmes

Monitoring and evaluation is an integral part of each phase of the project life cycle of community-based health programmes. It is essential to define measurable milestones in the project plan. Continuous and periodic monitoring helps to establish to what extent the programmes have achieved the set goals and targets. Upon completion of the project, a final evaluation is carried out to measure the outcome of the project in terms of predetermined targets and articulate the accomplished goals. In the recent days, many health and development organisations have been using logical framework analysis. The logical framework approach (LFA) is a management tool mainly used in the design, monitoring and evaluation of health and development programmes. LFA was first developed by USAID during the 1970s but now it is widely used by bilateral and multilateral development agencies and most recently by NGOs as well. It provides clear, concise and systematic information about a project. The framework helps in connecting all the project components including goal, purpose, outputs/results, inputs/activities and indicators, in one framework, presenting the relationship between them and leading to the achievement of the anticipated project outcomes. Please refer the link below as for an example of a guideline for preparing a logical framework developed by AusAid.

An evaluation framework for community health programmes developed by the Center for the Advancement of Community Based Public Health is found to be useful tool for the evaluation of community health programmes (see link below). The evaluation framework emphasizes programme evaluation as a practical and ongoing process that involves various stakeholders including programme staff, community members, partners, clients, donors and evaluation experts. The framework consists of six steps namely, engage stakeholders, describe the programme, focus the evaluation design, gather and analyze evidence, justify conclusions and ensure use, and share lessons learned.

Tearfund UK has developed a Capacity Self-Assessment (CASA), a tool to assess an overall impression of an organisation, identify the stage of its development and provide insight into its current and potential impact. A pilot study of this tool was carried out involving partner organisations from Cambodia, Haiti and UK. This is a quality assessment tool, which is found beneficial to help organisations to improve their standard of service and their overall results. Further, this tool helps to identify both positive and negative aspects of organisations so that organisations are aware of their strengths to be retained and weaknesses to be improved. The CASA tool is divided into three assessment modules: International Organisation, External Linkages and Projects. Please refer to the link given below for the full version of CASA manual.

References & Links:

• http://www.ausaid.gov.au/ausguide/pdf/ausguideline3.3.pdf
• http://www.cdc.gov/eval/evalcbph.pdf
• http://tilz.tearfund.org/webdocs/Tilz/Roots/English/CASA/CASA_E-%20full%20document.pdf

Community Health Workers

The global policy of primary health care support was initiated with Alma Ata Declaration in 1978. Since then primary health care and community health programmes have become synonymous. Community health workers (CHWs) play a significant role in the delivery of primary healthcare in the resource-poor countries. World Health Organisation (WHO) recognises that CHWs are providing services in remote and inaccessible parts of the world. There are programmes run by various national and international agencies to build the capacity of CHWs. However, Low and Ithindi (2003) claim that such programmes have been criticised either as being inappropriate and ineffective or as having problematic relationships between partners.

The role of CHWs has become very important due to the shortage of qualified health professionals, particularly in resource-poor countries. Hence, they have become prominent players in bridging the health care gap. Their role and activities are enormously diverse across countries, programmes and scope. CHWs are making valuable contribution to primary health care services and overall community development. However, some challenges exist on the selection, nurturing and remuneration aspects of CHWs. Further, a key challenge lies in setting up vision and systems, and institutionalising and mobilising community participation (see link below).

A DFID funded research programme called ‘The Consortium for Research on Equitable Health Systems’ has carried out a research study on ‘community health workers: a review of concepts, practice and policy concerns’ (see link below). This study suggests that CHWs have evolved with community-based health care programmes. However, the concepts and practices of CHWs differ across countries, conditioned by their aspirations and economic capacity. Seven critical factors have been identified. These are gender; selection of CHWs; nature of employment, career prospects and incentives; educational status; population and service coverage; training; and feedback, monitoring mechanisms and community participation that influence the overall performance of CHWS.

Low and Ithindi (2003) identify a set of steps and roles and responsibilities of partners involved in utilization of CHWs. Those steps include:

·        Strategic direction – steering committee representation

·        Preparatory phase – selection of the pilot constituency, needs assessment, development of the CHW job description, selection of the CHWs, CHW training

·        Operational phase – provision of the kit box, uniforms and shoes, operational work planning, visiting households and other tasks, supervision and support, reporting to the steering committee, monitoring

·        Evaluation – outcomes, efficiency and effectiveness

Further, they claim that three major types of problems can prevent programmes functioning. These are: lack of commitment by the partners, poor management and the limited scope of the partnership. These problems exclude the community from involvement in decision making and result in the top-down orientation of the programme.

References & Links:

• Low, A. and Ithindi, T. (2003). Adding value and equity to primary healthcare through partnership working to establish a viable community health workers' programme in Namibia. Critical Public Health. 13(4):331-346
• http://www.who.int/hrh/documents/community_health_workers.pdf
• http://www.crehs.lshtm.ac.uk/Community_health_workers_prasad.pdf

Principles and Practices of Sustainability

Sustainability is the capability of a community to continue the programmes and remain reactive to change after the termination of external assistance. Many community development institutions remain active only while they are supported by external agencies. Hence there is huge dependency among community-based health and development institutions. They are not organisationally independent and financially viable while they are sustained by international support agencies in one way or the other. However Karim Sahyoun (see link below) suggests that development institutions can make a positive contribution without becoming totally dependent on outside help. He states that local community participation with clear ownership, commitment and enhanced capacity may prevent dependency. In this context, sustainability can be considered as the ability of the local institutions to maintain and continue the programmes incepted by international development agencies without interference by such external agencies.

