Strategy for a rural community health program:
An overview of MIT students’ 2009 strategic analysis and planning for a participatory organization serving multiple needs in rural Uganda.

Kyetume Community-Based Health Care Programme (Kyetume or KCBHCP) was founded in 1994 to serve local residents of the Ntenjeru and Nakisunga sub-counties of the Mukono South county in Uganda, an area with a 2010 population of over 100,000. KCBHCP strives to improve the health standards of the undeserved by influencing the socio-economic and spiritual behavior of rural communities using a community-based involvement/participatory approach. By 2010, KCBHCP programs included health care prevention and treatment,  HIV/AIDS and other STD care, community outreach and education, water and sanitation, vocational training and orphan support. In 2010, the Programme had grown to operate two health centers, Kyetume (categorized as a Level III) and Katosi (Level II)*, along with 29 outreach centres where monthly visits by KCBHCP provide immunizations, child growth monitoring, antenatal deworming, and other treatments.

The Global Health Delivery (GHD) Lab is a graduate-level class at MIT that pairs teams of graduate students with partner enterprises delivering health care in resource-limited settings in Sub-Saharan Africa and elsewhere. Part of MIT Sloan’s flagship Action Learning program, the course puts students to work on practical challenges that limit access of health care, addressing specific business and organizational needs.

Our relationship with the Kyetume Community-Based Health Care Programme began at the 2008 AIDS Conference in Mexico, where we met Reuben Mubiru, KCBHCP’s Programmes’ Manager. At the time, his organization was smaller than it is today, with a single site in Kyetume. The conference drew in participants from all over the world with the goal of sharing and identifying solutions to the challenges faced in addressing the HIV/AIDS epidemic. Taken by Reuben’s commitment to his community, we invited him to join our GHD Lab class later that Fall to work with a team from MIT. The goal would be to address Kyetume’s pressing needs on a project defined by him. He took us up on our invitation.

Half a year later, a team of four Sloan MBA students headed to Uganda to help Kyetume  (in Reuben’s words) “develop a five-year strategic plan using a participatory approach; develop a sustainable fundraising / resource mobilization strategy for the two health centers; (and) establish a monitoring and performance framework for the management and progress against the key policy and objectives of the Kyetume CBHC Programme.”

In this article we’ll take you through the strategic planning process that the MIT student team carried out in close collaboration with Kyetume’s Board, staff and volunteer community. Our hope is that this short guide will be a helpful reference in similar strategic or long-term planning initiatives.

What is strategic planning?

Strategic planning is the process though which an organization determines where it intends to be in the future and how it will get there.  Strategic planning entails developing a vision for the organization’s future and determining the necessary priorities, goals, and strategies to achieve that vision. When done right, this process will involve all stakeholders with a vested interest in the direction of the organization, the board (or leadership team), staff (employed and volunteer), government, donors and other partners.

Getting started or “Planning to plan”

With the MIT coursework and professional background as the foundation, the team began by carefully outlining the stages, objectives and activities they would need to undertake to successfully carry out the strategic process at Kyetume. Defining a process framework in advance allowed the team to identify key contributors at each step, get ‘buy-in’ from the board and key stakeholders, and reserve staffs’ precious time in advance of their site visit.  Given the tight timeline, it was especially important to get everyone’s commitment and line-up needed resources before the work would start. The team worked part-time for two months from MIT, for close to a month intensively on site, and then for another 6 weeks at MIT wrapping up their work.

For the strategic planning process itself, the team followed a goal-based strategic planning methodology that focused on the organizations mission and values as the basis of outlining goals, developing strategies to achieve the goals, and finally planning for implementation. (There are a few models for strategic planning, depending on an organization’s needs and concerns.)

Here is the process framework defined by the team:

The MIT student team started with the recognition that values, vision and missionframe what the organization is all about. Together they capture why the organization exists, what it seeks to achieve and how it will go about accomplishing its objectives. Many organizations have a ‘feel’ of who they are, what they stand for and hope to accomplish. Formulating values, mission and vision statements articulates this ‘feel’ for everyone in the organization and provides a basis for participants to discuss and weigh strategies in the strategic planning process.

Values represent the core principles and beliefs of the organization and its members. Internalized values drive behavior, action and decision-making in accordance of what’s most important to the organization.

Vision defines what the organization seeks for the community and itself in the future – the end goal or results of their work.

