In public health, technical assistance (TA) ranges from sharing information and data to delivering training or building capacity. When technical assistance is intended to help communities bring about systems change and improve health, the scope and intensity of the TA process must align with those desired outcomes. Outcome-driven technical assistance is a deliberate and systematic approach to TA that helps create systems change. This intensive form of TA is defined by five steps.
Step 1: Pre-intervention
At this stage, the TA provider’s goal is two-fold: 1) to define the scale and scope of the issue to be addressed through TA and 2) to determine if the client* (the entity for whom the technical assistance will be provided) is ready and able to fully take advantage of the assistance and have it be of value.
The TA provider and the prospective client work together to clarify what results the client is seeking and if the provider’s skills, style, expertise, and availability are a good fit for the situation.
* I use the word “client” deliberately rather than partner or community. While the provider may have a collegial style and work in partnership towards outcomes, a client–provider relationship implies an objective relationship with clear roles and responsibilities. The provider serves the client with information, assistance, or guidance; but the client is generally responsible for application towards successful implementation.
Step 2: Analysis
Analysis is a necessary prerequisite for designing the appropriate TA intervention strategies for the issue or problem to be addressed. Good analysis defines the situation, provides the context for change, and offers insight into the opportunities and obstacles to success. It also helps to further clarify outcomes and ensure they are realistic.
For example, a client might request the provider to hold a series of trainings for staff and community members. But an objective analysis may show that the core issue is not a need to build skills but a high rate of staff turnover. In such a situation, training would be, at best, a short-term fix and an unwise use of resources. By taking time to conduct a thorough analysis, the TA provider can create an approach that addresses such root causes and is most likely to result in a successful outcome.
Step 3: Agreement
Drafting a written agreement is a best practice for an intensive TA intervention. Such an agreement defines the outcomes to be achieved, services to be provided by the provider, and the role, responsibilities, and commitment of the client. A process or project plan is another useful tool that can be developed at this stage to outline the path the intervention will follow to achieve the agreed upon outcome.
An agreement for an intensive TA intervention must be in writing and signed. It then serves as the foundation for a more seamless and productive long-term relationship between the parties. It maintains the provider-client relationship when individuals change positions and enhances the likelihood that the effort will be sustained.
Step 4: Intervention
The first three steps are the prelude to step four—the intervention itself. A TA intervention that is designed to bring about some level of systems change will be an intensive engagement. The provider serves as a catalyst, a guide, and a resource to move the project forward.
The provider not only guides and supports the work but also remains cognizant of building the systems or infrastructures that enable the client or community to carry on the work without the provider (In other words, they build sustainable capacity). A good TA provider leaves a lasting legacy.
The process or project plan is used throughout the intervention to monitor progress, ensure milestones are met, and make adaptations as needed. It is also useful to track time and resources expended as a way to determine if the time and investment made is actually making a difference. A sophisticated TA provider will use this information to know when to declare success or admit defeat (or at least futility) and move on.
Step 5: Long-Term Relationship
I often hear from my clients that community-level decision makers, who can be risk-averse, are more likely to engage and support an effort that has been successful elsewhere. So when an intervention successfully leads to the desired change, the TA provider working at the community, regional, or state level has a responsibility to leverage that success. How can the process, tools, or outcomes be replicated?
By taking care to systematically follow up and maintain a relationship with the client in the long term, the TA provider has a partner to explore these possibilities and perhaps find other opportunities to build future successes. Nothing breeds success like success!
And, if the intervention is not successful and one or more outcomes is not achieved, maintaining the client-provider relationship may be even more important. Through that relationship, the provider can debrief the intervention, determine what obstacles hindered success, and learn what future success will require them to do differently.
Those of you familiar with project management will recognize these 5 steps as analogous to a basic project management cycle. Achieving specific outcomes and ensuring return on investment for technical assistance requires focus and discipline. Conducting TA interventions using these best practices helps ensure that investment brings about (some level of) change.