Let's be honest: Internal CSR Communications Suck

By Prof. Wayne Dunn, Fellow, Centre for Responsible Business-Ghana and President of CSR Training Institute, Canada.


CSR Mumbley Gook communications need to stop. Until us CSR Professionals get better at internal communications and engagement we will stay in an irrelevant sandbox away from core business activities and decisions. [For those unfamiliar with the acronym - CSR stands for Corporate Social Responsibility]

CEOs, because of the broad and diverse constituents they deal with, generally get the relevance of CSR.

Too often the Finance, Operations, Engineering, Production and other functions don’t get it. They may make the right noises (because it is expected of them) but at a fundamental level they don't get the core relevance of CSR to their role and their career.

Part of the reason they don’t get it is because the CSR Pros (myself included) can’t or won’t spend the time making focused internal business cases.

The “What’s in it for me?” case must be developed and communicated across the entire organization.

It is the CSR team's responsibility to help EVERY leader and their team understand the relevance of CSR for their role and work.

There is a strong What's in it for me? for Finance, Operations, Engineering, Production, R & D and other areas of the business. If they don't know it then it is up to the CSR team to develop and communicate it so they can hear it.

Until they do, CSR will remain an outsider to the inside of the business.

CSR is important for Shareholders AND for all functions and divisions inside a company. It is CSR’s responsibility to help those functions and divisions to understand why.

If they don’t, then the CSR team has failed. If CSR is on the outside looking in at company operations then the CSR team has to take the lead to change that. By making it clearly understood how and why CSR is directly relevant to the organization's Departments and Units, Leaders and Workers.

Some thoughts on how to do this are in Engaging Internal Stakeholders in our CSR Knowledge Centre. But don't expect all the answers there. They aren't.

Many of the answers are in your experience and insights. Look there for the stories and the business case that can help your colleagues to understand the importance of CSR for all functions and departments in your organization.

Remember, if you are not creating value with CSR then you will have a tough time to communicate value. But, when you do create value with CSR, be sure to communicate it.

Not communicate in a Socialwash sort of way, but it a way that can be heard and accepted.



CSR is about value. Figure out the value for them and communicate it clearly to your internal stakeholders.

When we get internal CSR communications right not only will our work be easier and our external CSR projects work better and have more societal impact. Our company and our shareholders will capture more value too.


Get CSR value right AND get the internal and external communications right and get ready for an exciting ride.

Corporate Social Responsibility: Is it an ‘‘alternative to government’’?

Corporate Social Responsibility (CSR) programmes are initiated by companies to give back to society what they have taken from them. It is a tool meant to gain ‘‘informal license to operate’’ in a particular community. As David Henderson puts it, CSR is meant to give capitalism a ‘‘human face’’.  Simply put, CSR is when a company lives a good neighbourly life with the community in which it operates.

Blowfield and Frynas described CSR as an ‘‘alternative to government’’ and this is ‘‘frequently advocated as a means of filling the gaps in governance that arisen with the acceleration of liberal economic globalization’’. Should companies do the work of governments particularly in the developing world where basic amenities are lacking? Are governments not shirking off their responsibilities simply because multinational companies have been providing schools, hospitals, roads in the name of CSR?

In an article, titled, ‘‘CSR as Corporate Social Responsibility or CSR as Colonial Structures Return, the case of Nigeria’’, my own Professor and Supervisor, Stephen Vertigans enumerated how people in the Delta State of Nigeria often complain about lacking basic human needs such as shelter, toilet facilities, portable drinking water among others. However, anytime they lay their concerns before the government, they are told to contact the oil companies operating in their community. The oil resource has become a curse to them rather than a blessing and that explains why many in Ghana think that if the country’s oil wealth would not bring the desired benefits to the populace, it should be allowed to stay where it is.

Many multinational companies operating in the developing world especially Africa are richer than the countries in which they operate in. As a result, they capitalize on that and sign contracts with government officials in secrecy and with confidentiality clauses. They dictate to our governments and virtually run our economies. Kwame Nkrumah was right when he said, ‘‘the resources are there. It is for us to marshal them in the active service of our people. Unless we do this by our concerted efforts, within the framework of our combined planning, we shall not progress at the tempo demanded by today’s events and the mood of our people. The symptoms of our troubles will grow, and the troubles themselves become chronic. It will then be too late even for Pan-African Unity to secure for us stability and tranquility in our labours for a continent of social justice and material well-being’’.

While it is unacceptable for multinational companies to dictate to governments in countries where they operate, it is unpardonable for governments to shirk off their responsibilities to their citizens. The right thing is for governments to partner with non-governmental organizations and the private sector to serve as drivers of CSR in order to have a win-win situation between business and society.

It is the duty of every government to draw public policies and programmes to ensure that environmental and social problems caused by multinational companies are reduced if not completely eliminated. The dependence of the state on multinational companies may hinder such noble initiatives but governments have no choice than to promote the greater good of their citizens.

Civil society organizations, businesses and the government all have roles to play in ensuring that there is accountability and transparency in the system and that, multinational companies by virtue of their financial muscle should not dictate to our governments. Responsible business is a driver to sustainable and inclusive development. Therefore, it is important for both governments and businesses to identify their roles and responsibilities and play them accordingly and not lord it over the other in the name of CSR.

In conclusion, businesses can only gain the trust of the communities in which they operate by incorporating the ‘triple bottom line’ which are; environmental sustainability, economic sustainability and social sustainability and not by dictating to the government of the day. Stakeholders are as important as the shareholders and every business decision must consider the concerns of both.

Eleven mistakes to avoid in CSR Communications

-By Prof. Wayne Dunn


CSR and stakeholder communications have a strong relationship to value. Do it right and you can create and preserve value. Do it badly and you can destroy value, or simply leave value on the table.

Yet, CSR communications are seldom looked at strategically, and almost never from a value creation/preservation perspective.

Let’s take a look at eleven common mistakes that I’ve come across over the last couple decades of working in the space where business meets society.

These mistakes cost shareholder value and too often result in missed opportunities for companies and stakeholders.

1. No Socialwash (Greenwash for CSR)

We’ve all seen it, glowing corporate communications that would make you think the company was up for a sainthood nomination. Yet, when you get behind the glitter, there isn’t much there.

Don’t oversell what you are doing, or talk about results you ‘expect’ or haven’t achieved yet.

Trust me, ALL of your constituencies will appreciate candor and clarity.

Your company or project isn’t expected to change the world through CSR. Don’t use language that suggests you might, or worse yet, that you are changing it.

Language that communicates genuine effort and real results is your most effective message.

I’ve actually found that a sprinkling (or more) of humility is actually helpful.

And on this socialwash word. I’ve struggled to come up with a word that is equivalent to greenwash. If you have a better one, my email is below – please let me know!

2. It was all us

Amazingly, you can read some CSR communications and you’d think that nobody else did anything to make the project successful. That the company did it all.

Share the credit. Liberally. It is way better in every way (and probably way more honest too)

As much as possible in your communications acknowledge the work of all who are associated with the project or work. Do this in writings, in presentations, in casual conversations; inside your company and outside.

Credit for CSR is NOT a zero sum game. When you share the credit with others it doesn’t make you have less credit. You end up with more. And with more willing and engaged partners.

3. Focused on company and not on issues and stakeholders

CSR is about the company’s interests, but not so much about the company. It is about the space where business meets society and how value is created (or not) for shareholders and society.

Yet, we often see or hear CSR communications that sound like an advertisement for the company.

Yes, it is OK to focus on the company’s interests. But, make the overall focus more on the issues, the stakeholders and the partners and the efforts to address/resolve problems.

If people want to know more about how wonderful your company is they will ask. No need for you to volunteer it and take away from the important messages of your CSR communications.

4. Doesn’t acknowledge concerns, shortcomings, alternative views

Don’t try to use fancy communications as a veneer to cover CSR challenges and shortcomings.

If your CSR project is like a pile of crap right now, try to fix it, not to spin a pretty picture.

Life is complex. Issues are complex. Accept that and don’t try to disguise it in your communications.

Nobody expects you to be perfect or to have all the answers for everything.

Often an open acknowledgement of concerns, shortcomings and alternative views can make your message more credible and help to facilitate dialogue and engagement.

5. Too complex

If you can’t make your CSR communications easy to read and digest, then you better take a look at your projects and work. I’m guessing they are too complicated and complex.

Remember, CSR is simple, but not easy. Stay focused on the simple stuff.

If you get stuck when you are doing CSR communications ask these sorts of questions.

Who is benefiting from the CSR project?
Why is that important for them?
Why is it important for society?
Who is helping us with it and what are they doing?
What have we really achieved?
How have we achieved it?
Why is the company investing in it?
What are the challenges and issues?
Somewhere in the answers to these questions is a simple, concise, humble and informative communication that can create or preserve value for your company and your stakeholders.

If you can’t escape the complexity, then you better take a look at your strategy and how you are doing CSR because I’m guessing that is over complicated too!

Step back and try and look at it with fresh eyes, or, consider getting a set of experienced fresh eyes to come and do a quick review. That may be the highest return CSR investment you ever make.

6. Doesn’t openly acknowledge the company’s motivation

If you don’t own your interests it will be hard for the communication to seem sincere and transparent.

Your company doesn’t exist to save the world. Don’t pretend that it does. Nobody will believe you anyway.

Your company exists to serve its shareholders. That is actually the law.

In the process of serving your shareholders you can also serve society, often through CSR projects and activities. That is what you want to communicate.

You don’t need to hide your interests or try to hide behind some altruistic motivation that nobody will believe.

Be open about what is in it for you and for your stakeholders. That will make the rest of the message much more credible.

7. Too Defensive

Sometimes the best CSR projects are initiative in response to activists or as a response to larger issues.

Sometimes the company is on the wrong side of these issues, or is seen to be on the wrong side, or has just messed up really bad.

Don’t let your CSR communications end up being a defense of your stand or situation. Deal with that directly.

Let your CSR communications be about the questions asked under #5, Too Complex. Let them tell stories about what is happening where your business meets society.

If you are too defensive, and often even a little bit defensive is too defensive, the rest of your message will get lost.

8. Too much promote, not enough share

Of course you want your CSR communications to support and promote your company and your social license, reputational capital and other issues.

But, often your effectiveness at that is much better if you simply share the CSR story and don’t try too hard to promote your company story.

If your company is doing good works through your CSR then you don’t need to shout it.

Simply sharing the CSR story, complete with credit for all who deserve it, is the loudest and most effective way to carry your own message.

9. Too much fact, not enough story

Sure, you want to have some data and details, but you also tell the people stories too. Have a mixture of both balanced to suit what you are communicating and who you are communicating it too.

And, if want it to reach more people, circulate further and be seen as more credible, consider having a third-party do a case study and publish it, especially if they have a relevant publishing platform.

You lose a bit of editorial control but will gain from the added credibility and circulation.

And, if you have a third-party that knows the CSR space you can likely get strategy and execution feedback as well.

10. Bad timing

Sometimes the best communication is silence and simply let your results speak for themselves, even if they take time to be heard

This can happen if there is a lot of controversy around the company or issue. In that situation communication can easily backfire.

It can serve as a catalyst for opposition and you end up with the CSR message getting lost in the controversy and noise.

When I was advising Placer Dome in South Africa they launched an incredibly ambitious and far-reaching CSR program in the midst of a huge controversy. A controversy that had them in court with the National Union of Mineworkers and led to their being named as the worst employer in South Africa.

In the midst of this the company committed several million dollars to a massive and ambitious CSR program, one that was eventually credited with changing the social face of the mining industry in South Africa.

Despite the stakeholder pressures the company was under and the very public criticisms it was enduring, they resisted unnecessary public communication about the CSR program.

As tempting as it was to tell the world what was being planned, they maintained public silence. Even after the project started achieving results we stayed silent.

We knew that if we opened any public discussion we had problems. Those who were in a public battle with the company on other related fronts would bring the battle to the public face of the CSR project and it would be much harder to succeed.

