Coordinating to Improve Services

For the purposes of program management, coordination can be defined as the planned collaboration of two or more individuals, departments, programs, or organizations who are concerned with achieving a common goal. In order to provide family planning clients with the best and most accessible services possible, you need to work collaboratively with your colleagues, who may include individuals from the departments within your own organization, as well as people from other family planning organizations in both the public and private sectors.

As a manager, you have probably heard many times about the importance of coordinating all of the elements of your program, and about coordinating your efforts with those of other programs. Coordination can be difficult to carry out, but it is so important for effective program operation that the issue must be addressed. Although you have considerable influence over coordination within your organization, you will find it more difficult to promote coordination between your program and another, but the benefits of coordination are important enough for you to make the effort.

With effective coordination, each party can focus on its strongest areas. By cooperating with all interested parties, you can provide broad-based and high-quality family planning services to everyone who needs and wants them.

As more and more parties become involved in family planning, it becomes increasingly important to coordinate their programs and activities. In fact, coordination is so important that many countries have created organizations whose principal role and mission is to ensure coordination. Examples include Kenya's National Council for Population and Development, Rwanda's Office National de la Population, and Indonesia's National Family Planning Coordinating Board.

The rewards of coordination usually outweigh the difficulties involved in establishing effective coordination mechanisms. Some of the benefits of coordination are as follows.

Coordination makes the most efficient and effective use of:

• Staff
• Equipment, supplies, and physical facilities
• Funding
• Services provided
• Knowledge, experience, and skills
• Research and evaluation results
• Educational activities and materials
• Access to client groups

Coordination improves services: Most family planning providers share a mission of delivering high-quality services to the population. To fulfill this common mission, a number of organizations can work together, each in its area of strength, to provide the highest quality of services. For example, one organization might be best able to provide services to adolescents, another might be able to supply IEC materials to all providers, another might be most suited to work in a particular region, etc. As explained later in the chapter, a functional allocation exercise can determine who is doing what. With such coordination, organizations can:

• Have more effective programs which reach a greater number of people;
• Reach new and different client groups;
• Discover any gaps in services;
• Create a larger family planning program with greater impact.

Coordination builds trust and decreases competition and conflict among family planning providers: Since family planning is inherently more controversial than any other health service, it benefits everyone if all the interested parties can work as a united group. By identifying and discussing their common problems and concerns, organizations will realize that they are not fighting all the battles alone, and that it is to their advantage to work together.

Coordination shares information and the lessons learned from the experiences of others: Family planning organizations have always had to overcome numerous difficulties of all kinds. By sharing information, an organization can avoid mistakes, learn from the problems and successes of others, and avoid wasteful and unnecessary programs and activities.

Coordination reduces or eliminates duplication of or gaps in services: When an organization knows exactly what other providers are doing, it won't waste its resources or efforts on a service that another group is already providing adequately. It also won't neglect a needed service because it thinks another group is providing it.

Coordination enlarges the scope of activities: When organizations coordinate, they can assign activities to those organizations which are best qualified to carry those activities out, thus putting an end to duplication of services. This should free up both funds and personnel to take on new activities, and thus broaden the scope of the services provided.

Coordination standardizes policies: Coordination is more easily carried out when the programs involved all operate under similar policies. Interaction among organizations becomes much easier when such policies as client eligibility, contraceptive methods recommended, medical protocols, media messages, clinic and reporting forms, and records are standardized. Similar personnel policies may help to reduce competition among organizations for recruiting and retaining staff.

Coordination brings greater influence: When all the family planning providers speak with one strong voice, they are much more likely to be heard, respected, and answered.

If, in theory, coordination is necessary and desirable and frequently leads to many positive outcomes, why is it so hard to do in practice? There are several potential problems which you may have to deal with:

Territorial battles: Some organizations may view coordination as a threat to their established role or responsibility, or as causing a loss of autonomy or the abdication of their leadership role. These fears exist in every organization but tend to be most pronounced among weak or young organizations, or in a particularly fragile or volatile environment for family planning. However, when the right conditions of trust and need exist, the risks involved are far outweighed by the potential benefits of coordination.

Leadership vacuum: Coordination will only take place if someone pushes for it. It requires a persistent effort, and many managers or organizations prefer to let another manager or organization assume the burden. If no apparent coordination is taking place in your country or region, it may be that no organization has recognized the need or is willing to lead the coordination effort. This provides your organization with an opportunity to take the lead. When you do so, remember that you will be more effective if you guide the process rather than if you try to control it.

Passivity when action is needed: Your colleagues may be unwilling to get involved in coordination efforts if they think it will involve a series of long, unproductive meetings. One way to convince the skeptics is to structure the first coordination meetings around issues that have been problematic for some time, and which are generally considered to require resolution and action. When an agreement has been reached, put it down in writing, make sure everyone understands what she or he has to do, and let everyone know what specific outcomes will occur as a result of that meeting. These should be reviewed at the next meeting. People will begin to believe in coordination and actively promote it when they see concrete results. Some results might be:

• Agreement on national priorities and strategies
• Joint training programs for family planning providers
• The development of standardized reporting forms for service statistics
• Integrated supervisory visits
• IEC and training materials for common use
• Agreement at the local operational level on the division of roles and how responsibility will be shared

An unwillingness to do too much work: It takes quite a lot of time and effort to initiate and maintain coordinated efforts, and the initial attempts at introducing programmatic or organizational coordination may not be very rewarding. Try to keep the effort from being abandoned before the benefits can be seen. The department or organization responsible for initiating the coordination effort will have to do some background research, understand the differing perspectives and worries, and know how to nurture the participation of the other organizations. This calls for skills in negotiation, problem solving, and team-building (which requires an understanding of the interests and sensitivities of the players). The final challenge is to reach a consensus on a plan for coordination.

Fear of being used: Managers may worry that another department or organization will use them for its own benefit. These fears can be minimized by making the effort to open communication channels and to understand the interests of the other department or organization.

Crediting success: A successful coordination effort often creates disagreement among organizations as to which one deserves the credit for the success. If you ensure at the outset that all organizations will receive equal credit from any success, you can reduce this distrust.

Fear of revealing secrets or weaknesses: Organizations may feel that they have to share the innovative ideas and methods which they believe give them an advantage over the competition, or they may fear that their individual, divisional, or organizational weaknesses will be exposed. These issues of competition and pride must be taken into account.

The competing interests of donors: Donor agencies can impede coordination among organizations by deciding to fund a program without investigating the activities currently being carried out in the area. By setting up a program that duplicates or contradicts the work of other programs, donors can interfere with effective program activity. One solution to this problem is to set up a committee consisting of representatives of the donor community and of donor-funded organizations, in order to reduce duplication of and gaps in services offered.

Example from Peru - From Confusion to Coordination