Illustrative Capability Statement

Nicaragua

Management Sciences for Health (MSH) applies nearly four decades of worldwide experience to help governments, local organizations and international agencies rebuild and scale up comprehensive, integrated health services. For the past 15 years, MSH has been providing technical assistance in Nicaragua to both the public and private sector. MSH has worked to increase institutional capacity in health and education and has enhanced citizen participation and transparency - leading to the improvement of social capital indicators related to health, education, citizen participation and governance.

The LMS Program in Nicaragua, PRONICASS (Nicaragua Social Sector Support Program), worked in partnership with both public and private organizations to improve social services. PRONICASS was built upon the foundation set by the Management and Leadership (M&L) Program, a USAID-funded cooperative agreement implemented by Management Sciences for Health (MSH). From 2001–2005, M&L worked in partnership with public and private organizations with close coordination with the USAID mission and with nongovernmental organizations (NGOs) including Nicasalud (the Nicaragua NGO Health Network), Profamilia and the Prosalud Project, the former USAID bilateral program. The Ministry of Health, the Social Security Institute, the Ministry of the Family and the Ministry of Education were among M&L’s client organizations, with some support provided by the Harvard School of Public Health.

Throughout the lifespan of LMS, PRONICASS was tasked with confronting challenges such as these in implementing projects in several social sectors.

Institutional capacity building challenge with Nicasalud: In 2005-06, PRONICASS received an urgent request from USAID to assist Nicasalud in becoming certified for direct USAID financing. The USAID health strategy called for providing funding for community health activities directly through Nicasalud, rather than through a central project as had been done in the past. In response, PRONICASS led an institutional reorganization initiative to develop budgeting, procurement, accounting and financial management systems. The approval and implementation of these systems permitted USAID certification that benefited 10 Nicasalud staff and its 27 affiliate NGOs.

Supporting the Global Fund CCM: LMS was requested by the USAID Mission in Nicaragua to provide technical assistance to rapidly strengthen management of all Global Fund projects being implemented in the country. Management development assistance was required to ensure compliance with terms of existing projects. The project specifically called for strengthening the management and improving the communication of the Country Coordinating Mechanism (CCM), as well as clarifying its internal roles and responsibilities. Using the systemic approach of “management by process,” which is being utilized in other LMS Nicaragua projects and elsewhere in Latin America, the technical assistance teams produced expected results within the two-month timeframe. A key tool produced during the LMS’s Global Fund work in the country was the “Early Alert System.” This system facilitates routine monitoring and decision-making concerning priority management and technical needs of sub-recipients

Key Results: PRONICASS has been working with 49 organizations to apply leadership and management skills to improve performance in service delivery. More than 4,400 senior leaders have been trained in these practices, with more than 2,500 of them women. PRONICASS has helped transform and update the curriculum of seven medical specialties, including Pediatrics and Obstetrics, in public medical schools.

• Twenty-nine communities and 750 people in the departments of Leon, Nueva Segovia and Boaco were trained in and applied a guide to implement the new health care model of the Ministry of Health.
• PRONICASS has helped transform and update the curriculum of seven medical specialties, including Pediatrics and Obstetrics, in public medical schools.
• PRONICASS provided technical assistance to the Ministry of Education to develop educational plans to improve local development. To date, over 114 schools in 14 municipalities have begun this school planning process involving the participation of 3,500 school directors, teachers, students and parents.
• Technical assistance provided by PRONICASS resulted in USAID certification of Nicasalud in mid-2006. Under a second request for LMS technical assistance, a contract performance monitoring system was established. PRONICASS completed its technical assistance with the design of the remaining Nicasalud systems – governance, communications and federation network management.
• During the first phase of PRONICASS, the project extended its institutional reorganization efforts to eight federation members and has worked with them and the Nicasalud technical office in helping align institutional operations with the mission, vision and legal mandate of the organization.