We stayed quiet and let the results accumulate and pretty soon our partners started to communicate the results. This actually led to an incredible public, and promotional, profile for the company and the project.

At the end of the day the project and the company gained a global profile and won many prestigious awards (see Stanford Case Study on it here). Had we communicated it too early I am not sure it would have survived.

11. Too boring

Make it interesting and fun.

You are communicating about good works and helping to advance good interests. Let it come alive.

Use pictures and videos and graphics. The project is often about real people and situations. Let that come through. Tell the stories.

Let people feel the energy that your company and your stakeholders and partners bring to the project.

Sure, sometimes you have corporate communication guidelines that seem to stifle the life out of anything.

If you have internal communication cops don’t be afraid to sneak something past them in the interest of making the communication less boring. After all, do you think the first CSR projects had all the appropriate internal approvals!!

--------------

As with most of my Thoughtpieces this one will have missed some important mistakes and you may even disagree with some of them.

That’s all good. None of us (and especially not me!) has all the answers.

-------------

CSR in Budget Crunch Times: 12 strategies for success

Prof. Wayne Dunn


1. Helping business to serve shareholders AND society SIMULTANEOUSLY CSR in Budget Crunch Times 12 strategies for success -by Wayne Dunn www.csrtraininginstitute.com/knowledge-centre
2. With plummeting oil prices, the mining industry facing sustained low prices, high costs and economic turmoil and the world economy looking scary, many firms are taking close looks at budgets and cutting far and wide. When budgets get tight CSR is often at the top of the list for cuts. Sometimes this makes strategic business sense. Sometimes not. When CSR is at the top of the cutting list it may be because that makes the most sense, given all of the other constraints and issues the company is facing. After all, the business does need to survive financially if it is to be able to produce value for society. A bankrupt or shuttered business produces few benefits for society or shareholders. Sometimes CSR is at the top of the budget cut list for the wrong reasons. This isn’t good for shareholders or society. I’ve found two main reasons that CSR can be wrongly placed at the top of the budget crunch cut list. After this I’ll list twelve strategies for addressing CSR when budgets are getting cut. They are mostly about CSR and value so are good practice at any time. 1. Company CSR leaders were not effective at internal communications and helping internal stakeholders understandthestrategicandshareholdervalueofCSR(see Seven proven ways to engage internal CSR stakeholders http://linkd.in/1z7vQN7 for more discussion on how to do this). CSR in Budget Crunch Times 12 strategies for success
3. CSR in Budget Crunch Times 12 strategies for success Page 02 Of course, there are exceptions and sometimes it is just a bad decision to cut CSR first. Or, sometimes budget crunch times help CSR to be smarter, more streamlined and more efficient at delivering social and shareholder value. Over a lot of years, a lot of projects and working with a lot of smart and experienced people I’ve come up with twelve strategies for CSR in budget crunch times. There are no magic bullets in this list. Budget crunch time is not easy, for anyone. Hopefully you might find one or two things in this list that can be helpful. Internal communications is critical 2. Not enough was done to capture all available shareholder value from CSR projects, investments and activities (For more discussion on this see Smarter CSR Budgets: Connection budget to value http://linkd. in/1wa8W8L and Eight self-interested steps to a CSR Plan http://linkd.in/12viCNs)
4. Page 03 And, remember, many of them are good to do on an ongoing basis – you don’t have to wait for budget crunch time. Here’s the list. This shouldn’t wait for budget crunch time. The link between a CSR project/budget item and shareholder value (and societal value) is absolutely key. Always. Why else would you want to do a CSR project if it didn’t create value? It doesn’t make sense. Of course, you may not have a directly quantifiable relationship between a specific project and value. It isn’t likely you can say something like ‘if you invest in this CSR initiative share price is projected to go up by X% next quarter’. But, there should at least be logical and anecdotal connections to shareholder value. Find it. Build on it and know how and when to communicate it. Sometimes CSR budgets and departments end up with projects that are much more properly in another area of operations. A colleague was recently telling me about a supply chain project she was working on. She discovered that basic things to bring workplace health and safety in-line with regulations was budgeted and done through a Foundation the firm had set up. Meeting workplace health and safety was booked as CSR in the budget. Nobody can question the importance of this work but it certainly shouldn’t be seen as part of a CSR budget. 1. Know the link to shareholder value 2. Check how your budget lines are positioned CSR in Budget Crunch Times 12 strategies for success
5. Page 04 There will be some in your company who think that $0.00 CSR budget is probably about right. Sometimes you can get through to them and sometimes you can’t. But, you can limit their influence on your work and your budget. Be sure that you are communicating effectively about the value the company is getting from your CSR projects. Give your internal allies information and motivation to advocate for CSR. Helping people to understand the value that CSR work brings to the company and to their work can help to bring them onside and neutralize those who might like to totally eliminate CSR. Shareholder value doesn’t happen by accident – at least not very often. With CSR projects initial work on aligning interests can go a long way towards optimizing shareholder and stakeholder value. And to keeping CSR budgets from the top of the cut list. But, there is often a lot more that can be done to increase shareholder and/or societal value. Partnering and communications are two prime areas to look. Strategic initiatives in these areas can often create additional value at little or no cost. 3. Don’t leave money on the table! Look for ways to enhance shareholder value 4. Internal communications Too often CSR projects leave all kinds of shareholder value on the table. This makes CSR more vulnerable when Budget Crunch time happens and cuts are being made CSR in Budget Crunch Times 12 strategies for success
6. Page 05 Budget crunches seldom sneak up unannounced. You can see and feel them coming. Know where you can cut and get by with less budget (and if you don’t need to drop it for a budget cut, then look to repurpose that spending to something with more value). Always be looking for how your CSR budget can create more value, for shareholders and society. CSR projects and activities shouldn’t be designed to go on forever. Periodically, and at least once a year, take a look at your CSR budget and make sure that you are getting the best value from all of your spending. Identify projects and line items that can be phased out with the budget repurposed to other CSR areas or offered up for cutting in budget crunch times. Saying everything is critical and can’t be cut likely won’t work! If it does you either don’t have a real budget crunch or there are some questionable decisions being made. 5. Be proactive You can’t get everyone onside but effective internal communications can mitigate their impact on your budget and work CSR in Budget Crunch Times 12 strategies for success
7. Page 06 If your company, your industry or the whole economy is in trouble your stakeholders and partners likely know about it. If not, they should. If you are hitting budget crunch time be open with them. Bring them inside your thinking. Tap into their thinking, networks and resources. You’d be surprised at how often out of the box solutions can emerge that can end up actually being better than the starting point. In one case budget cuts were about to eliminate two company positions that were supporting a community/NGO/company partnership. The CSR leader looked at this with project partners and then went back to the company with a proposal to move the positions to the NGO where they would be cost-shared for two years and then the NGO would take them over totally. This eliminated operating budget for the company, reduced overall cost and helped to grow the capacity of the NGO. Much better than just cutting the two positions Always worth taking a look at this. Sometimes natural partnerships were somehow overlooked, or failed to start at the beginning of a project. (See13 Common mistakes that prevent and destroy multi- sector CSR partnerships http://linkd.in/1y830NH for more on this) Or perhaps the motivation on the part of the company or partner wasn’t all it could have been at the time. When budget crunch happens motivations can change and/or new synergies can be found. Definitely worthwhile to take a close look before axing people, projects and programs. Sometimes you just have to fight! Seriously. There will be times when you are asked/ordered to make cuts to staff, programs and activities that just don’t make sense. Cutting them will clearly destroy shareholder and societal value all out of proportion to the budget that is saved. It may cause long term damage to the company and brand. 6. Be open with stakeholders and partners 7. Can partnering help reduce your direct cost 8. Be ready to fight. But, stay rational. CSR in Budget Crunch Times 12 strategies for success
8. Page 07 When this happens be ready to fight for your budget. But, fight rationally. Fight with logical and rational arguments, tied to value and the interests of the company. Use your communication skills to help key decision makers and influencers understand how the company’s interests are harmed if they go ahead with the cut. But, before doing any of this, make sure that you are not simply looking at things too subjectively. Make sure that an objective, rational person can understand your argument and justification. Don’t let emotions drive your decisions and actions. It’s OK to be emotional about your projects and work, but don’t lead with that. Let your emotions drive you to develop and deliver strong rational arguments in a way that can be heard and accepted. When budgets get slashed it can get emotional. You will lose battles that you fervently believe you should win. That’s life. You will lose staff, budget and programs while others that you think less deserving remain. This can be incredibly frustrating. Especially when you feel like you may have let down fellow workers, communities or project partners. At the end of the day the company needs to survive if it is to be able to continue producing value for shareholders and stakeholders. Decisions have to be made and some of them will be tough to accept. Sometimes you will find, even after trying to create some emotional distance you can’t support the decision or let go of it. 8. Be ready to fight. But, stay rational. 9. But, be part of the team. Or leave. Sometimes you have to step up and battle hard for budget that you know is critical for the company’s success. Base your battle on rational arguments and value centered reasoning, not on emotions CSR in Budget Crunch Times 12 strategies for success
9. Page 08 If you can’t agree to disagree maybe you owe it to yourself and your company to resign. Take time, make sure it is the right decision for you. Hopefully it doesn’t come to that and you will continue on but sometimes it does. If you can’t be a fully engaged and contributing part of the go-forward team do yourself, your stakeholders and the company a favour and find another place where you can be fully engaged and contributing. Every CSR program started because it filled a need and provided value to society and shareholders (or at least that should be why it started!). If you don’t know why a particular program started (and you should know that) then find out. It may be that the underlying why that prompted the creation of the program is gone and the program is no longer crucial. Or, it may be that it is there stronger than ever and what seemed like an inconsequential program is really quite strategically important. At any rate, find out the why of your CSR programs, especially before cutting them. Finding the why also helps you to focus your value creation thinking, arguments and strategies. Is it possible to move staff to partner organizations? Maybe this is good long term strategy anyway. Sometimes budget cuts will have the capital to cover the costs of transferring a position but not to retain a position. This won’t work for all situations, but there are some where it might work nicely. 10. Find the why. 11. Can you second staff to your partners? Good teams are diverse. They don’t have to all think alike, look alike or even like the same things. Diversity brings strength. But, you need to be able to fully engage with the team. CSR in Budget Crunch Times 12 strategies for success
10. Page 09 This really is worth doing twice. Identify all the ways in which each CSR project or budget line is creating value for society and for shareholders. Budget crunch time is difficult and nothing on this or any list is going to erase that difficulty. What is important to remember is that achieving success is like solving a puzzle. It takes many players, many pieces of the puzzle and different perspectives. Nobody has all the answers. None of us is as smart as all of us. 12. Look for the value connection again 9. But, be part of the team. Or leave. Look hard to make the connections to value. They aren’t always obvious. Missing them can be costly CSR in Budget Crunch Times 12 strategies for success
11. Professor Dunn brings a practical and realistic approach to CSR, blending theory and practice to develop realistic models and approaches to address real-world challenges Dr. Ellis Armstrong Former CFO, BP Exploration …coherent, thoughtful, stimulating and insightful… state of the art! The network of participants from the public, private and civil society sectors was incredible, some of the leading experts in the field.   Kojo Busia, Ph. D. Snr. Mineral Sector Governance Advisor United Nations Economic Commission for Africa/UNECA …pragmatic blend of theory and practice, very applicable to helping organizations meet real-world challenges. Frank McShane Manager, Corporate Responsibility Policy and Ethics, Talisman Energy … readily available to provide support to organizations like Amref that are seeking partnerships, and looking to bring about positive change in a collaborative and concrete way. Wayne and the CSR Training Institute helped us to identify and connect with potential partners and are always available. The training, the expertise, the network and the overall support are world-class. Onome Ako Director of Strategic Partnerships, Amref Health Africa “The program enhanced the CSR knowledge and strategic skills of our Kosmos Energy Ghana team, and offered the participants a platform for networking with professionals from other organizations across Africa and Ghana.”  Reg Manhas Sr VP Kosmos Energy Very much helpful Wayne; some of the tips and questions you gave will be an extremely helpful guide in the process of developing a CSR Strategy for my company. Emmanuel Aubynn Regional Social Responsibility Manager, Newmont Africa The CSR Program was excellent. A key aspect of my work is to encourage and support private sector development that contributes to Ghana’s overall socio-economic growth. The learning that I and my staff take away from attending this program will help us immensely with this responsibility. I highly recommend this program. Hon. Rashid Pelpuo (MP) Minister of State for Private Sector Development and Public Private Partnerships (Ghana) New and exciting insights into the theory and practice of CSR… great faculty and participants, very diversified. An excellent learning experience, very practical and useful. I’m very happy I was able to participate in it. Hon InusahFuseini (MP) Minister of Lands and Natural Resources (Ghana) WHAT OTHERS SAY ABOUT OUR WORK
12. Should Business Serve Helping business to serve society and shareholders, SIMULTANEOUSLY. Should Business Serve WAYNE DUNN, PRESIDENT AND FOUNDER SHAREHOLDERS? SOCIETY? IT SHOULD SERVE BOTH. Wayne Dunn is President & Founder of the CSR Training Institute and Professor of Practice in CSR at McGill. He’s a Stanford Sloan Fellow with a M.Sc. in Management from Stanford Business School. He is a veteran of 20+ years of award winning global CSR and sustainability work spanning the globe and covering many industries and sectors including extensive work with Indigenous Peoples in Canada and globally. His work has won major international awards and has been used extensively as ‘best-practice’ by industry and academia. He’s also worked oil rigs, prospecting, diamond drilling, logging, commercial fishing, heavy equipment operator, truck driver and underwater logging, done a couple of start-ups and too many other things to mention. Wayne’s career includes big successes, and spectacular failures. He hopes he’s learned equally from both. www.csrtraininginstitute.com

