East Africa Uses the RAISE Tool to Evaluate Readiness of Cities for Graduation from TCI
The Challenge Initiative (TCI) lets local governments self-select and lead the implementation of TCI’s high-impact best-practice family planning and adolescent and youth sexual and reproductive health (AYSRH) approaches, while TCI provides coaching and access to its Challenge Fund. From the outset, local governments are set on a path toward self reliance, eventually “graduating” from TCI.
Being able to scale to more and more cities means TCI strives to graduate cities once engagement hits around three years. TCI views graduation as a process and recognition of sustainable success – not an “exit strategy” or one-time event. This year-long process begins in a pre-graduation phase where the city demonstrates improvements not only in the uptake of family planning methods but also in its health systems.
In 2018, TCI’s East Africa team developed the Reflection and Action to Improve Self-reliance and Effectiveness (RAISE) tool to measure the intensity and effectiveness of implementation in supported cities, and gauge progress towards ownership and sustainability of the family planning program. RAISE utilizes a standard set of indicators to help governments reflect on their implementation progress in the following sustainability domains: increased political and financial commitment; capacity (knowledge) transfer of family planning skills; institutionalization of TCI’s high-impact best practices at all levels of the health system; and sustained demand through improved attitudes and behaviors towards family planning. This tool is used directly by government staff, in partnership with TCI.
The East Africa team has thus far conducted quarterly RAISE assessments in all 41 implementing cities with 100% of the cities completing one assessment, 88% completing two rounds and 74% completing three rounds. The results over time show tremendous improvement in all four RAISE domains across Kenya, Tanzania and Uganda.
Between April and June 2019, TCI conducted its first round of assessments in all the implementing cities. Most locations scored within the “beginning” and “developing” levels, with Kenya’s scoring an average of 50%, Tanzania scoring 56% and Uganda scoring 50%. Coupled with HMIS and TCI project records data, the RAISE tool helped the government teams develop action plans to strengthen areas in need of improvements.
During the second round of assessments between October and December 2019, most cities saw increases in their RAISE scores – average scores rose to 75% (+50%) in Kenya, 69% (+23.2%) in Tanzania, and 75% (+50%) in Uganda. In round three – conducted between January and March 2020 – most cities saw further increases with average scores increasing to 79% in Tanzania (+14.5%) and Uganda (+5.3%), while Kenya maintained at 75%.
TCI regularly triangulates data from RAISE assessments with its other monitoring tools including HMIS, local tracking surveys, project reports and qualitative methods. The findings from the triangulated analysis and learnings currently show seven cities in East Africa ready to move into the pre-graduation phase this year. TCI has sensitized government staff in those seven cities on the concept of graduation and developed action plans to ensure government ownership of TCI’s high-impact best practices, encourage diffusion to public and private health facilities, and have greater coaching emphasis on sustainability.
As a city nears graduation, TCI reduces its coaching and financial support. Post-graduation, cities are expected to sustain results, which TCI will continue to track while also providing coaching on demand.
Below are lessons learned by TCI’s East Africa team from conducting three rounds of RAISE assessments.
RAISE Lessons Learned
The following are experiences and key lessons learnt from the process of implementing the RAISE Tool in East Africa. The lessons are structured by the various aspects of the RAISE assessment process, beginning with planning through to implementation of Action Plans.
It is important that cities include RAISE Assessments in their annual workplans. This increases the likelihood of implementation of the assessments. Based on the expected outcomes of the RAISE Tool, it is advisable that the assessments are regularly conducted on a quarterly basis for a city that has not yet graduated. Hold adequate consultations with the city during preparations for the RAISE exercise for an appropriate schedule, date and venue. The activity venue should be in the city offices or boardrooms to minimize costs. Don’t mix the RAISE exercise with another activity as it compromises the quality of the RAISE process and results.
Capacity for RAISE Implementation
In each city, identify local coaches and focal persons for RAISE and train them in the use of the RAISE tool. These coaches need to participate in the adaptation, pretest, pilot and rolling out of the tool. This ensures local capacity, empowerment, ownership and sustainability of the process.
Participants for RAISE Assessments
Provide adequate guidance to the cities on the selection of the essential and relevant persons and stakeholders to participate in the RAISE assessments. For meaningful and comprehensive deliberations, the participants should be multi-sectoral (finance, political leaders, FP/AYSRH focal persons, planners, private sector, social services, community health, healthcare providers, etc) and include all the persons described in the RAISE tool, key decision makers and FP/AYSRH Program implementing partners in the city. Ensure participation of the geography leadership (both technical and political) for: ownership, quality and success exercise, prompt decision making, accountability, advocacy, strengthening of leadership capacity and oversight of follow-up actions. It is good practice for each city to maintain an inventory of the RAISE participants. Always involve the participants of the previous rounds of RAISE in the subsequent ones to ensure consistency and hasten the process. People who are familiar with the RAISE Tool will usually complete the process faster and better.
At this phase, espouse the TCI Lead, Assist and Observe methodology. During the initial first RAISE meeting, TCI staff should lead all the sessions as city staff observe and learn second and third meetings, both TCI and city staff should co-facilitate the sessions to ensure progressive capacity transfer and empowerment of city staff to lead the implementation. When city staff capacity has been strengthened, they can then lead the succeeding meetings with minimal coaching and assistance from TCI. Disseminating previous RAISE results prior to the succeeding RAISE exercises sets the pace for new round and provokes instantaneous self-refection, decision-making, problem and solution identification. Clear explanations and reminders to participant about all the five stages of the RAISE process, tool and outcomes at the beginning of each RAISE exercise creates confidence. Completion of all the five RAISE stages: individual assessment, small group assessment, group consensus, Action planning and implementation; improves the success and quality of the process. The process could last between four and six hours, hence time-keeping and management during the meeting is very important.
Feedback and Utilization of RAISE Results
It is vital to provide feedback and share preliminary results, immediately after the meeting, with the city’s leadership and key decision-makers through a one-on-one meeting for their insights and buy-in. Immediate feedback also allows quick decision-making, accountability, oversight and ownership. It is good practice to leave the leadership with a brief copy of the RAISE report after this debrief meeting for future reference. For effective, evidence-based and focused coaching, use the City Action Plans to inform and revisit the coaching plans of both the city coaches and TCI staff. Regularly refer to previous RAISE assessment results during planning cycles as this helps cities to reflect and develop effective work plans that address the already identified gaps.
Follow Up on Action Plans
For better follow-up purposes, group consensus and Action plans should be in duplicate: one for TCI and the other for city. Each city needs to keep a file of all the RAISE Assessments data sheets for future references. Regular monthly discussions of action plans through mechanisms like Project Implementation Teams, help cities to keep track of their implementation progress and results.