Mission captures what the organization aims to do in service of its vision. An organization’s mission answers the question “Why are we in business?”

KCBHP had already spent time thinking through it’s values, vision and mission. At a dedicated meeting at the start of the strategic planning process that included board and senior staff, the team helped refine and articulate them into the following:

KCBHCP Statement of Values

KCBHCP believes in human rights and equal treatment of all individuals, regardless of religion, race, creed, health, economic or social status
KCBHCP is a participatory, community-based organization that values the contributions of all stakeholders including staff members, volunteers, beneficiaries, government leadership and the community at large
KCBHCP respects and values the multiple religious denominationswithin Mukono South and their role in mobilizing the communityKCBHCP develops and revises programmes and activities in response to the needs of the community
KCBHCP believes in providing holistic, wide-reaching care to the community, especially those who are underserved
KCBHCP attempts to implement change by influencing the behavior of the members of the community

KCBHCP Vision

KCBHCP exists to see a productive healthy society responsive to its fundamental human rights and obligations.
Kyetume’s organizational vision for 2014 is one of financial strength and demonstrated impact through quality, holistic support services for the residents of Mukono South.

KCBHCP Mission

Kyetume CBHC Programme strives to improve the general health standards of underserved rural people within Mukono District and Uganda at large by influencing socio-economic and spiritual behavior of rural communities using a community based involvement/participatory and human rights approach.

2. Defining goals

Next, the team worked closely with Reuben and KCBHCP’s leadership team to define the program’s strategic goals. Goals come from the vision the organization has for itself and position the organization for the change needed to realize its mission. Goals describe what the organization seeks for itself in the future and can span a variety of categories: resources, operations, finances, customers etc.

In close collaboration with Reuben, the team helped define the following overarching goals for KCBHCP in its next 5-year period from 2009-2014:

• Goal 1: Increase and diversify revenue portfolio in order to secure stable funding and improve KCBHCP’s long-term financial position.
• Goal 2: Improve the recruitment, retention and development of KCBHCP human resources, including personnel, volunteers and partners, resulting in a transparent, client-friendly, professional organization.
• Goal 3: Define and develop progra focus by balancing the portfolio of activities and investing in program development in order to more fully meet the mission of holistic, community based care.
• Goal 4: Improve KCBHCP’s ability to measure program impact and client health outcomes in order to implement continuous improvement strategies and increase organizational learning.
• Goal 5: Grow KCBHCP programs at an appropriate and sustainable pace in order to maximize the organization’s impact in the community and continue expanding its reach.

3. Defining strategies and tactics

Strategies and tactics describe specifically how the organization will reach its stated goals.  Strategies are the plan of action or approach for reaching the goals and tacticsare activities needed to carry out each strategy. Here is an excerpt from Kyetume’s strategic plan that highlights the relationship between goals, strategies and tactics. (The entire 5-year plan is available as a download at the end of this article).

Goal 2: Improve the recruitment, retention and development of Kyetume human resources, including personnel, volunteers and partners, resulting in a transparent, client-friendly, professional organization.

Strategy 1: Focus on staff development and retention activities that incentivize long-term employment and professional growth of employees within the organization.

• Improve operational effectiveness by increasing leadership capacity within the organization, focusing on developing the management team and beginning to plan for succession of key leaders.
• Invest in staff by offering continued training and recurrent vocational education opportunities, or by enabling staff to take short-term leaves in order to enroll in training programmes related to their work.

Strategy 2: Increase ability to reward and retain volunteers.

• Improve volunteer recognition programmes by hosting events, providing small supplies to support their work and presenting annual awards. Focus on reinforcing their role as key stakeholders in the organization.
• Develop systems for managing the work of visitors and foreign volunteers, defining possible projects and appointing a member of the management team to serve as a lead liaison.

At this stage of the process, the MIT student team ensured that all stakeholders in the program were involved in contributing their ideas and input: medical and administrative staff, volunteers, donors and the executive board. The team conducted a total of 45 interviews between January 8-20, 2009. Especially important was input from team leaders responsible for implementing the strategies and staff who would be carrying out the required activities.

4. Tracking and monitoring results

As a last step, the team worked closely with staff to put together a set of metrics for each of KCBHCP’s main areas of intervention. With more than 2 dozen programs across 6 areas of intervention, KCBHCP relies on metrics for reviewing and reporting progress across the organization and to financial donors. Metrics also tell the story of whathappened as the result of new strategic initiative and tactics. Well-defined metrics are needed to track progress, quantify improvements (or declines) and communicate results. Stressing this importance, the last section of KCBHCP’s 5-years strategic plan identifies key metrics that will be tracked as part of the organization’s overall metrics and reporting initiative.

