Summary of Stakeholder Interviews, Tonga by skatzz


									                                PAHP Evaluation Report
                              Dr Jan Ritchie M&E Adviser
                Summary of Stakeholder Interviews, October-November 2004

Short visits were made by the Project’s Short Term Adviser (STA) in Evaluation to each of the
participating countries to undertake interviews with key stakeholders who had a stake in the
conduct and the outcomes of PAHP. Interviewees were asked their perceptions of the Project both
from the point of view of its practical day-to-day running, and more importantly, whether they saw
value in the impact it was making. Viewpoints were also sought on where the Project might go
from here, should it be extended. Detailed transcripts of these interviews were taken and are on file.
For the purpose of the overall evaluation, a summary of the pertinent perceptions of stakeholders
has been compiled here.

Summary of Stakeholder Interviews, Tonga
As part of the evaluation of the PAH Project, a series of eight interviews of key stakeholders was
conducted on Tongatapu from 19-23 October 2004.

Stakeholder perceptions of the Project process
Stakeholders reported they saw the Project as having two arms: the community arm and the policy
arm. They saw the community activities as commencing from the inception of the Project, whereas
they felt the policy activity had only arisen more recently.

Despite some initial hesitancy on the part of the Director of the Tongan Family Health Association
(TFHA), there was eventually absolute consensus that basing the Country Coordinator in this NGO
was a most constructive arrangement even though it was pointed out the stated purpose of this
NGO did not originally include non-communicable disease. Some stakeholders commented that
the success of this working arrangement was more due to the fact that the TFHA was well above
average in the way it was managed rather than because it was a non-government agency. Overall,
those interviewed indicated there was high respect for its Director in this regard. On a similar
aspect of Project process, it was clear the interviewees regarded the Project’s overall Team Leader
as having outstanding project management skills and they welcomed his ability to influence Project
processes actively even though based outside Tonga, especially in the way he succeeded in building
capacity in team members and associates.

Perceptions of the Project impact – Community-based interventions
A major strength was felt to be the fact that rather than devising new community interventions,
most of the community components PAHP chose to be work with were already well in existence
prior to the Project beginning, and building Project activities around these had succeeded in
hooking on to them and strengthening them. This was seen as a great advantage as the Project and
existing activities tended to enhance each other reciprocally. Stakeholders felt the chances of
sustaining these positive activities was relatively high compared with their experiences with other
aid projects with more discrete activities. Here there was unanimity in agreement that the Country
Coordinator had high-level skills in group facilitation and an obvious aptitude for engaging with the
community over Project objectives.

Interviewees explained how Tongans work and play more comfortably in shared situations rather
than as individuals, so that team activities are very important to them. Linking the smokefree
message to youth sport generally was seen as valuable both in promoting the sport in itself and also
in making the healthy connection between sport and a smokefree lifestyle. Some pointed out that
the focus on sport was also working towards other NCD objectives as it was enhancing the kids’
involvement in physical activity.
Perceptions of the Project impact – National NCD Policy Implementation
Stakeholders saw the outcomes in two separate stages – those of more immediate smoking
reduction actions addressing tobacco as the primary and visible outcome, and the wider NCD
policy implementation. However, there was a real recognition by some of those interviewed that
the strength of this Project has been the way it has used smoking as the entry point yet contributed
to real and potentially more sustainable action regarding NCD prevention in its entirety. Although
some of those interviewed saw smoking reduction as a discrete project, more saw that the use of
tobacco issues as an entry point could strengthen other NCD components even without the focus on
the larger NCD strategy. It was felt that much had been gained by the coincidental timing of the
Project really getting underway as the Pacific Health Ministers Meeting was held. The Ministers’
issuing of the Tonga Commitment recommending that each Pacific country establish a NCD
strategy and produce this in documented form gave a tremendous boost to this aspect of project
activities. Stakeholders explained proudly that Tonga was the first country to demonstrate meeting
this Commitment.

Stakeholder opinions on future directions
Most of those interviewed noted the fact that PAHP was taking place in the main island and the
other islands were at this stage unable to reap benefits from it. Virtually all felt that any extension
of the funding should be used to spread the community-based Project activities beyond Tongatapu.
Specific aspects of a further phase that stakeholders saw to be important were the establishment of a
smoking hotline, greater focus on evaluation criteria that would be more result-focused,
consideration of occupational health and safety issues for those exposed to tobacco in the tobacco
factory, strengthening of the effort to gain other collaborators for future funding, and greater
exposure of all aspects of the Project through a concerted media campaign and associated publicity.

Positive concluding opinions voiced by stakeholders included the view that the Project was
welcomed due to its spreading its positive ‘smokefree’ message rather than the more usual negative
‘don’t smoke’ directive often given to young people and that this was very important to continue.
A few perceptively stated they welcomed the focus on teachers acting as role models and that
similarly, coaches and top players could next be induced to realise their strengths in influencing
young people’s behaviours.