SERVICES & PROGRAMS

Services


We offer CSR and Environmental Management Services to mining companies, oil and gas companies, governments, banking and non-banking sectors, telecommunication companies and communities. The Centre believes responsible business is the key to sustainable development.


Programs


We are currently working with the chiefs and people of New Takoradi on stakeholder engagement and activism with the oil and gas companies operating in that community

13 Common mistakes that prevent and destroy multi-sector CSR partnerships

By Prof. Wayne Dunn (Fellow, Centre for Responsible Business)

The private sector is playing an increasingly important role in development. Companies from all sectors, including especially the extractive and fast moving consumer goods sectors, are investing in development initiatives in areas such as education, health, poverty alleviation and livelihoods, environment and gender equality.

The impact areas of these private sector social responsibility investments closely maps the impact areas outlined in the Millennium Development Goals (MDGs) and anticipated impact areas of the soon to be adopted Sustainable Development Goals (SDGs).

The MDGs and SDGs serve to guide the development activities of the member countries of the United Nations and the vast majority of development NGOs and organizations. Official Development Agencies, national governments, multi-lateral and international organizations and NGOs focus development efforts on areas such as education, health, poverty alleviation and livelihoods, environment and gender equality

While the various private, public and civil society organizations noted above approach development with a focus on common areas, they often bring unique skills, experience and capacities to the work.

In many cases these are complimentary and synergistic, at first glance, would seem to naturally invite partnerships and collaboration and the various sectors (e.g., ODA agencies, private sector, NGOs, etc.) even have stated goals of collaborating with each other in support of their development efforts.

Simple logic would suggest that collaboration would result in efficiencies and more and better development impact per dollar spent or effort expended.



Chasms often separate natural development partners

Yet, the reality is that, while there are notable exceptions, this collaboration is not easy to achieve. Whether on an individual project level or a strategic organizational level these natural partnership opportunities too often do not result in effective partnerships.

Value is lost when natural partners can't bridge the chasm that separates them

Value is lost for the organizations involved but the real price is paid by their community partners who do not receive the full impact that they could have received had these natural partners found an effective way to collaborate.

Here are thirteen common reasons why they start and fail, or even fail to start.

1. Egos of main actors

This is common to the destruction of many different sorts of partnerships. What makes multi-sector CSR partnerships more prone to ego related challenges is that, in many cases, the partnering organizations will have a general history of opposition or antagonism towards each other.

For industry to embrace and support the role that NGOs and development agencies can play in the success of a business or project is relatively new. Similarly for NGOs and development agencies to acknowledge the important role of the private sector in development projects. In many cases the sectors, or at least many organizations within them, have been actively opposed to each other.

These means that in some instances a 180 degree about face is necessary along with an acknowledgement that previous perspectives were flawed. This can often be overlooked during the giddy early days of a partnership but will often come back in a destructive way as the partnership plays out over time

2. Didn’t hang in through the tough stuff

Every partnership is bound to run into difficult challenges over time. Project issues arise, personnel changes, partners have strong opposing views on external issues, finances come under pressure, etc. Sometimes these come out of the blue and sometimes there is a slow build up over time.

In many instances if the partners can hang in there the issues will either resolve themselves, or they will find a mutually acceptable way to work through them.

However, for reasons discussed above, there are latent pressures in the partnership that can surface when other issues emerge. This can make it more difficult to work through the inevitable issues and challenges that always show up.

Those partnerships that survive over time will find ways to hang in and work through the rough spots and will also actively seek to reduce the latent pressures.

Conflict and differences of opinion happen in every partnership. All the time. There are ways to systematically prevent conflict and disagreement from destroying partnerships

3. Internal buy-in wasn’t there

Multi-sector CSR partnerships are often developed and negotiated by front line personnel with some level of support or acquiescence from corporate and NGO head offices. They frequently end up in place and operating without ever really getting the attention of key senior stakeholders.

In many cases the partnerships bring both an expanded and enhanced ability to achieve some of an organization’s objectives and, along with that, constraints in other areas.

As partnership and relations issues arise, as they always will, there is sometimes a sudden realization in the leadership ranks that the partnership has taken away degrees of freedom to act. This can be exacerbated by historical organizational opposition as noted above.

When this happens you can have key internal stakeholders, who hadn’t really paid attention to the creation of the partnership and don’t have any ‘ownership’ in it, start to question both the partnership itself and the general principle of multi-sector CSR partnerships.

Keeping everyone pulling in the same direction takes ongoing effort. Just because everyone pulls together at the start doesn't meant that they will keep pulling in the same direction.

Many things can happen to change aligned interests to opposing forces

4. Only business is efficient mentality

Historically there has been a strong theme in many business sectors that business is inherently more efficient. The theme maintains that because it more directly subjected to the demands of the marketplace, business is somehow more efficient than NGOs and governments.

Dig deep enough and you will find that perspective exists somewhere in most businesses and sometimes can permeate individual businesses and even large swaths of industry sectors.

This mentality can surface when problems arise and present barriers that prevent the challenges from being worked through objectively or prevent constructive solutions from emerging.

Too often you will see much effort being put into finding confirming evidence of inefficiency, rather than a balanced analysis looking for examples of efficiency and inefficiency and their underlying causes.

This can create a dangerous spiral that can undermine even the best partnerships.

5. Business is too greedy mentality

The NGO equivalent of the Only business is efficient mentality is the Business is too greedy perspective.

NGO partners that fall into this perspective are prone to examining business decisions only from this vantage point and not taking a more balance and objective approach to understand the ‘why’ of business decisions.

Confirming evidence is sought and focused on and more and more partnership and operational decisions of the business are seen as being based, at least partly on greed

There is another discussion on the relationship between greed and shareholder interest, which are often quite different. Greed based decisions tend to be short-term and with narrowly defined interests. Longer-term strategic shareholder interests are broader and provide much more scope for interest alignment.

As with the only business is efficient mentality the business is greedy perspective can create a partnership killing spiral of unbalanced confirming evidence.



Strategy and insight can turn opposing forces into aligned interests

6. Not enough entrepreneurship and innovation

There is generally a high level of entrepreneurial energy and innovation amongst the partners at the beginning of a partnership. In many cases they would not have gotten together to launch the partnership without the innovation and entrepreneurship of at least one of them.

As time goes by the partnership activities can become routine and the workers and leaders stop looking for ways to do things better and/or new areas that they might collaborate on that would be mutually beneficial.

Over time a stagnation can develop and energy drains from the partnership. This can end up killing the partnership itself but more often it simply makes the partnership much more vulnerable to the impacts of other mistakes.



Diverse and committed partners collaborating and innovating together can solve complex puzzles

7. Didn’t get to know each other deep enough and broad enough

Often partnerships will form quickly around a specific opportunity. Partners will see that by collaborating they can advance their interests and objectives further than they could by working individually.

This can create a euphoria that tends to generate a forward momentum and the partners don’t take time to get to know each other well enough or deep enough. This happens at the individual and the organizational level.

Then when issues arise and differences emerge they are often seen as surprises and somehow a betrayal of what was represented at the onset. This can put a lot of strain on the relationships.

8. Organizational stakeholders didn’t support it

Every organization has a range of internal and external stakeholders, many of which have significant influence and impact. Sometimes a partnership will develop and create conflict with key stakeholders.

For example, many NGOs rely on individual and organizational donors for financing and for general support. In some cases the same individuals and organizations are also writing checks to support advocacy NGOs that are in direct opposition to either the industry sector, or in some cases the actual partner (this can often happen where an industry partner has multiple projects, some of which are actively opposed by advocacy organizations)

This places leadership in uncomfortable positions and may result in the need to make hard choices if agreeing to disagree isn’t a viable option.

Similar situations can occur when development agencies begin to develop mechanisms that either enable direct funding of industry led CSR projects or that will facilitate or partner with such projects.

These development agencies often have key stakeholders that may be generally opposed to certain industries like extractives, or have unrealistic social performance expectations. In many cases the development agency will also be providing direct or indirect support to the opposing organization.



Internal support and understanding is critical if an organization wants to be a strong partner

(If you are interested see Seven proven strategies for getting colleagues onboard with CSR http://bit.ly/7internalbestpractices)

9. NGOs look at the company as just a set of deep-pockets

A deep and nuanced understanding of the other partners is so critical. Too often as the euphoria of the early days wears off deep seated, underlying assumptions and perspectives emerge that can be poisonous.

Partners (individuals and the institutions) forget that all partners are in the project because there is something in it for them.

NGOs can start to perceive corporate partners as just a set of deep pockets, of money that should just be allocated in support of community and NGO priorities, without a thought for what’s in it for the company and how to optimize value across all partners and stakeholders.

10. Company looks at NGO as just a do-gooder

In the same was as NGOs can see companies as just deep pockets, companies can often develop a perspective that NGO partners are only interested in doing good works and not understand the many other interests and realities of a modern NGO

11. Project solitudes.

No real collaboration between partners. If not nurtured project partners can end up withdrawing, or being relegated to project silos. This can result in each contributing individually, but can lose all of the potential synergy from the diversity of experience, perspectives and insights that each bring.

When this happens it can suck the energy out of a project and be the start of a downward spiral.

It may seem easier to carve things into discreet silos and minimize collaborative interactions, and the disagreements, stresses and tensions that can come with them. In the long run it is far better to work together and get stronger by working through the differences, and staying open to the synergy that can be found in diversity.

As the African proverb says.

If you want to go fast, go alone. If you want to go far, go together.

Good partnerships go far.

12. Unrealistic cost expectations

Cost expectations can be unrealistic. Companies will sometimes think that NGOs will almost work for free, forgetting that they too have organizational and institutional overhead that needs to be covered.

NGOs will sometimes think that companies have tons of money and shouldn’t be concerned about cost.

13. Different standards around quality, flexibility / adaptability and reporting

This can be especially true when small, nimble companies partner with development agencies that have seemingly incomprehensible sets of reporting and operational requirements.

This can be especially true in partnerships where one partner comes with compliance requirements and obligations that are foreign to the other.