Following up with Reuben afterwards

In March of 2011, we had a chance to visit Kyetume again and speak with Reuben in person. Here’s what he had to share with us when we asked him if, two years later, there was any evidence that the project had helped his organization to deliver more or better care:

In order to have care, you must have resources. And you’re always asked what instruments you have to track care which are sound and representative. The strategic plan did something very good for us. We presented the strategic plan to one donor and they gave us an ambulance because they saw we organized our strategic plan and what we intended to achieve and they appreciated that. Number two, part of the evidence, our donors, like PEPFAR [came] here to evaluate our capacity. We had the strategic plan in place and we were able to reflect on the questions PEPFAR was asking and we knew what made us skilled enough to implement. PEPFAR was satisfied with the evidence, the relationship with MIT, the capacity we had built and that we were able to respond to our gaps. … Another thing is that the MIT team came here they were empathetic to our organization. They donated some money to support our programs ($200-$300 each) and involved themselves to support our organization. During that time we had a chance to have our program sponsorship catalog out of the MIT capacity which helped us have a catalog to present so people could provide support. We knew the cost of each item (i.e. heifers, goats) that we use in our income generation. I have not lost touch with the students. I have a relationship with them. I can write to them and forward them our documents and they can give us feedback. If you talk to John Potter, he sent us Quickbooks. They [the program] now have a person who can use the Quickbooks system.

We also asked Reuben if he could identify any resulting differences in Kyetume’s approach to management, for instance in how staff thought about things and approached problems. Had he had changed the way he manages the organization as a result of the collaboration with us? This is what he had to say.

Originally, staff implemented activities just to do them, to check them off as a routine. But now the staff and the implementers look at the targets to determine their activities. While implementing, they check themselves with it. They have a direction in the organization, in operations. Secondly, I can say that the impact generally is that there is an improved service provision. If you go to the health center you can see the different roles are ironed out well, especially with the sliding scale framework. Everyone knows who is responsible for what. Customer care is higher than before. People now understand who their real boss is–not the manager but the client. So they can service the client better than the way they used to do it.

I listen more to the implementers than talking to them and giving them orders. They know what they are supposed to do. I want to listen to their challenges and hear feedback on what they’ve done instead of directing them on what to do. They have their targets. This time they can check themselves to see if they are achieving. As far as myself is concerned, I have a plan to refer to. I can look on what we’re supposed to achieve. I have evidence [to share:] …….what we have done and why we have not done things, I can still present it to the Executive Board.

And there’s more: in 2011, a second team of MIT students took up a follow-on project with Kyetume. Stay tuned for more on their experience!

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* A level II health center (HCII) provides more preventative than curative care. Treatment for minor illnesses is done via out-patient services and patients requiring higher levels of care are referred to a HCIII. Can dispense medication. Staff includes: nurses, health educators, and administrative personnel.

A level III health center (HCIII) includes both out and inpatient services, including routine labor and delivery services, dispenses medication and provides some emergency care. Facility operates 24 hours/day and serves a wider area. Staff includes: a part time physician, nurses, clinical officer, midwives, lab technicians, counselors, and support staff.

What to know more about this project? Download the team’s Final Presentation(pdf) and Kyetume’s 5-year strategic plan (pdf).

What to know more strategic planning? This 10 Step Guide for strategic planningis an excellent and succinct resource that provides guidance on how to carry out the planning process. Managementhelp.org also provides an overview and further links on strategic planning with application in both non-profit and for-profit organizations.

Was this article useful to you? Please give us feedback on how to improve sharing our work by leaving us a comment or e-mailing us at ghd.projects.lab@mit.edu.

 

Prepared by Eriola Kruja, drawing on the team’s reports and coursework under the supervision of Anjali Sastry. Thank you to the MIT student team and our partners at KCBHCP.
Eriola Kruja, MBA, collaborates with Anjali Sastry and MIT Sloan colleagues to develop, manage, and asses academic projects designed to address global health delivery needs.
MIT Senior Lecturer Anjali Sastry, Ph.D., teaches, researches, and writes about global health delivery at the Sloan School of Management.