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Enhancing Food Security and Physical Activity for Māori, Pacific and Low-income Peoplesprogrammes should be encouraged. Formalised links to decision makers would helpensure the research question tackled priority health services and policy issues. Third,there should be improvement in access for funding for research projects, andstrengthening of research networks. Access to physical capital in the form ofinfrastructure such as computers, databases and personnel was also recommended.Key elements from the nursing literature above have been applied to build sustainableresearch capacity in a rural brain injury rehabilitation service in Australia. 17 The projectinvolved a partnership with a university organisation, which helped develop amultidisciplinary reference group. Key steps for the programme included appointing aproject coordinator, establishment of a cross-institutional skills database to match staffwith relevant experience, offering competitive small project grants, assistance for staff todevelop project ideas, and support to identify and apply for external research grants.This project represents a successful partnership between academics and clinicians todevelop research capacity. 17The improvement of human capital of community health workers has been a priority areain some countries, mainly due to the lack of access to healthcare services in culturally,economically, and geographically isolated communities. A national survey of communityhealth worker training and certification programmes highlighted the importance ofimproving human capital. Specifically, schooling at the community-college level providedcareer advancement opportunities. On-the-job training was associated with improvedstandards of care. Certification at the US state level recognised the work of communityhealth workers and resulted in medical insurance reimbursement. 18 Training has been acommon approach for developing capacity among health care workers. For example, afour-hour training curriculum was developed and implemented for community healthworkers working with Native Hawaiian and Pacific people on diabetes prevention,control, and management. 19 The curriculum developers incorporated teaching strategiesshown to be effective with this population and included culturally-relevant material.Nineteen health organisations participated in the training that reached 111 communityhealth workers over a three-year period. Results showed significant gain in diabetesknowledge. A five-day short course in health promotion was implemented and evaluatedin Australia, 20 and resulted in increased confidence and skills of participants to engage incollaborative opportunities. Positive effects were also reported in health promotionpractice and on organisational capacity to conduct health promotion. Other qualitativeresearch, 21 however, has suggested that training alone is insufficient for capacitydevelopment. Providing additional support to help workers manage their workload andmaintaining the fidelity of the intervention is important.Capacity development has been a key focus in projects that aimed to developpartnerships with indigenous people for community-driven health initiatives. 9 Aninternational partnership between indigenous people in Canada (Musqueam) andEcuador (Totoras) provided a useful framework to develop capacity among indigenouspeople internationally, and to facilitate indigenous knowledge mobilisation andtranslation to promote cultural community. A number of elements of this framework arepertinent to this chapter. The development of partnerships with key stakeholders,establishing the needs of the community and their commitment to developing communityhealth support was considered an important first step in supporting the process ofcapacity building. As with previous research, mentoring of community heath workers wasconsidered a critical step, as was the need to secure funding to ensure the sustainabilityof the programme. Wahbe et al 9 discussed the desire to implement project activities that153
Enhancing Food Security and Physical Activity for Māori, Pacific and Low-income Peopleswere based primarily on local cultural knowledge of each community and were designedto revitalise indigenous culture and skills. Participation in these activities also increasedcapacity via community-based training. Other international collaborative partnershipshave been successfully implemented to develop capacity among community healthworkers in Uganda. 8One review presented the MuSCLE (multi-stakeholder capacity building and learning forempowerment) framework, which incorporates a multi-stakeholder process to fostersocial learning to strengthen social capacity. 22 This paper was presented in response todelays in achieving the Millennium Development Goals for substantial reductions inpoverty and hunger, child mortality and disease, as well as significant improvements inmaternal health, gender equality, primary education, and environmental sustainability.The aspects of the MuSCLE approach most salient to this chapter are (a) havingcommunities act as agents of change, (b) the need to develop enabling environments,(c) negotiating partnerships to make progress, and (d) moving from technical experts inoutside agencies to a process in which people within the community play a central role.The MuSCLE process is focused on developing social capital to sustain interventionsand to respond to changing conditions. It utilises a participatory approach which hasbeen used successfully in Mexico to sustain urban water supply. 22This review highlighted evidence which showed that to sustain net benefits over timerequires the co-strengthening of six interdependent levels of social capital:1. Political will and financial seed capital to initiate transitions and improve policiesand practices.2. Human resource strengthening – education, training, communication, and raisingawareness within formal and informal institutions and among stakeholder groups.3. Information resource strengthening – monitoring, data synthesis, analysis andmodelling to characterise baseline conditions, identifying priority problems andinform future direction.4. Policy-making and planning – the design, enactment and enforcement ofresponsive policies, practices, laws, regulations, and rights with equity,accountability and incentive mechanisms.5. Basic infrastructure and appropriate technologies – health care facilities andprevention technologies.6. Enterprise and development and investment stimulation – provision of productsand services, stimulation of entrepreneurial activities that provide economicsustainability to the programme and substitute seed finance.These six levels interact with each other to support the intervention and programmeobjectives. Although this model was developed for interventions to help addressMillennium Development Goals, it provides a useful conceptual framework fordeveloping capacity, and given the participatory focus, might be useful for New Zealand.The effectiveness of other models for developing capacity has also been investigated.These models have included many of the strategies or components already presented.Two are relevant here because of their focus on indigenous and Pacific people. The firststudy 23 presented the community readiness model for developing Native Americans’capacity to implement community interventions for the management of HIV/AIDS. Theauthor stated that the nine-stage model provides communities with a user-friendly‘diagnostic tool’ that identifies multidimensional stages of readiness that support the154
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