Multi-sector CSR partners can bring unique pieces of the puzzle to the table. They can create value and mitigate risk for all partners, and benefit society in the process.

Often they can be difficult to create and even more difficult to maintain, but the effort can be worth it.

11 strategies to maximize value from CSR

By Prof. Wayne Dunn

Value is the theme that should unite all CSR projects and should be a key factor in major project decisions and strategies.

Value for shareholders, value for local communities, value for stakeholders; these are the considerations that should underpin program and budget decisions and actions.

If value is not central, what is?

What can make a CSR project sustainable if value is not present?

Yet, too often the issue of CSR and value is looked at only peripherally, if at all. It is almost as if somehow value is crass and CSR should be ‘above or beyond’ value considerations.

Hogwash! Balderdash! Why else would industry, communities, development partners and others engage in and with CSR if not for creating, preserving or maintaining value?

CSR is truly a self-interested activity and has a much better chance of success when the value interests of industry and stakeholders can be aligned and maximized.

Over the last couple of decades of working on and analyzing CSR projects and activities across many industries and on all continents I’ve noticed some strategies for maximizing value from CSR.

These have worked quite consistently across industries, sectors and geographies.

That doesn’t mean that they all work, or even that they all apply all of the time. But, if you are looking to maximize the value created through CSR this is a good list to review. You may find some gems.

This list of eleven strategies for maximizing value from CSR is applicable to all partners and stakeholders in CSR.

1. Strategic partnerships

CSR is tough and expensive to do alone. Strategic partnerships can bring incremental resources (financial and other), execution synergies, and an expanded network and enhanced sustainability to CSR initiatives.

But, be careful, partnerships take work and planning and can go off the rails if not developed and managed properly.

For more on this see Multi-sector CSR Partnerships: Natural Partnerships – Unnatural Partners (http://bit.ly/13pGNhI).

Two steps are critical to developing partnerships that add value.

The first is to ensure that there is a meaningful alignment of interests; that all parties can share at least some common objectives and approaches.

The second is to get to know your partners well – see 13 mistakes that prevent and destroy multi-sector partnerships (http://bit.ly/1znszsj)



Partnerships can make your project smarter and stronger. But, only if planned and executed well

2. Communications

CSR should seldom be a stealth operation. Neither should it be the focus of a ‘shout from the rooftop’ type of indiscriminate communication strategy.

Communicating the right messages to the right audiences at the right times and doing so in a way that they can hear and absorb the message can add a lot of value to most CSR projects. Doing it wrong, or badly can destroy a lot of value.

Key audiences to keep in mind include partners, stakeholders, influencers and (often missed, or misunderstood) internal stakeholders.

For more detail on CSR communications see: CSR Communications: Eleven mistakes to avoid (http://bit.ly/1qQMM9t)

For an example of when it made sense to run a CSR project in stealth mode see From Pariah to Exemplar: Applying the six best practices (http://bit.ly/CSRAnalysis)

3. Internal synergies

Often you need to look no further than the next desk to find strategic opportunities to add value.

Engaging your internal colleagues can unlock value for shareholders and stakeholders and often enhance the long-term sustainability of CSR projects.

Some of the most efficient and effective ways to create community and stakeholder value may be through integrating corporate CSR objectives across corporate operations.

Local procurement, local hiring, enhanced training for locally engaged staff, employee volunteerism and other strategies and tactics can create value for shareholders, communities and other stakeholders.

In addition to the obvious synergies for companies, there is often an enhanced camaraderie amongst staff as a result of this sort of internal collaboration – and this can translate into value on other dimensions.

For more on developing internal synergies see Engaging Internal Stakeholders: Seven proven strategies for success (http://bit.ly/1BOFGWF)

4. Fresh-eyes review

Familiarity creates blindness, or at least vision problems!

Sometimes, quite often actually, a fresh set of experienced eyes can see opportunities (and challenges) that are easy to miss if you have been involved in a project day after day after day.

Experienced fresh eyes take less for granted, ask dumber questions. Sometimes the dumbest questions can unearth the most amazing insights.

Don’t hesitate to bring someone in who knows nothing about your project (but a lot about CSR and value) and have them take a look at where new or enhanced value may be found.

There are frequently gems hidden in plain site that only a fresh set of eyes can see.



Fresh eyes can often spot value gems that are hidden in plain site

5. Forget do-gooderism

If you are doing CSR because you want to save the world, or even just to save the adjoining village, do everyone a favour and resign.

Seriously, CSR is not about do-gooderism. It is about hard-headed value creation, value optimization, risk management and other core business needs.

If done well CSR can and does do a lot of good work and value creation for communities, stakeholders and society at large (and for shareholders too!).

But, always remember, that if you set out on a CSR journey with a plan to only do good works you are likely to stumble and fail and do damage rather than do good.

And that is not a strategy that will produce much value for society, for shareholders or for you.

For a deeper exploration of this see Don’t be an Altruistic Angel: Be transparent about what’s in it for you (http://bit.ly/16nR3rH)

6. Metrics and measurement

You can’t measure temperature with a speedometer!

The key to using metrics and measurement to unlock value is having project-appropriate metrics and measurement.

The metrics and measurement should drive from the ‘why’ and the ‘how’ of the project itself and not from some preconceived corporate or external framework.

We’ve all heard that you can’t manage what you can’t measure. In CSR there is another every bit as true.

You can’t measure what you can’t measure!



Metrics need to fit the project and be as simple as possible. If they don’t they cost money, cause frustration and accomplish little

Metrics and measurement are important for sure but sometimes corporate reporting frameworks, or directives to adhere to this or that global norm, standard or protocol, end up with the CSR frontline teams trying to measure the wrong things in the wrong ways.

Every CSR project should rigorously and systematically measure progress and key indicators and have appropriate frameworks for recording and analyzing the data.

At the beginning of every project, or right now for those that started without this, there should be a thorough analysis of the ‘why’ and the ‘how’.

Why is the company investing time and money into this particular project and not another? And ‘how’ can it track progress towards the ‘why’.

This should give you the insights to help identify what metrics you need to track and measure.

The answers will generally be specific to each project so it stands to reason that the metrics that are tracked and managed would be unique as well.

Once you have settled on metrics you need to set up a systematic process for gathering them on a regular basis.

You also need to regularly review the metrics themselves. It is not uncommon that a few months into a project it becomes evident that some new metrics need to be tracked and/or that some of the existing ones aren’t helpful to track.

What is key is to find the metrics and the data collection and analysis protocols that allow the project to efficiently track progress and use that information to constantly improve project management and implementation.

This isn’t to say that all corporate CSR frameworks should be ignored or abandoned, or that compliance with global norms and protocols is unimportant. Far from it.

It is to say that project specific metrics that help you do a better job of managing and implementing a particular project are as important. Sometimes even more important.

Good corporate frameworks should have the flexibility to accommodate and support project specific metrics and management.



Get the metrics right and new value can emerge

Compliance with global norms, protocols and standards should be considered carefully and where/if they create too much added burden on CSR project management maybe they need to be reconsidered.

7. Strategic focus

How strategic and how sharp is your strategic focus?

Some CSR programs end up looking like they are trying to be everything to everybody.

Most of these end up accomplishing very little except burning through budget and goodwill; both internal and external goodwill.

See the next point for what to focus on…



Lose focus and lose value. Stay focused and create value.

8. Systematically review CSR programs and their connection to value



Like most things in business and in life, CSR programs can get off track and out of focus. They can drift this way or that, or the reasons they started may no longer exist.

Periodic reviews should be carried out on all CSR programs. They don’t have to be complex but should answer some basic questions.

Why did this program start? What was the original value proposition?
Is the original need still valid?
Is it still as important as it was?
Is the program meeting that need effectively?
Does meeting that need produce value for society AND shareholders?
If the program were just being launched now, is there anything that you would organize or do differently?
Are you engaged with the right partners? Are there new ones? Are the old ones still the right partners?
For more information on reviewing CSR programs see Smarter CSR Budgets: Eight steps to connect budget to value (http://bit.ly/1BOG083)

9. Interest alignment analysis

This is all about lining up what’s in it for you with what’s in it for them.

The essence of CSR is about aligning shareholder and societal interests in a way that produces value for both.

An interest alignment analysis examines CSR programs to ensure that value is produced for both society and shareholders.

It also explores opportunities for additional value and alignment, which can help to identify and develop strategic partnership opportunities.

The essence of this process is discussed in Creating a CSR Program: in eight self-serving steps (http://bit.ly/1suoOC1)



Aligning interests more effectively increases value for shareholders and society

10. Use consistent frameworks to understand value

Don’t expect value to emerge spontaneously, even if you are doing good work.

Meandering through CSR projects waiting for value to show up may produce some results. But, not many and not consistently. And you should be fired for doing it!

Value happens when you plan for it and work for it.

It helps to have a framework, or frameworks that help you to better understand value and how to optimize it so you are maximizing value for shareholders and stakeholders.

I often use a series of related frameworks based on a CSR Value Continuum. You may have others that work as well or better.

What is important is to find a way that allows you to quickly and consistently analyze and understand the value dimensions of your CSR projects.

There is some discussion on the CSR Value Continuum and Shared Value in this CSR Thoughtpiece if you are interested. CSR Value Continuum: A unique perspective on Shared Value (http://bit.ly/16nQYEA)



The CSR Continuum is part of a series of frameworks that I've found to be quite helpful. There are others. Find one or more that work for you.

11. Understand the value sustainability

How long does the value last? Is it like OpEx or CapEx?

CSR programs and investments produce value (or they should!). You can often find ways to generate and capture more value if you look at it in terms of time.

Does the value that your program produces last beyond the current period? Will it continue to produce value over time?

It can help to think of it in terms of Operating expenses vs Capital expenses. One produces value that is basically used up in the current period and the other produces value that lasts beyond the current period.

Don’t make the mistake of thinking that CapEx type of CSR programs are necessarily better. They aren’t.

What is important is to understand what type of CSR investment you are making and use that knowledge along with other insights and analysis as you seek to maximize value for shareholders and stakeholders



CSR investments can be broken into OpEx and CapEx types of investments

--------------------

These eleven strategies for maximizing value from CSR have been developed over a lot of projects and with insights and support from a lot of colleagues and mentors. If you find them helpful use them and share them.

If you don’t find them helpful I’m interested in your thoughts as to how they could be more useful. Remember, we all learn from and with each other.

Moving from Rhetoric into Action: Effectiveness of State-Civil Society Synergy for Healthcare Delivery in Rural Ghana

Abstract
The issue of extending healthcare to marginalized underserved rural population remains a cardinal rhetoric policy of the Ghana Government. Meanwhile we note a growing inequity in terms of access and utilization of quality and affordable healthcare between urban and rural areas of the country. The Government of Ghana through its various policy initiatives in 2002 collaborated with civil societies with the aim of bringing healthcare to the doorsteps of rural folks in the country. Using a mixed method approach through a semi structured interviews and questionnaire administration, and focusing on the Community-based Health Planning and Servicesn(CHPS) programme in Nsanfo community in the Mfanstiman Municipal Area, this study  assesses the effectiveness and challenges confronting state-civil society partnership in co-producing a public good (healthcare). We found that synergy between the state (Mfanstiman Municipal Health Directorate) and the civil society (community health volunteers) has yielded positive results in bringing healthcare to the door steps as well as improving the health conditions of the local people in the study area. Nonetheless, certain challenges such as lack of volunteer motivation, deplorable state of the CHPS compound and logistics threaten the very existence of this collaboration. Our study has far reaching implications for healthcare planning in Ghana.





Key words: State, Civil society, Healthcare, Synergy, Rural, CHPS, Ghana



Authors: Francis Jagri (B.A, MSc) and Thomas Yeboah (BA, MSc.)