The Tongan stakeholders appeared to regard community-based interventions as central to the
promotion of health whereas they saw the policy and legislation advances as an unusual Project
part that was not usually the responsibility of health promoters. Hence they believed the
continuation of PAHP was essential if further development of NCD policy implementation would
continue, otherwise this was not likely to be integrated into the work of the Health Promotion Unit
or other agencies and the current positive momentum would get totally lost without PAHP.

Summary of Stakeholder Interviews, Kiribati
Ten interviews were conducted with key stakeholders at South Tarawa, 8-13 November 2004.

Stakeholder perceptions of the Project process
There was a perception held by some of those interviewed that the Project had got off to a false start
in Kiribati, but interviewees voiced they felt subsequent relief when the current Team Leader took
over. The way the Project then succeeded in building on existing community activities was
welcomed, although it was thought by some that the Project’s reach was unrealistically wide. The
flexibility of Project interventions allowing variations in outputs was seen as really positive.
Stakeholders were very accepting of recent processes emphasising intersectoral collaboration
between health and education. Some aspects of the Project were not seen to have attained fruition,
as for instance the management program that should have been put in place by the University of
Guam. There was only veiled attention brought in the interviews to the series of difficulties that
PAHP had experienced in this country, resulting first in having to replace the Country Coordinator
and more recently in the move of the whole local Project management to an alternative NGO.

Perceptions of the Project impact – Community-based interventions
Enhancing young people’s opportunities for active leisure through Project support of sporting and
craft activities across Tarawa was well accepted by all and interviewees agreed it was an effective
way to replace lethargy and associated alcohol abuse. The small grants scheme was regarded as a
great success but the micro-credit scheme was not felt yet to be working well. Reducing the paper
work related to the latter was a recommendation from a couple of interviewees. The ability of the
Project to reach disadvantaged youth was welcomed by interviewees.

Perceptions of the Project impact – National NCD Policy Implementation
One disadvantage pointed out by a couple of stakeholders was that this was yet another NCD
prevention project and there had been so many before it. They explained how the previous ones
had achieved little and there was not much reason to think this could be better. Donor activities
were widespread across Tarawa with little benefits ensuing. However, it was thought by some that
the potential of this Project had more chance of success since the focus was on health rather than
the more usual focus on prevention of some disease or other. This was because only health sector
people were concerned with disease prevention whereas the other sectors such as police, education,
commerce and agriculture were much more keen to be involved in this Project’s aim of promoting
health and well-being. The improved relationship between the MOH and the police since the
provision of the breath-testing equipment was a case in point.

Stakeholder opinions on future directions
Those in decision-making positions saw the NCD policy development as a real success and felt any
future developments should take the policy forward to implementation. The formation of a health
promotion foundation could act to support this move. There was an interesting polarisation of
opinion as to whether any potential future funding for community activities should be directed only
to alcohol abuse prevention as already occurring or should spread to address tobacco at the same
time – both ideas were put forward strongly. Those interested particularly in young people having
a say in their own lives were particularly excited about the potential for the Youth Parliament to be
formed and felt that future Project activities should be determined by a youth consensus group of
this nature.

Summary of Stakeholder Interviews, Vanuatu
Fifteen persons were interviewed during the STA’s brief visit to Port Vila, from 22-26 November

It was apparent that stakeholders saw themselves primarily working with either the Project’s
Component No 1: National NCD Policy Implementation, or Component No 2: Community-based
Interventions. Even those who were involved in both components tended to only give opinions on
one. Those discussing the former tended to have a big-picture view of all NCDs with the whole Ni-
Vanuatu population from a central government level, whereas those giving perceptions on the latter
aspects were specifically concerned with reducing alcohol overuse and abuse in young people.

Stakeholder perceptions of the Project process
Interviewees were decidedly positive in the way they viewed the practical conduct of the Project.
Many interesting comments were forthcoming regarding the wider scope and broader networking
that have been brought to the Project through it being based at a well-respected non-government
organisation like the Foundation of the Peoples of the South Pacific (FSP). Overall, it was felt that
the Country Coordinator was exceptional in his networking skills and his ability to relate so
positively to so many different organisations. In addition, it was perceived by those interviewees
working with disadvantaged youth that he was always responsive and open to hear their requests
for assistance.

Stakeholders perceived that the Project was clearly set out so that the aims and objectives were very
understandable to them. They believed the Project was carried out as intended although some
noted how much they valued the flexibility inherent in its implementation. All agreed the Project
reach was excellent in that it did get to the most needy. It was felt that participants were genuinely
pleased to be a part of the PAHP activities. Feedback to stakeholders who were involved in the
various activities was far more positive than negative.