Dr Emelita Santos Goddard claims that it is important to have a shared vision and plan for community-based development interventions to be sustainable (follow link below). Being fully dependent on outside charity does not promote sustainability. She suggests that sustainability is achieved when development initiatives and interventions are owned and managed by local people. Hence shared vision, local participation, authentic institutional partnership between support agencies and local implementing organisations, and a clear plan for local handover and continued encouragement are the keys to sustainability. In many cases, partnership has been focused on project funding systems, as donors give grants and in return recipient organisations provide reports. However, a partnership between agencies, based on a mutually binding covenant relationship goes far beyond project-based funding contract that has reciprocal relationship and mutual understanding on long-term sustainability of programmes.

Enhanced capacity and reinforced confidence of community-based institutions and individuals are vital for sustainable development. In order to implement a strategy of sustainability, the community must believe that they are capable of solving their problems and shaping their own future. Engaging stakeholders in all stages of development process and creating a network and extending cooperation among likeminded individuals and institutions locally and internationally are equally important. It is also sensible to have a very strong core group of individuals, who are guided by a shared vision and have strong desire to run the programmes, and the organisation is positioned in strong values. The following steps are the key to achieve sustainable community health and development:

• Identify stakeholders and get their agreement on programme implementation
• Conduct a participatory community assessment
• Perform community organisation and raise awareness
• Create a community vision and develop a roadmap for reaching that vision
• Develop sustainability indicators to measure progress
• Introduce organisational development practices
• Run training and capacity building activities
• Identify sources of assistance and mobilize resources
• Carry out regular monitoring and evaluation

Link and Resources:

• http://tilz.tearfund.org/Publications/Footsteps+61-70/Footsteps+64/Planning+for+sustainability.htm
• http://tilz.tearfund.org/Publications/Footsteps+61-70/Footsteps+64/Principles+and+practices+of+sustainable+community+development.htm

Financial Sustainability

Sustainability, a long-term perspective in which organisations or programmes aim for independent operations, has become a buzzword in the NGO sector. The concept of sustainability has long preoccupied donors and development practitioners, but there is a lack of clarity in its meaning. Sustainability is the ability of organisations to continue their institutions and programmes beyond the termination of external assistance and remain reactive to changes. Sustainability has two key dimensions: institutional and financial. Institutional sustainability is the capacity of viable and stable organisations to continue programme interventions on their own, whereas financial sustainability refers to the capacity of generating required revenues locally or ensuring that the external source of fund is available to continue the programmes.

Financial sustainability is the state of having financial continuity and security where the organisations or programmes do not collapse if the external funding is withdrawn. Many international development agencies desire that their community-based programmes should evolve into self-reliant local entities that are able to continue the programme activities. With increasing international donor fatigue but the potential availability of resources locally, many development professionals are talking about local institutions becoming independent and financially sustainable. However community-based health care institutions remain weak because they lack reliable and long-term funding mechanisms. They become vulnerable to outside influence and project-based funding that inhibits the ability of the local institutions to respond to their beneficiaries. It needs a long-term strategic vision for them to become financially self-sufficient. From the financial sustainability point of view, it is good to have diversity of funding or income sources to avoid dependency on a single donor or income source.

Here are some tips for the secrets of financial sustainability given by the organisation called Mango (see link below), which include:

• A diversified funding base
• Availability of unrestricted funds
• Availability of financial reserves
• Strong stakeholder relationships
• Assessing and managing risks

It is a huge challenge for community-based health programmes to become financially viable on their own without external support, especially in the context of the resource-poor countries. Many community-based health care programmes do not have a strategy for cost recovery through local income as they are heavily dependent on the external grants. Community-based health programmes should therefore develop fundraising mechanisms that include both internal and external sources of funding. Most community-based health programmes are struggling to develop a sound funding base due to a lack of a fundraising strategy.

David Moore, the Programme Director of International Centre for Not-for-Profit Law has written an article on Laws and other Mechanisms for Promoting NGO Financial Sustainability in the NGO sector (see link below). He claimed that NGOs are predominantly dependent on international donor funding. However these NGOs are challenged by the tendency of withdrawal or reduction of levels of support by the international donors, thereby increasing the urgency of long-term sustainability. He has outlined the mechanisms that promote the financial sustainability of the NGOs. Some of them include:

• Government or public sector support
• Private charity
• Self-generated income
• Community contribution
• Volunteerism

References and Links:

·        http://www.mango.org.uk/Guide/TT4

·        http://www.mango.org.uk/Guide/FinancialSustainability

·        http://www.icnl.org/knowledge/pubs/Financial_Sustainability.pdf