Introduction

Over the last few years, debate about the relationship between the state and civil society in achieving the developmental agenda of countries has been a very interesting topic among development practitioners and policy makers (Nair, 2011). This is especially so in the case of developing countries where the challenge of providing quality and affordable healthcare to the citizenry especially those who live in rural areas persists (Berwick, 2004). The state has been the lead agent of development in most of these countries (Nair, 2011; Massoud et al., 2012). One plausible explanation for the dominant role of the state in the development agenda has been that, since the state collects taxes from citizens, it is argued that- it should solely be responsible for delivering public goods and services (Ostrom, 1996).

In this regard, civil society participation in the development agenda of such countries has largely been insignificant. This conventional practice constructs state-civil society relationships on patron-client basis in which the patron (i.e. state) is expected to deliver public goods and services to its clients (i.e. civil society) from whom it collects taxes. In this construct, civil society assumes a passive and “backstage” role in national development instead of playing an active role (Nair, 2011). In some extreme instances, such relationship is even characterized by conflict and distrust as this situation positions the state and civil society as mutually exclusive entities with competing goals instead of being partners in development (Unnithan and Heitmeyer, 2012; Ostrom, 1996).

In reality, however, evidence abounds to show that the state in many countries has not been able to solely deliver the developmental needs of its increasing population (Unnithan and Heitmeyer, 2012; Evans, 1996). This has given rise to further debate among policy makers with the aim of finding more sustainable means of promoting human development. In that regard, the realm of civil society has been identified as one missing link necessary to partner the state in driving general socio-economic development (Banks and Hulme, 2012; Baru and Nundy, 2008; Ostrom, 1996; Evans, 1996). This new discussion is what has triggered the emerging phenomenon of state-civil society synergy in development discourse. The concept is now largely touted as necessary for broadening the developmental framework of nations because synergy fosters complementarities and collective actions that can lead to sustainable developmental ends (Unnithan and  Heitmeyer, 2012; Banks and Hulme,  2012, Bruce, 1996).
 Contemporary development practitioners thus contend that both the state and civil society have unique qualities that are potentially complementary and compensates each other’s limitations towards achieving significant developmental goals (Baru and Nundy, 2008). As Evans aptly puts it, “state-civil society synergy can be a catalyst for development” and that “the combination of strong public institutions and organized communities is a powerful tool for development” (Evans, 1996:130).

This interesting debate among others motivated the researchers to study an example of state-civil society synergy in co-producing a public good which is rural healthcare in this case. The overall objective of the study was to find out how state-civil society partnership could be adopted as a strategy for bringing healthcare services to the doorsteps of marginalized rural dwellers in Ghana. The paper also looks more closely into the issues that threaten state-civil society partnership in co-producing a public good (healthcare). Our aim was to identify possibilities for state-civil society synergy as well as constraints to such synergetic relationship using the Community-based Health Planning and Services, hereafter (CHPS). This is collaboration between the state and civil society in providing healthcare for excluded rural people in Ghana. We demonstrate that partnership between the state (Mfantseman Municipal Health Directorate) and civil society (healthcare volunteers) has been beneficial in bringing healthcare to the door steps of previously marginalised groups in the Nsanfo community who hitherto did not have access to prompt healthcare. This notwithstanding key challenges such as lack of motivation and dwindling commitment of volunteers, deplorable state of the CHPS compound and logistics among others threatens this synergy and therefore warrants urgent attention from all stakeholders. Although this study did not seek to provide generalizations of the impact of state-civil society synergy in providing healthcare, the findings have far reaching implications for rural healthcare planning and community development.
The paper is structured as follows: The next section provides a brief theoretical framework underpinning the study. A review on the manifestation of state-civil synergy in developing countries is outlined. We then provide an overview of the CHPS in Ghana. This is followed by the methodology employed in the study. Section five presents the results of the study. The penultimate section discusses the results in the light of existing literature. The last section concludes by offering some policy suggestions.



Theoretical Framework
An important theory identified in the narratives regarding state-civil society partnerships in co-producing a public good is the role of social capital in nurturing effective synergies between state institutions and civil society. Indeed it is believed that social capital is one of the crucial elements necessary for synergic relationships to emerge in the first place and or to be sustained. According to Brown and Ashman (1996), cultivating and enhancing social capital in the forms of local organizations and networks is an essential task in building state-civil society partnerships that taps local resources and energies for addressing developmental challenges such as healthcare. This social capital of a community has been defined in terms of those societal networks that are grounded in structures of voluntary association such as family relations, norms of reciprocity and cooperation, attitudes of social trust as well as respect shared by the state and members in a community (Putnam, 1996).
In a number of different synergy case studies conducted by authors such as Ostrom (1996) and Evans (1996), they all theorize in their conclusions that high social capital endowments in a community had been found to be associated with cooperative social problem solving whiles low social capital endowment affects the sustainability and effectiveness of any state-civil society collaborations for problem solving. This study therefore adopted the concept of social capital as an underlining theoretical framework.

Healthcare delivery in developing countries: A manifestation of state-civil society synergy in practice
Access to quality and affordable healthcare remains a major challenge in most developing economies especially in sub-Saharan Africa (SSA) (Massoud et al., 2012). As a result of established correlations that exist between health, productivity and equitable development, healthcare improvements have become a key agendum of developing countries (United Nations, 2000; Sachs, 2005). The state in most countries especially in SSA has predominantly been the provider of healthcare services but this has been confronted with several challenges. According to the World Health Organization (2012), issues such as economic mismanagement, geopolitical constraints, transportation, limited healthcare workforce and infrastructural challenges affect the attainment of sustainable healthcare in many developing countries. In spite of the billions of dollars of aid dispensed over the years, an astonishing 50 percent of SSA total health expenditure is financed by out-of-pocket payments from its largely impoverished population. In addition, most SSA countries lack trained personnel, facilities and infrastructure necessary to provide and deliver even minimal levels of health services (World Health Organization, 2012).
This rather uncomplimentary description of healthcare delivery in sub-Saharan Africa is not surprising. Given the complex and interconnected nature of the healthcare sector, it is practically impossible for states in such economies to possess all the resources, information and competence necessary to effectively deliver quality healthcare without assistance from other sectors of the society (Centre for Global Development, 2009). In this regard, civil society especially private sector actors have intervened to compliment the efforts of governments in the provision of public goods. According to the Centre for Global Development (2009), more than one-half of all healthcare services to the poorest people in developing economies are provided by civil societies including private doctors, volunteer workers, drug sellers, and other non-state actors.
In supporting the increasing importance of the civil society in healthcare delivery, Burger et al. (2012:1) also argue that “it is unlikely that any pragmatic solution to increase healthcare access can be achieved without active participation of both the private and public healthcare sector”. In such collaborations, civil society organizations act as either direct providers of healthcare services in partnership with the state, contracted by the state, or they totally take over in areas where the state has ceased to operate (Unnithan and Heitmeyer, 2012). The former typology manifest in the CHPS programme as it is based on collaboration between the state i.e. Ghana Health Service, and civil society in the form of community health volunteers. State-civil society relationship in healthcare provision could also manifest by way of the state giving preferential incentives to private sector health providers in forms such as subsidies for their cost of operations, special tax exemptions and even direct funding (Brinkerhoff, 1999).  Civil society organization’s engagement in the health sector of countries thus introduces new institutional, social, financial and other complementary resources to the healthcare systems.

One important advantage of civil society involvement in healthcare delivery is that, they most often possess the ability to reach usually marginalized and poorly served remote communities (Unnithan and Heitmeyer, 2012). The Centre for Global Development (2009) argues that civil society, especially the private health sector, often present significant opportunities to improve access to and coverage of services critically needed to achieve the internationally acclaimed health-related Millennium Development Goals. These reasons and more therefore make valid cases for the state to collaborate with civil society to fill in the gaps where the state is lacking.
The Community-Based Health Planning Services (CHPS) in Ghana: An Overview
The introduction of the CHPS is in line with the national healthcare agenda of posting health nurses to every corner of Ghana with the ultimate aim of bringing healthcare to the doorstep of every citizen (Ghana Health Service, 2002). The implementation of the programme had become necessary when it became evident that more than some 70% of the Ghanaian population still lived over 8 km from the nearest healthcare centre after years of experimenting with various “health for all” strategies. This slow progress thus necessitated the need to bring healthcare service closer to the rural dwellers (Ghana Ministry of Health, 1998). The CHPS programme was devised as the most appropriate solution after thorough pilot experimentation in Navrongo in the Upper East region of Ghana focusing on the mobilization of “volunteerism, resources and cultural institutions for supporting community-based primary health care” (Nyonator et al, 2005:25).

The prime motivation for the Navrongo experiment was based on the conviction of stakeholders that social resources such as community organization and pre-existing social networks had been underutilized and thus could be tapped to make volunteering services in healthcare provision more effective and sustainable. This pre-existing social network is what Ostrom (1996) and Evans (1996) refer to as social capital, i.e. the single most crucial resource needed for effective state-civil society synergy. The Navrongo experiment and subsequent nationwide implementation of the CHPS programme was therefore seen as finding a sustainable solution to healthcare deficits throughout the country (Binka et al., 1995 as cited in Nyonator et al., 2005).

A key component of CHPS is that, it is a community-based and volunteer-led service delivery point. In practice, it is run by a community health nurse from the Ghana Health Service and community health volunteers who participate in the provision of primary and family planning services through outreach programmes led by the health volunteers. A typical CHPS compound serves as community of not more than 3,000 residents and focus on such health services as family planning, treatment of minor ailments, supervising child delivery, antenatal/postnatal care, immunization and health education (Nyonator et al., 2005). Figure 1 depicts how the CHPS compounds have increased across the country since its conception in 2002. As at 2011, about 1675 CHPS compounds had been constructed across rural communities in the country.



Figure 1: Number of CHPS compound from 2002 to 2011

Source: Ghana Health Service, 2011
Establishing a CHPS programme like the one in Nsanfo requires six (6) processes. These procedures are based on lessons from the Navrongo experiment.  In chronological order, Table 1 depicts these six procedures.
Table 1: Procedures for establishing CHPS compound
IMPLEMENTING ACTIVITY TASK REQUIRED IN ESTABLISHIG A NEW CHPS IN A COMMUNITY
Planning Community awareness building, outreach to traditional leadership
Community entry Community mobilization and participation, involvement of traditional leadership through durbars and cultural diplomacy
Community health compound Community labour ad resource mobilization for construction of health compound to instill community ownership of primary service point.
Community health officer appointment Mobilize providers to visit households’ community and mass education on CHPS operations.
Procurement of essential equipment Procurement of logistics such as bicycles, motorbikes, health kits, motorbike riding training and maintenance capacity building.
Recruitment and deployment of volunteers Selection of health volunteers by the community health committee in conjunction of traditional leaders. Training of volunteers in basic healthcare provision, family planning and the administration of first aid.
Source: (Ghana Health Service, 2002).
This study specifically takes notice of the third (3rd) and sixth (6th) milestone which involves the use of volunteer labour and community resources to construct the community health compounds and the recruitment and training of community health volunteers respectively.