Perceptions of the Project impact – Community-based interventions
Many commented on that fact that the Project has been flexible enough to not only address the need
to help young people realise the dangers of alcohol, but actually to address the underlying factors in
the social environments of Ni-Vanuatu youth that has contributed so greatly to overuse and abuse
of alcohol. Stakeholders were unanimous that youth unemployment was the biggest social
determinant leading to this problem. They were very concerned that better education and schooling
have in recent years enabled young people to expect to get a job on leaving school, but the lack of
job opportunities across the urban area was all too clear. This was agreed to be a very constructive
approach – ‘We are really talking livelihood rather than lifestyle’ was a perceptive comment from
one interviewee. However although the small grants and micro-credit schemes has resulted in
really effective job creation with small numbers of recipients, it was pointed out by a couple of
interviewees that this issue was important enough to require a much more concerted effort by the
whole of government and it should not be just a component of a health promotion project.
Stakeholders noted that balancing the work with disadvantaged youth was the focus on youth with
potential for leadership

Most expressed the opinion that the second most important aspect to be addressed by any approach
aiming to reduce alcohol use and abuse was the need for young people to have constructive and
healthy leisure pursuits to overcome the boredom and inactivity that can set the scene for negative
substance use. There was considerable satisfaction that these pursuits were being well supported
through the Project. A couple of stakeholders wanted more focus to be put on supporting female
adolescents since as they pointed out, traditional values favoured males. Another interesting
suggestion was that the Project should consider the needs of employed youth as well as
unemployed, as most had minimal social skills and capabilities in such essential skills as personal
financial management.

Perceptions of the Project impact – National NCD Policy Implementation
Here the understanding that NCD prevention could start in other areas as well as reduction of
alcohol use and abuse was clear. The publicity given to the Framework Convention on Tobacco
Control seemed to reinforce the project activities and give them more credibility. This was
epitomised in the country’s top under-21 soccer team contracting to be smoke and alcohol free.
Most of those interviewed were strongly of the opinion that a the new National NCD Plan of
Action could never have been developed without the assistance from a project like PAHP.

Stakeholder opinions on future directions
There was unanimous agreement that project’s of this nature require years to reap the positive
outcomes of implemented activities and that ending the Project now would undo any benefits
accrued to date. In recommending that PAHP should continue, the most commonly expressed
opinion was that the community-based interventions should expand to rural areas. Some felt that
specific rural localities must be clearly designated as key areas for entry otherwise it would be
spread too thinly. Related to this suggestion was that youth should be given the opportunity to have
a say in the future direction, especially in regard to the skills they want to attain, and that
consideration should be given to activities in Bislama rather than just English.
Regarding PAHP’s role in the development of the new NCD Plan of Action, it was clear that
stakeholders did not feel the MOH could successfully commence the next stage of implementation
of the action without the support of a project of this nature. Specifically, if the National NCD
Committee were to continue effectively they would like some designated funding for a secretariat
as the intersectoral linkages and policy development will require careful documentation of all steps.

Synthesis of Stakeholder Opinions across All Countries
It is understood that any stakeholder review of an existing donor program will naturally attract
positive responses as stakeholders, by their very definition, will likely have a vested interest in the
nominated project being seen positively. However, in this current evaluation, it appears that the
positive responses have been backed by robust reasons for stakeholder satisfaction and supported
by the logical framework indicators. Strong leadership by the Team Leader and excellent work by
Country Coordinators in two of the three countries have confirmed that the Project process has
been thought out well and implemented accordingly. Flexibility to adjust to specific country needs
has been a decided plus. Basing the Project within an NGO had allowed more positive
relationships to develop across sectors and less concern about ‘turf protection’ than would have
been expected should the MOH have been the driver.

Stakeholders in all three countries believed that the Project had effectively raised awareness of the
tobacco or alcohol risk factor nominated as a Project entry point, and that this awareness was
particularly heightened in the target group of youth. The mechanism of attaching Project goals and
activities to existing youth programs rather than developing a Project specific program was felt by
all to be very effective and to have greater potential to be sustainable through this linkage. Actually
addressing unemployment as the primary social determinant of the substance abuse problem
through the small grants schemes was exceptionally well received compared with more
conventional youth health educational approaches, and seen to be really positive compared with
negative messages merely attacking the symptoms. The Project was initially announced as a non-
communicable disease prevention project and as such could have taken a narrow focus on direct
risk factors, as indeed the decision to have each country nominate the NCD risk factors of alcohol
or tobacco as an entry point showed. Moving the focus to address social determinants worked
powerfully. The only negative comments here were from some who were personally not happy
with the small grant selection committee decisions.

Although fewer interviewees had had the opportunity to be working at a policy development level,
those who did were quite adamant that their country NCD plans of action could only be developed
through the existence of the Project. It is obvious that all three countries have moved faster than the
rest of the Pacific island countries in getting their plans launched.

All unanimously stated that the changes sought by this Project could not be achieved in this small
time frame and that an extension of some years would allow objectives to be more realistically met.
Two primary directions were nominated by interviewees as the way forward. Stakeholders in all
countries wanted to take the community-based interventions of the Project to rural areas and outer
islands, probably not in an expansive countrywide manner, but systematically choosing defined
areas of real need. Those working at the policy level were proud to have the plan of action on
paper but were very keen to have the Project extended to commence implementation. Whereas
some were critical of using Project monies for funding out-of-pocket expenses of committee
members, it was agreed that secretariat support could enhance implementation of the plan
considerably. Finally, if the Project is extended, stakeholders pointed out more attention could be
paid to heeding the advice and input of young people on which to take forward project

Jan E. Ritchie
STA Evaluation
16 December 2004

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