Exchange for Change (E4C)

Using LEGO bricks to foster transformative processes amongst Global Fund partners from 16 African countries

Workshop participants from six countries

In January and February 2018 the German BACKUP initiative organised two regional workshops in Ouagadougou and Lilongwe. Health experts from 16 countries used the innovative ‘LEGO Serious Play’ methodology to explore common bottlenecks in implementing Global Fund-financed health programmes and to design novel solutions to address them.

Fostering South-South exchange is an integral part of the BACKUP Health approach to capacity development in countries implementing Global Fund grants for their HIV and AIDS, malaria and TB programmes. At the two regional learning events in Burkina Faso and Malawi, BACKUP sought to provide a forum for exchange and joint learning for more than 100 participants from 16 countries.

Representative delegations of civil society and state actors from French-speaking Burkina Faso, Ivory Coast, Cameroon, DRC, Guinea, Niger and Togo and from English-speaking Ethiopia, Kenya, Liberia, Malawi, Namibia, Nigeria, Rwanda, Sierra Leone, South Africa, and Tanzania were invited to take part in the E4C learning events.

The workshop methods were chosen with a view to stimulating debates, bringing forth novel and transformative ideas and giving voice to each and every participant. This article gives an overview of what the two workshops covered (and why), which methods they used and which results they achieved.

What the workshops covered, and why

To make sure that the workshop content responded to participants’ needs and interests, BACKUP conducted an online survey amongst them prior to the two workshops. The delegates were asked to reflect on the most important challenges they faced related to Global Fund processes and health programme implementation. Looking at the three main pillars of BACKUP support, namely strengthening health systems, national coordination mechanisms and grant management, the survey assessed which issues participants most wanted to discuss with peers from other countries. The resulting topics were an accurate reflection of the different types of challenges that participants encounter when preparing and implementing Global Fund programmes in their home countries. The organizing team ensured that most of them were covered in the course of the two 3-day workshops.

Which methods were used?

Together with a moderator team, BACKUP chose the innovative LEGO Serious Play method as one of the workshop tool. The method fosters creative thinking as it encourages teams to use LEGO bricks to construct tangible models of their working environments and the challenges and bottlenecks they face in it. Participants work through imaginary scenarios using visual three-dimensional LEGO constructions, which is why the method is called ‘serious play’.

Expressing ideas through LEGO bricks

The approach is based on research which suggests that hands-on, "minds-on" learning produces a deeper, more meaningful understanding of the world and its possibilities. At the same time the method is inclusive as it works across hierarchy-, gender-related and other boundaries. Participants move from constructing their personal views and towards creating joint models, accompanied by lively discussion: ‘I gradually realized how things and situations which are normally quite complicated to explain can easily be brought to life if you use LEGO bricks!’ said one participant from Liberia and his colleague confirmed: ‘Nobody in our group was left behind; all of us could easily explain our challenge and come up with solutions as this method is so down to earth! ’

Each participant was asked to name topics of high priority for their particular context from the overall list of topics generated by the pre-workshop survey. Partners then formed mixed-nationality groups to work on topics they were particularly interested in. For each topic, they had to jointly construct three consecutive scenarios: the challenge – the ideal situation – the solutions. Local filmmakers documented this interactive and highly creative process.

One ‘challenge model’ showed how, in Guinea, the oversight committee of Global Fund grants struggles to collaborate with implementers and to successfully perform its oversight role. Another group with participants from Eastern and Southern Africa chose Nigeria as their country case. They started by visualising the lack of coordination at country level which prevented them from designing and implementing effective health system strengthening interventions.

Next, each group constructed a model of the ‘ideal situation’. The model for Guinea showed well-organized collaboration between the oversight committee, principal and sub-recipients. The group working on challenges facing GF-funded programmes in Nigeria envisaged the creation of one national coordination body to manage health systems strengthening resources. This body should have the mandate to allocate funds based on joint planning and a health systems strengthening strategy.

Between the LEGO brick building sessions, the working groups had time to share perspectives on priority issues and to formulate recommendations. Two recurring themes that participants raised in their discussions were their wish for regular, well-coordinated communication amongst key actors in the health sector, and the need for mechanisms to ensure transparency and accountability.

What the workshops achieved

At the end of the three day workshops, a number of concrete results have been attained: All delegates had been equipped with a novel way of understanding health system challenges and of co-creating solutions for them. In addition, many country teams left with concrete ideas for ways to overcome current challenges in their national settings. The Guinean team, for example, took away that it was important to clarify the roles of actors involved in grant oversight and that it needed to strengthen implementers’ capacity to collect quality data so that implementation bottlenecks could be identified at an earlier stage. The Nigerian team left the workshop in Malawi with a plan to initiate discussions about a health system strengthening investment strategy and operational plan so that funding could be allocated systematically to achieve joint impact.

Visualization of solutions on "How to deal with grant management risks and reporting challenges"

On the third day, participants used time allocated for networking to establish a number of virtual groups through which they will continue to exchange on topics of shared interest, using Whatsapp groups, webinars and mailing lists as means of communication.

At the closing session, one participant from the Democratic Republic of Congo expressed a sentiment many delegates shared: ‘The dynamics we have experienced over the past three days showed us that each country has a specific way of doing things. So the workshop really complements the work we will have to do back home in our country.’

Upon return to their home countries, the teams will further elaborate the solutions they developed during the ‘Exchange for Change’ events and then pursue their implementation. Regional collaborations, BACKUP Health and other partners will continue to support them in their endeavours which, in turn, will contribute to the achievement of national and Global Fund goals in the years to come.

Further information

Dr. Klaus Peter Schnellbach, Annabelle Metzner, Han Kok
February 2018

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