Data and Research Methods
The research reported in this paper adopted case study/mixed methods design which combined qualitative and quantitative methods but with more focus more on the qualitative method. The adaptation of this mixed method is aptly supported by Yin (2003) when he argues that it is necessary to use both qualitative and quantitative methods in a case study because it enhances and strengthen research findings. Caruth (2013) also argue that, the mixed methods offers richer insights into a case being examined and enables the capturing of some relevant information that might be missed by relying on only one research method. In this regard, qualitative methods such as the semi-structured interviews and a review of secondary documents including official Government reports, articles and books were employed in data collection, complemented by quantitative methods by way of household survey based on a questionnaire.
Official data on the total population of the study community-Nsanfo is not available.  So it was difficult to decide for a representative sample who will respond to the questionnaire before the data collection started. In this way, in selecting participants for the study, our approach was meant to interview as many people as possible until data collected from the participant(s) reached saturation point i.e. when no more insight from the participants will be useful. This was achieved when the 103rd person was interviewed. This approach provided equal space for each member of the community to be interviewed. We recognise the possibility of sampling bias especially in terms of age, gender, occupation etc although this did not affect the conclusions reached. Moreover since the data was more qualitative, sampling representation was not much of a focus as the intention was to understand views and perceptions regarding the effectiveness and threats to state-civil society synergy in providing rural healthcare. Interestingly, there was a 100% response rate to the questionnaires as households were eager to participate in the exercise.
The relevant key informant that were selected for a semi-structured interview using the purposive sampling technique included the Director of the Mfantseman, Municipal Health Directorate (MHD), the Mfantseman Coordinator of CHPS, the Health Nurse at the Nsanfo community CHPS compound and 5 out of the 8 Nsanfo CHPS community health volunteers(civil society group). The choice of the semi-structured interview technique was because it was flexible and gave the interviewees a great deal of free hand in how to reply to our interview schedule (Bryman, 2008). More importantly, the semi structured interview provided us the space to single out and probe further on some key issues raised by the interviewees which were crucial to the study. Data collected covered respondents’ level of access and utilization of healthcare before and after the implementation of the CHPS as well as benefits and challenges of associated with the programme.
The information gathered from these set of interviews were transcribed and triangulated to identify concurring and deviating themes and what they meant for the phenomenon under study. The quantitative data obtained has been analyzed using descriptive statistics such as percentages and frequencies with the aid of the Statistical Package for Service Solution (SPSS) while direct quotations and thematic analysis were used in reporting the qualitative data. It is important to state that, this study did not seek to make generalizations about its findings, but rather to investigate the specific local context of the impact and challenges of the CHPS programme in the Nsanfo community. However the findings reported herein has far reaching implications for general socio-economic development, particularly healthcare planning. The next section presents our results from the field work.
Moving from Rhetoric into Action: Analyses of the effectiveness of the CHPS in rural healthcare
Respondents were asked to provide the nature of healthcare delivery before and after the implementation of the CHPS programme, the effectiveness of the CHPS in improving community health and the various pathways through which the programme has improved their health conditions. Table 2 submits respondents’ perspectives on the main source of health treatment for ailment before the introduction of the CHPS in the local community.



Table 2: Main sources  for treatment prior to establishment of CHC
Source of healthcare before the CHPS Frequency Percentage
Mfantsiman hospital 4 3.9
Clinic in nearby village 96 93.2
Self medication 3 2.9
Total 103 100
Source: Field work, 2014

Generally, discussions with the local people suggest that, prior to the establishment of the CHPS compound, the health conditions of people was not something one could be proud of. Frequent injuries without treatment, occurrence of communicable and non-communicable diseases, maternal deaths, poor child health and insanitary living conditions are among some the health challenges that the local people were confronted with. Results in Table 2 reveal that majority of the people (96) 93.3% resorted to a clinic in another village (Anomabo) which is about 15km away from Nsanfo in their effort to treat ailment. This coalesces with information obtained from the Municipal Health Directorate as seen below:
“Almost all of the people of Nsanfo before the programme had to travel long distance to another community especially Anomabo to access healthcare. In instances where there were emergency cases, there was always a high likelihood of death especially maternal mortality. Most of the pregnant women died on their way to hospitals to deliver when there were emergencies. This was so as a result of the bad roads, you yourself am sure you have seen the nature of our roads as you travel to the community every day. The CHPS compound has drastically changed this situation”.

The above statement begin to capture the decision of the Ghana Health service to partner with volunteers in providing rural healthcare which is justified by the issue of accessibility, i.e. long distance covered before accessing health facility. To compound the problem of long distance from Nsanfo to Anomabo, the poor nature of the road linking the two communities further affected the capacity of the people in attending the clinic in Anomabo with some resorting to traditional medicine. The situation became more precarious when emergency health issues came up such as transporting women who were in labour.
 Another factor that affected the capacity to seek proper healthcare before the CHPS in the adjoining village was the obvious high poverty levels. Majority of the inhabitants of Nsanfo are essentially peasant farmers who cultivate purposely for subsistence. In instances where they are able to sell some of their farm produce to raise some money, the accrued funds is usually spent on buying some items for the home which is barely enough for them to afford proper healthcare services in the Anomabo clinic. Overall, the state of healthcare delivery prior to the establishment of the CHPS was generally poor as the local people could not easily access health services as and when needed. Thus the establishment of the CHPS has not only been beneficial in the treatment of ailment, but has also reduced transportation cost of getting to the next village to access health service.
   Table 3: Use of CHPS facility
Use of CHPS facility Frequency Percentage
Use 99 96
Non-Use 4 4
Total 103 100
Source: Field work, 2014
Table 3 displays the views of the respondents regarding the use of the CHPS in the study area which indicate a high level of use of the facility. As seen majority (99) of the respondents representing 96% indicated to be among those who use the CHPS compound when there is the need to seek for treatment of an ailment while only 4% affirmed otherwise. Even the 4% who indicated otherwise suggested that the only reason they had not used it yet was the fact that, since the establishment of the clinic, they have not fallen ill up till now.  However in the event that they needed healthcare services for treatment of an ailment, they will of course utilize the services provided at the CHPS compound.
Among those who used the health service, it was discovered that pregnant women represented a high proportion. The reason is that about 50% and 22% of those who use the health facility indicated that pre-natal and post-natal care is the major reason why they visit the health facility respectively. This revelation implies that, the CHPS programme if properly resourced can go a long way in helping to reduce cases of maternal and infant mortality rates in the village and Ghana at large. This can help achieve the 4th and 5th goals of the MDG and the national healthcare aspiration of zero maternal and infant mortality. The high level of patronage of the CHPS on the part of the respondents is consistent with information that was gathered from the Municipal Health Directorate.  In an interview, the Municipal Health Director stressed:
“The community uses the CHPS facility for its purpose. There is high attendance rate.”
On the same issue of utilisation of the facility, the Municipal CHPS Coordinator also had this to say:  “I will rate the patronage rate as 80-90%.”
Result on the perceptions of the people regarding the effectiveness of the CHPS in improving healthcare delivery shows that the programme has been beneficial to the local people in terms of their health needs. All the respondents (103) indicated that the CHPS programme has been effective in improving the health needs of the Nsanfo community and even surrounding villages. It has radically aided the local people to have prompt access to healthcare service; thus, bringing affordable healthcare to their doorsteps. In an interview, the community health nurse professed:

“ As for this CHPS compound in Nsanfo, I can say it came at the right time because it serves all the surrounding villages such as Akraman, Fomena,Gyakuma, Nsaadze, Obontsir and Eshirow which have an estimated population of 4,075 and hitherto had to travel long distances to Anomabo for healthcare. All the nursing mothers and pregnant women from these villages all come to this CHPS compound for post-natal and ante-natal services”.

This statement from the community health nurse suggests that surrounding communities in Nsanfo all seek healthcare from the CHPS compound in the Nsanfo village. However specialised cases such as problem of the eye, kidney, ear and especially complicated delivery are not catered for by the community health officials under the CHPS programme. Thus, cases beyond the control of the officials are transferred to larger hospitals in the municipal capital. This is a major principle underlying the CHPS programme. The inference that can be made is that, had respondents been asked to evaluate the ability of the CHPS centre in terms of treating all of these special cases, there is the high likelihood of generating contrary results. Nonetheless the CHPS programme in Nsanfo has been beneficial in responding to basic healthcare needs. Its relevance should therefore be evaluated against this background.
Interviews with respondents further indicate that, cases of maternal and child death, malaria and diarrhoea have also decreased due to the operations of the programme as volunteers constantly visit households and educate them on good sanitary practices. Table 4 depicts the services provided by the CHPS compound in Nsanfo. It contains official health statistics obtained from the Mfantseman Municipal Health Information Officer as part of data collection. The statistics presented reveals the important role that the CHPS programme is playing in the Nsanfo village.




Table 4: Services provided by the CHPS compound
Services 2013 2012 2011 2010 2009
Family planning (new registrants ) 97 36   _    _   _
Child welfare services( no. Of children attended to)   2,211 1431 1432 1084 1014
Immunisation for children between 0 to 11 months 2452 1192 760 962 1104
Integrated management of childhood illness (no. of cases reported by volunteers) 91 104 31 22 16
School health services by community health officials (no of children examined for health complications) 2449 2111 179 256 304
Vaccination (no. Of people vaccinated)   26 1268 760 659 1104
Out Patients Department 849 752 _ _ _
Source: Nfanstiman Municipal Health Directorate, Information Office, January 2014
 As can be seen, the numbers represent the annual record of beneficiaries that patronised the various services offered under the Nsanfo CHPS programme. Prior to the introduction of the CHPS compound, all these services as presented in the earlier discussions were received from the Anomabo clinic which is about 15km away from the Nsanfo community. The bad nature of the road and high cost of transportation further discouraged the inhabitants from travelling to seek medical attention even when the need arose. Thanks to this CHPS compound, the residents are now relatively enjoying the above illustrated services ranging from immunisation of their children to child welfare services, family planning and vaccination within their backyard.
It is important to state that the Integrated Management of Childhood Illness also known as IMCI is volunteer-run. Indeed, the volunteers who form a crucial part of the CHPS programme are given some intensive training in early childhood illness detection courses in order for them to be able to detect such diseases when they visit homes in the performance of their duties.  In effect, it can be said that these services rendered by the Nsanfo CHPS compound has cumulatively improved the quality of healthcare of the people of Nsanfo through prompt access and reduction in the distance covered in order to seek for health treatment. Indeed, healthcare is now delivered at the doorsteps of the Nsanfo people as envisaged by the Ghana Health Service.

Challenges associated with state-civil society partnership in healthcare provision
Inspite of the benefits discussed in the foregoing section, the programme is beset with key challenges which hinder its smooth progress. These cover issues relating to the volunteers, logistics, finance and the deplorable state of the CHPS compound..

Lack of motivation and fatigue of Volunteers
One major factor which poses as a threat relates to volunteer-fatigue. Interviews with the Community Health Officer, the district CHPS programme Coordinator and the Municipal Health Director all show that the commitment of the volunteers is waning down. The volunteers play a crucial role in the smooth operation of the CHPS programme hence a loss of interest in the volunteering cannot be underestimated as it poses grave danger to the whole existence of the CHPS programme. The reason for this apathy on the part of the volunteers could be summed up in the words of the Municipal Health Director:
“.....The commitment of the volunteers is dwindling. They sometimes demand monthly allowance for the work they are doing but that would defeat the whole purpose of the CHPS programme. Even if we were to give them some allowance for their work, such monies must come from the community because the CHPS compound and programme itself is for them. No such monthly allowance has been budgeted for in the annual budget of the Ministry of Health and the Ghana Health Service for that matter. Monthly allowance for volunteers was not factored into the original design of the whole CHPS concept so there is no way we can pay them such monies. However when there are isolated World Bank funded programmes like immunisation, we involve them so that they could receive some motivation/allowances as such World Bank projects come with funding .....”

This information from the Municipal Health Director raises quite a number of salient issues. Arguably, civil society side of partnerships in the synergy equation often involves voluntary collective action. Now, as the CHPS concept does not make any component to remunerate volunteers, it leaves us to wondering if the programme can stand the test of time. As civil society (volunteers) form the backbone of the CHPS programme and their interest in this particular case study for example is dwindling; then it raises issues about how sustainable the CHPS programme would be in the Nsanfo community. Although the volunteering work under the CHPS programme attracts no financial reward, lack of motivation for the volunteers has also accounted for the current feeling of volunteer-fatigue. This prompted the researchers to enquire what is meant by “motivation” on the part of the volunteers. One of the volunteers shared his ordeal:
“Even the last time when we went for a programme, there was a promise of GH¢10 (about $3) a month to cover cost of transportation and feeding for volunteers when they come for monthly weighing programmes. However they have not paid us that money for about 9months now since we started going there. They keep re-assuring us that they will pay all the outstanding arrears but still have not as we speak now. so my brother, if we use our little savings for transportation and feeding at these programmes and they make these promise to re-imburse us and then fail for 9 months now, how do they expect us to continue to go round the village volunteering ?”

