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Enhancing Food Security and Physical Activity for Māori, Pacific and Low-income Peoplesdevelopment of strategies that are more successful and are cost-effective. An importantpoint of difference of this model is that it is stage based and relies on communityinformation to identify readiness to address a health issue (such as HIV/AIDS). Theimplementation process and level of capacity building differ according to each stage.Three case studies were presented which demonstrated the effectiveness of the model.The second paper 7 outlined the use of a conceptual model for culturally-appropriate HIVprevention capacity building among Asian Pacific Islander (API) providers in southernCalifornia. The three-year programme provided by an Asian Pacific AIDS InterventionTeam to API providers included the following strategies. One was technical assistance inorganisational stability/viability: one-on-one contacts/organisational ‘coaching’ (at leastonce per quarter with API staff) and workshops (about one per month on topics such asboard development, project management, collaboration, needs assessments/researchand strategic planning). These provided strategies and skills for enhancing stability andviability. Also, two symposia, which led to further meetings between participatingorganisations and other agencies, thereby increasing potential partnerships. Thesecond was technical assistance on HIV knowledge environments: workshops on HIVprevention and diverse populations, knowledge about cultural norms and obstacles toHIV prevention; and programme meetings held once per quarter at the differentorganisational partner sites.The effectiveness of the programme was assessed via an organisational survey andstaff observations. The organisations were mostly small, targeted diverse populations,served a large geographic area, and were knowledgeable about HIV. Organisationsbecame more viable (more capacity in human resources, financial, external relations,and strategic management), but also more unstable (large growth in paid staff and boardmembers), and showed more capacity in HIV knowledge environments. The resultssuggest that capacity can expand over a short period of time, but as capacity increases,organisational viability/stability and HIV knowledge environments change, meaning thatdifferent types of technical assistance would be needed for sustainability. 7Feasibility (level of evidence of effectiveness)The international research into research and workforce capacity building is encouragingand highlights the development and implementation of conceptual and theoreticalframeworks. These models have been implemented in a variety of settings and withindigenous people and minority groups. Very few evaluations of the effectiveness ofcapacity building approaches have been conducted. Of these, surveying workers hasbeen the preferred method. Generally, there was sufficient evidence to support thedevelopment of capacity; however, more robust evaluation is required with quantitativedata to support the effectiveness of capacity building initiatives. There is no reason tobelieve that the components of workforce development cannot be applied in the NZenvironment to develop capacity for culturally-specific physical activity programmes.SustainabilitySustainability is important; however, few high quality evaluations have been conductedto provide data on this issue. From the limited knowledge available there is a need toprovide ongoing support in the form of education and training, mentoring, advice etc, aswell as adequate and sustained funding to ensure ongoing development of capacity.More research is required to determine the sustainability of capacity building. One of thecapacity building initiatives 7 was implemented over three years, providing some support155
Enhancing Food Security and Physical Activity for Māori, Pacific and Low-income Peoplesfor sustainability. The issues raised internationally are relevant to the ongoingsustainability of physical activity programmes in NZ.Effect on equityDevelopment of capacity will have a positive impact on equity, provided the rightcapacity is developed. There is evidence of improvements in capacity among indigenousand minority populations. There is an ethical consideration, which may impact on equity.Cash 24 asked is it ethically defensible for society to train people and then not supportthem at the most basic level? Society and communities must ensure that whoever istrained develops skills that can be supported by sustained work. To do otherwise wouldbe a waste of resources, and potentially exacerbate inequitable distribution of theseresources.Acceptability to stakeholdersEngagement of stakeholders is a fundamental step for developing capacity. A number offrameworks and models have been proposed, all of which reinforce the need forstakeholder engagement using a participatory approach. Engagement of stakeholdergroups will increase the sustainability of the programme and acceptance by participantsand community members. Qualitative data exists to support the acceptability for thosewho have been recipients of capacity building initiatives. 21 Lessons learned from theinternational arena are particularly relevant to the NZ environment. Consultation andthoughtful engagement of key stakeholder groups would be a fundamental principle.Key components for effectivenessTheoretical and conceptual models exist for developing capacity and creating stronglinks within the community and include:• collaborative community participation and consultation ,• early, meaningful and ongoing engagement with community leaders and diversestakeholder advisory groups to encourage alignment between the innovation andstakeholder needs; positive relationships among key stakeholders; andownership of the innovation among stakeholders,• political support and adequate funding to provide both seed capital andsustainability,• human resource strengthening, through education, formal and informal training,mentoring, and communication,• information resource strengthening such as monitoring, data synthesis, analysisand modelling to characterise baseline conditions,• provision or infrastructure and appropriate technologies, and• ongoing support in the form of enterprise and investment stimulation, which willensure the economic sustainability to the programme.Potential side-effectsThere are generally no anticipated side-effects of developing capacity. As highlightedabove, it is unethical to train people and then not provide support for them at the mostbasic level. This issue is particularly salient in the New Zealand environment, in whichthe opportunities and career pathways for those trained in delivering physical activityprogrammes might be limited.156
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