The above quote aptly re-echoes the sentiments most of the volunteers interviewed expressed. This promise of GH¢10=$3 a month is different from the monthly allowance the volunteers are demanding. The promised monthly GH¢10=$3 which is even in arrears is far less than what the volunteers are demanding as monthly allowance and can only be received as and when a volunteer comes for the monthly weighing programmes organised by the Mfantseman Municipal health Directorate. What this implies is that, failure to attend such programmes means that the volunteer receives nothing at all. In all, the picture that was painted was that, even though at the commencement of the CHPS programme, it was made clear to the volunteers that they would not be paid for their work; most of the volunteers interviewed now feel at least they should be given ”something small” monthly for sacrificing their time to serve the community. In the words of one of the oldest volunteer (63 years old):
“My son, look at me, at my age I still felt it good to volunteer. I go round the village all the way to Akraman to do my job. Even if they will not pay us for our work, at least they can give us logistics like motorbikes or bicycle to help us in our work. Sometimes, you are sleeping and they call you to come and attend to an emergency situation in a nearby village. I have to walk all the way to Akraman in the night and even sometimes in the rain, it is not good at all, the authorities have to help us.”
The inference this study makes is that, in the absence of isolated programmes like the World Bank funded health projects, the Municipal Health Directorate would not have the financial wherewithal to sustain the CHPS programme in the Nsanfo community. The expectations that the community should bear the responsibility of remunerating the volunteers too is not feasible as it was obvious from discussions and observations that they lack the economic power to shoulder such a responsibility on a sustainable basis. Information gathered from the volunteers confirms that this lack of adequate motivation and support is what has accounted for their dwindling interest in the operationalisation of the programme.

Deplorable condition of the CHPS compound
Aside the lack of commitment on the part of the volunteers, another factor that threatens the very existence of the programme in the study area is the poor state of the CHPS clinic. Visits to the CHPS compound revealed that the building is in deplorable state. One of the health officials could not hide her feelings as seen in the quote below:
“My brother, you just take a look at our CHPS compound (pointing to the building), it is in a deplorable and bad condition, how do you expect us to feel safe to give out our best under these conditions? “.
What is particularly worrying is that when it rains, the whole facility gets flooded and it considerably affects the day to day work of the health officials. The above issue was well echoed during the household survey when the researcher asked what recommendation they would give to improve the CHPS programme in their community. A whopping 96% of the respondents indicated that, they wanted a new community health because the current CHPS building is dilapidated. While this challenge particularly could lead to the collapse of the CHPS programme, it was discovered that there is currently no effort to help salvage the situation especially from the Municipal Health Directorate (MHD) as seen in the words of the Municipal Health Director:
“Infrastructure provision is outside the domain the of the Municipal Health Directorate , it is up to the community members to provide a proper CHPS compound and maintain it, that is the arrangement in the whole CHPS idea. Nonetheless we can appeal to the Government for support and see if something can be done about it.”

This response re-echoes the failure of the Government of Ghana in living up to its expectations. The Government among other thing is responsible for the provision of healthcare facilities for all citizens including the people of Nsanfo as they pay tax. The argument that infrastructure provision is outside the domain of the MHD leaves one wondering what then is the role of the Government. It therefore appears that the only role that the MHD plays in the operation of the CHPS programme is to post nurses to the facilities to run it and also periodically train volunteers. We acknowledge the logic that, even though the idea behind encouraging communities to build their own CHPS compound is to instil a sense of ownership of the programme, we nevertheless argue that, some provision should be made in the budget of the Ministry of Health to cater for the repairs of some of the dilapidated CHPS compounds. This is so because, high levels of poverty in most rural communities including Nsanfo makes it unfeasible for the inhabitants to bear the cost of building new a CHPS compound. The MHD just posting nurses to CHPS compound and undertaking periodic training of volunteers is not enough to ensure sustainability of the CHPS programme in the Nsanfo community.
Poor Logistics
There is also the problem of poor logistics and the lack of facilities such hospital beds, essential drugs and other equipment that could aid the work of the health officials. This has undeniably affected their work. Additionally, accommodation for health officials and lack of constant flow of water in the facility and security personnel to provide safety for the health facility especially at night directly or indirectly affect the smooth running of the programme in the study area. This latter problem was highlighted by one of the health officers in the CHPS compound when she indicated in the course of her interview that
“We are sometimes scared for our lives because of threats of assault from some of the youth in the community. Sometime ago, some young men came to knock on my door in the middle of the night claiming there was an emergency in a nearby community, I didn’t come out because I was afraid they threatened to assault me anytime they meet me in town”
When probed further as to why she refused to attend to an emergency situation, she responded that:
“My brother, how could I come out at that time of the night when it was all over town that the abrafu (executioners) were looking for human heads to bury the king with”

For clarification purposes, we could understand the predicament of the health officer in refusing to answer the call to emergency in the middle of the night. There is a prevailing myth especially in rural communities that whenever a chief or king dies, custom demands that humans are sacrificed as part of the rituals to bury the king and bid him a final farewell befitting of a king. Indeed there is a belief among majority of the populace that traditional rulers especially societies are somehow associated with human sacrifice directly or with their tacit approval for various secret rituals (Ephirim-Donkor, 2012). When a king dies for example there is usually a widespread perception that executioner (Abrafo or adumfor) from the king’s palace engage in an orgy of human sacrifice as part of burial rituals in order to transform the dead kings into deities. The supposed logic behind this alleged human sacrifice is that, as a king in his previous life, he would need people to escort and serve him when he finally arrives in the afterlife. Even though we cannot fully independently ascertain or validate this myth, one cannot also underestimate the claim by the community health officer because the myth is very popular especially in traditional communities. Her fears were therefore understood.

Discussion of Study Results
Bridging the rural-urban gap with regards to infrastructure development and access to social services especially healthcare has been on the policy agenda of successive governments in Ghana. Indeed Ghana government envisages providing quality, affordable and equitable healthcare to all its citizenry irrespective of their geographical location and socio-economic circumstances (NDPC, 2003). This ambition has however been stymied by several obstacles ranging from the lack of adequate financial resources to the sheer lack of political will to make healthcare provision a topmost priority by successive governments that have ruled the country. To suffice, one major initiative that has been implemented to reduce health inequities between rural and urban areas and of advancing equity in health outcomes through removing geographic barriers to healthcare service is the CHPS programme (GHS, 2002). The Ghana Poverty Reduction Strategy (GPRS) accordingly adopts the CHPS initiative as one if its major pro- poor health services intervention for the rural dwellers in Ghana (NDPC, 2003).
Effectiveness of the CHPS programme in Rural Healthcare Delivery
Empirical studies focusing on the outcomes of the CHPS programme has found that the programme represents an innovative approach of bringing healthcare to the door steps of hitherto marginalized. The CHPS initiative according to GHS (2007) is also reported to have enhanced child health, maternal mortality and treatment of basic diseases. Indeed, communities that have witnessed the implementation of the CHPS programme have seen a tremendous improvement in terms of access and health outcomes (Send Ghana, 2013). As argued in the theoretical framework of this study assessing the impact of cooperative programs as the CHPS is not a simple matter as the measurement of what constitutes a "success” or “failure” of the programme can be a thorny issue. Uvin (1995) as cited in Brown and Ashman (1996) maintains that it is practically difficult to calibrate the different impacts of such collaborative programmes but the capacity to affect large numbers of people is an important aspect of programme effectiveness. The Nsanfo case study largely validates the above assertion.
Results from the current study indicate that the implementation of the CHPS programme has significantly reduced the distance that the local people cover in order to meet healthcare needs. Residents hitherto had to travel about 15km to Anomabo to seek medical attention for the smallest illness but this has been drastically reduced to less than 2km (depending on one’s proximity from the facility) with the establishment of the CHPS compound in Nsanfo. This is consistent with studies that have been conducted by other researchers and organizations in the country (Tierozie, 2011; Nyonator et al., 2003). In his impact assessment of the CHPS initiative in the Berekum Municipality in the Brong Ahafo Region of Ghana, Tierozie (2011) discovered that the programme largely enabled people in the municipality to have convenient access to health service in their community instead of travelling long distances in order to access healthcare. Nyonator et al. (2003:24) in a similar study on CHPS in the Volta region of Ghana found out that “emergency services are available 24 hours per day, seven days per week; ...community people appear to develop rapport with the community nurse and feel they are obtaining services from a caring individual are all indicators that the CHPS programme has been effective in rural healthcare in the Volta region of Ghana”. Inasmuch as the case study of Nyonator (2003) seems to reflect the situation in the Nsanfo CHPS programme, this study acknowledges that the circumstances and characteristics in Nsanfo and the Volta region are not the same hence some other factors could account for the successes chalked by the CHPS programme in both communities hence both ought to be evaluated on their own merits.

 In the larger context, the programme contributes to poverty reduction by making access to healthcare more affordable. Fortunately for the people of Nsanfo, the implementation of the nationwide National Health Insurance Scheme (NHIS) in 2003 relieves them of any financial burden of paying for some common health conditions which are all covered by the insurance scheme. Once a community member is registered with the insurance scheme, he or she does not pay for any of the services and medication captured under the scheme when they visit the CHPS health centre. The little funds residents accrue from sale of farm produce and petty trading could therefore be channelled into other productive activities by households thus increasing their purchasing power and standards of living ultimately.

The volunteering component of the CHPS programme also brings healthcare services to the doorsteps of residents especially with special attention on preventive healthcare through their health education when they visit households thus improving their general healthcare conditions (Acquah et al., 2006). Undoubtedly the decision to experiment and subsequently extend the implementation of the CHPS programme to various parts of the country has afforded many people the opportunity to access health care service. This innovative synergy between the state and the civil society represents an important strategy in addressing the development challenge of healthcare access and utilization especially to rural inhabitants in the country (Adjei et al., 2002).

Data from the current survey indicates a high patronage in terms of usage of the CHPS compound by the people in the study area in the treatment of all sorts of illnesses. This finding corroborate with district, regional and even countrywide level situation. The Ghana Health Service (2011) report suggest that between the periods of 2009 to 2011, the total population who were actually utilizing the various CHPS compound in the country increased from 16.8% to 21.8%. This is partly attributed to the substantial increase in the establishment of functional CHPS compound from 868 to about 1,675 over the same period (GHS, 2011). Indeed the programme has been extended and has become truly a national development strategy in rural development in the country (Nyonator, 2003).

Results further indicate that reported cases of illnesses by patients from the Nsanfo community and its catchment areas in the CHPS health compound increased from 752 in 2012 to 849 in 2013 as seen in Table 3, an indication of actual utilization of CHPS facilities as a means to seek treatment for illnesses. Earlier researches in the Upper East region where the CHPS programme was first experimented have highlighted comparable conclusions. It is estimated that the CHPS programme contributed to a rise in out-patient department (OPD) cases from 5% in 2009 to 13% in 2011 while supervised delivery also increased from 52.6% to 67.5 % over the same period in the region. Indeed, the CHPS initiative serves as a means to bring to an end the vertical programmes through providing pathways and mechanisms for rendering healthcare services in a decentralized system. It thus involves processes of evidence-based organizational reorientation for extending the logic of the sector-wide approach at the community level (Adjei et al., 2002).
 Threats to the Synergy
Despite the active involvement and the crucial role being played by the volunteers in providing community access to affordable and quality healthcare under the CHPS programme, the realm of community volunteers are beset with a number of operational challenges which hinder their work. Brinkerhoff (1999: 63) theorizes “incentives are the essential lubricant that makes partnerships possible. Positive incentives provide the stimulus that impels both the state and non-state sides of the equation to work together; negative ones discourage them from doing so”. We gathered that there is generally lack of motivation and incentives for the volunteers to aid in the performance of their duty. Indeed lack of equipment to work with remain the major challenges affecting community volunteers in most CHPS zones nationwide (Tierozie, 2011; SEND-Ghana, 2013). This has the demerit of making the work of the volunteers more difficult and tiring especially in situations where they have to travel or walk longer distances to households in the performance of their duties. In other context, it has been noted that volunteers start off enthusiastically but then their level of engagement falls off due to the lack of incentives (Acquah et al., 2006). This seems to have manifested in the Nsanfo case thus validating Brinkerhoff’s (1999) theory on the role such incentives play in the synergy equation.
The lack of motivation for the volunteers contradicts what has been stipulated in the policy document regarding the operation of CHPS. According to the policy framework guiding the implementation of the programme nationwide, volunteers are supposed to be provided with a means of transportation like bicycles, tricycles and sometimes motorbikes since most of them travel longer distances in the performance of their duties (GHS, 2005). These are great incentives because they are dashed to the volunteers and become their personal property (and for private use) so long as they remain volunteers. It is only when one resigns from the volunteering on some intangible excuse that he or she is expected to return such items. We argue for appropriate authorities to pay critical attention to the challenges facing the volunteers in order to ensure the sustainability of the programme. It is evident that the CHPS programme has achieved positive impacts and remains one of the cheapest means of improving rural healthcare. The least government can do is to address the challenges confronting the scheme. Even if authorities cannot meet the demands of the volunteers, an acceptable compromise can be reached through dialogue and negotiations (Aquah et al., 2006).


Conclusion and the way forward
This study sought to examine how state civil society partnership could be leverage as a means of ensuring delivery of healthcare to previously underserved rural communities. Our study focused on the collaboration between the state (Mfanstiman Municipal Health Directorate and Civil Society (community health volunteers) in the provision of healthcare in the Nsanfo community through the CHPS. We found that this partnership has resulted in bringing healthcare to the door steps of the people in the study area through reducing the distance and the cost involved in accessing health service. In varied ways, the programme has contributed to improving the child and maternal health and also in managing issues of injuries without treatment, occurrence of communicable and non-communicable diseases, maternal deaths and insanitary living conditions. However we take cognizance of the fact complicated cases such as problem of the eye, kidney, lungs and complicated delivery are not treated under the programme as these are referred to larger health centres. Additionally key factors such as lack of motivation for the volunteers, poor logistics, and deplorable state of the CHPS compound are the challenges that threaten the very existence of the synergy.
Moving forward, we are of the view that the solution to these challenges is a matter of political will by way of government prioritising healthcare and making more budgetary allocation to the health sector and the CHPS programme in particular. Brinkerhoff (1999:79) argues that “successful policy implementation partnerships must pay attention to crafting an agenda and actions that solicit and hold the interests of the non-state partners whose contribution is usually non-compulsory and non- remunerative”. We agree perfectly with the author and further find it hard to understand why there seem to be no strong commitment on the part of government in ensuring that this CHPS programme is supported to work effectively. The onus therefore lies with health planners and policy makers to devise appropriate and context-specific ways in which to achieve sustainability by keeping such volunteers’ motivated while at the same time keeping in mind the limitations of cost-containment in such actions (Kironde and Kahirimbanyi, 2002). In this way, Government must resource the various districts assemblies and the Municipal Health Directorate. These agencies when well resourced must come to the aid of the volunteers by providing them with the necessary equipment such as motorbikes, raincoats and other essentials that will aid in the work of the volunteers. Moreover, the community could also set up a fund to reward their own community members who decide to work as volunteers annually, i.e a small end of year get together to celebrate and appreciate the volunteers for their work over the period. Additionally, the Municipal Health Directorate together with the community members and leaders must as a matter of agency contribute to providing the necessary logistics such as weighing scales, hospital beds, thermometers, constant flow of water and security for the CHPS compound.




REFERENCES
Acquah, S.,  Frelick, G.,  and Matikanya, R. (2006). Providing Doorstep Services to Underserved Rural Populations: Community Health Officers in Ghana Capacity Project USAID Global Health/HIV/AIDS and the Africa Bureau Office of Sustainable Development


Adjei, S., Phillips, J., and  Jones, T.C. (2002). Utilization of evidence from experimental research to guide sector-wide health care reform in Ghana. Paper presented at the 130th Annual Meeting of the American Public Health Association, Philadelphia, PA, 9-13 November.

Banks, N, and Hulme, D., (2012). The role of NGOs and civil society in development and poverty reduction,  BWPI Working Paper 171, Retrieved February 2, 2015 from http://civil20.org/upload/iblock/9b1/rolengo.pdf

Baru, R, and  Nundy, M. ( 2008). ‘Blurring of Boundaries: Public-Private Partnerships in Health Services in India’, Economic and Political Weekly 43 (4): 62–71.

Berwick, D. (2004). ‘Lessons from developing nations on improving health care’. Bio Medical Journal 328, 1124-1129.

Brinkerhoff, D. W. (1999). ‘Exploring State-Civil Society Collaboration: Policy Partnerships in Developing Countries’, Nonprofit and Voluntary Sector Quarterly, 28(4), 59-86.

Brown, D. L., and  Ashman, D. (1996). Participation, Social Capital, and Intersectoral Problem
Solving: African and Asian Casesî, World Development, 24 (9).


Bruce, R. (1994).  Mortgaging the Earth: the World Bank, environmental impoverishment and the crisis of development, John Wiley & Sons, Ltd and ERP Environment
Bryman, A. (2008). Social Research Methods, UK, Oxford University Press.
Burger, N.E., Kopf, D.,  Spreng, C. P., Yoong, J., and Sood, N. (2012). Healthy Firms: Constraints to Growth among Private Health Sector Facilities in Ghana and Kenya. PLoS ONE 7(2): e27885. doi:10.1371/journal.pone.0027885.

Caruth, G.D. (2013). Demystifying Mixed Methods Research Design: A Review of the Literature. Mevana International Journal of Education (MIJE), 3(2), 112-122.
Centre for Global Development (2009). Partnerships with the Private Sector in Health: What the International Community  Can Do to Strengthen Health Systems  in Developing Countries, Final Report of the Private Sector Advisory Facility  Working Group November 2009, Retrieved August  18, 2014, from  http://www.cgdev.org/files/1423350_file_CGD_PSAF_Report_web.pdf
Ephraim-Donkor, A. (2012). African Religion Defined: A Systematic Study of Ancestor Worship among the Akan. United States, University Press of America.
Evans, P. (1996). Introduction: Development Strategies across the Public-Private Divide, World Development, 24(6)
Foley, M.W., and  Edwards, B. (1996). The Paradox of Civil Society: Journal of Democracy 7.3. National Endowment for Democracy and the Johns Hopkins University Press. Retrieved October, 10, 2013,  from: http://muse.jhu.edu/journals/journal_of_democracy/v007/7.3foley.html
Ghana Health Service (2002). The Community-Based Health Planning and Services (CHPS) Initiative: The Concepts and Plans for Implementation PPMED, December 10, 2002. Retrieved February 2, 2015 from http://www.ghanachps.org/wp-content/uploads/2008/05/concepts.pdf


Ghana Health Service. (2005). Community Based Health Planning Services(CHPS). The operational Policy, Policy Number 20, Accra, GHS

Ghana Health Service.(2008). Community Heath and Planning Services: The Strategy for Bridging the Equity Gaps in Access to Quality Health Services. Policy Planning and Monitoring  Evaluation. Retrieved February 23, 2014 from: www.ghanachps.org/wpcontent/.../chstrategytobridgeequitygaps.pdf‎

Ghana Health Service. (2009). Health Administration and Support Services. Retrieved January 7, 2009 from http://tinyurl.com/nahh9uu

Ghana Ministry of Health (2012). Role and  Functions. Retrieved July 15, 2013 from  http://www.moh-ghana.org/pages.aspx?id=3

Ghana Health Service (2011). The Health Sector of Ghana, Facts and Figures: Accra, GHS

Joseph, A., and Kearns, R. (1999). Unhealthy acts: interpreting narratives of community mental health care in Waikato, New Zealand. Health and Social Care in the Community 7(1), 1-6

Kironde, S.,  and Kahirimbanyi, M. (2002). Community participation in primary health care (PHC) programmes: Lessons from tuberculosis treatment delivery in South Africa. African Health Sciences  2(1). Retrieved February 24 2014, from www.ncbi.nlm.nih.gov/pubmed/12789110

Massoud, M.R.,  Mensah-Abrampah, N., Sax, S.,  Leatherman, S., Agins, B.,  Barker, P.,   Kelley, W., Heiby, J.R and  Lotherington, J. (2012) .‘Charting the way forward to better quality health care: how do we get there and what are the next steps? Recommendations from the Salzburg Global Seminar on making health care better in low- and middle-income economies’: International Journal for Quality in Health Care 2012(1), 1–6

Ministry of Health of the Republic of Ghana. (1998). A profile of health inequities in Ghana. Accra:
Ministry of Health

Nair, P., (2011) Evolution of the Relationship between the State and Non-Government Organisations: A South Asian Perspective, Public Administration and. Development 31(1), 252–261

NDPC (2003). Ghana Poverty Reduction Strategy 2003-2005: An Agenda for Growth and Prosperity. Accra: National Development Planning Commission

Nyonator, F.K ., Koku Awoonor-Williams, J.K.,  Phillips, F. J., Tanya C. J., and Miller, R.A. (2005). The Ghana Community-Based Health Planning and Services Initiative For Scaling Up Service Delivery Innovation, Health Policy and Planning; 20(1), 25–34

Nyonator, F.K., Awoonor-Williams, J.K., Phillips, J. F., Jones, T.C.,and Miller, R.A. (2003). The Ghana Community-based Health Planning and Services Initiative: Fostering Evidence-based Organizational Change and Development in a Resource-constrained Setting. Policy Research Number 180. Retrieved August 12, 2013, from: http://tinyurl.com/

Ostrom, E. (1996). Crossing the Great Divide: Coproduction, Synergy, and Development. World Development, Vol. 24, No. 6.

Send Ghana  (2013). Healthcare at the Door-Step of the Citizens: Unleashing the Potentials of CHPS. Retrived  March, 30, 2014 from http://gh.sendwestafrica.org/downloads/RESEARCH%20REPORTS/HEALTH%20POLICIES%20MONITORING/Healthcare%20at%20the%20doorstep%20of%20Citizens%20Unleashing%20the%20Potentails%20of%20CHPSpdf.pdf

Sachs, J. D. (2005). Investing in Development: A practical Plan to achieve the Millennium Development Goals, A report to the UN-Secretary General, Retrieved January 1, 2013, from http://www.unmillenniumproject.org/documents/MainReportComplete-lowres.pdf

United Nations (2000). United Nations General Assembly: United Nations Millennium Declaration. A/RES/55/2: New York.
Unnithan, M., and  Heitmeyer, C.,  (2012).  Global rights and state activism: Reflections on civil society—State partnerships in health in NW India, Contributions to Indian Sociology 46 (3), 283-310, DOI: 10.1177/006996671204600302
Tierozie, C. (2011). Impact Assessment of the Community-Based Health Planning And Services Initiative in the Berekum Municipality. A Thesis Presented to the Institute Of Distance Learning, Kwame Nkrumah University of Science And Technology in Partial Fulfilment of the requirements for the Award of the Commonwealth Executive Masters In Public Administration Degree. Retrieved February, 5, 2015, from http://ir.knust.edu.gh/bitstream/123456789/4427/1/TIEROZIE%20CLEMENT.pdf

World Health Organization (2012) State Of Health Financing In The  African Region  Discussion Paper For The  Interministerial Conference:  Achieving Results And Value For  Money In Health 4–5 July 2012, Tunis, Tunisia Retrieved August 18, 2014 from http://www.hha-online.org/hso/system/files/health_financing_in_africa_edited_03_july_-_copy.pdf

Yin, R. K. (2003). Case Study Research.  3rd ed. Sage Publications, London, England.