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Sport in Society
Cultures, Commerce, Media, Politics
ISSN: 1743-0437 (Print) 1743-0445 (Online) Journal homepage: https://www.tandfonline.com/loi/fcss20
‘Governance’, ‘communication’, ‘capacity’,
‘champions’ and ‘alignment’: factors underpinning
the integration ofsport-for-development within
national development priorities in Tonga
L. Keane, J. Negin, N. Latu, L. Reece, A. Bauman & J. Richards
To cite this article: L. Keane, J. Negin, N. Latu, L. Reece, A. Bauman & J. Richards (2019):
‘Governance’, ‘communication’, ‘capacity’, ‘champions’ and ‘alignment’: factors underpinning
the integration ofsport-for-development within national development priorities in Tonga, Sport in
Society, DOI: 10.1080/17430437.2019.1678590
To link to this article: https://doi.org/10.1080/17430437.2019.1678590
Published online: 21 Oct 2019.
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SPORT IN SOCIETY
‘Governance’, ‘communication’, ‘capacity’, ‘champions’
and‘alignment’: factors underpinning the integration
ofsport-for-development within national development
priorities in Tonga
L. Keanea, J. Negina , N. Latub, L. Reecea, A. Baumana and J. Richardsa,c
aSydney School of Public Health, The University of Sydney, Sydney, Australia; bMinistry of Internal Aairs,
Government of the Kingdom of Tonga, Nuku’alofa, Tonga; cFaculty of Health, Victoria University of Wellington,
Wellington, New Zealand
ABSTRACT
Sport-for-Development (SfD) organizations and practitioners aim to
positively impact physical and mental health, contribute to the promo-
tion of peace in post-conflict settings, address a range of societal
inequalities, as well as improve community cohesion and build social
capital. SfD practitioners regularly align outcomes with international
development priorities such as the Sustainable Development Goals,
and more specific health and development priorities at the regional
and national level. The aim of our paper is to critically analyse factors
underpinning the integration of Australian-funded Sport-f or-
Development programs within the national health and
development
priorities of Tonga, a small Pacific Island nation. We
utilised a qualitative research
design including 32 interviews and 5
focus groups, local document analysis and direct observation.
Factors underpinning integration included the perceived
governance strength of sporting stakeholders; alignment throughout
program objectives and evaluation outcomes; inter-agency and
inter-personal communication; capacity of the local implementation
base and the identification of development ‘champi-ons’. Without
foreign funders addressing these critical factors, SfD risks
being
confined to fragmented and isolated project-based programming
with
only the potential for contributing to broader health and devel-
opment priorities.
Introduction
Sport-for-Development (SfD) refers to the intentional use of sport, physical activity and
play to attain specific development objectives in low-and middle-income countries (LMICs),
and disadvantaged communities in high-income settings (Richards etal. 2013). SfD orga-
nizations and practitioners aim to positively impact physical and mental health (DFAT
2017), promote peace in post-conflict settings (Hamilton, Foster, and Richards 2016;
Richards etal. 2014; Schulenkorf and Sugden 2011), address societal inequalities, as well
© 2019 Informa UK Limited, trading as Taylor & Francis Group
CONTACT L. Keane lewis.keane@sydney.edu.au
https://doi.org/10.1080/17430437.2019.1678590
KEYWORDS
Sustainable development;
sport; pacic islands;
governance; NCDs
2 L. KEANE ETAL.
as improve community cohesion and build social capital (Schulenkorf, Sherry, and Rowe
2016; Richards etal. 2013). Despite the limited evidence of program effectiveness or cost-
effectiveness (Coalter 2010), investment in SfD globally grew exponentially by 2005 being
proclaimed the International Year for Sport and Physical Education (Beutler 2006).
One example of investment expansion during this period is the ‘Pacific Sports Partnerships’
(PSP) SfD program, funded by the Australian Government’s Department of Foreign Affairs
and Trade (DFAT). After several years of design and planning, the PSP program was imple-
mented in the Pacific Islands in 2009. Since this time, the Australian Government has con-
tributed over AU $39 million to on-going SfD programming, providing funding to 15 sports
in 9 countries (DFAT 2017). The specific aims of the program include improving health
through targeting non-communicable disease (NCD) risk factors, disability inclusion and
advocacy, promoting gender equality, increasing youth participation in sport, as well as sports
diplomacy outcomes (DFAT 2017). One of these Pacific Islands is Tonga, a LMIC with a total
population of 107,122 (World Bank 2017). The Kingdom of Tonga is a Polynesian sovereign
state and Pacific Island country comprised of 170 islands, of which, 36 are inhabited (TDoS
2011). Tonga is divided into 5 main island groups: Tongatapu (75,416 population), Vava’u
(14,922), Ha’apai (6,616), Eua (5,016), and the Niuas (1,282) (TDoS 2011). The World Health
Organization STEPwise approach to surveillance (STEPS) representative health survey carried
out in Tonga in 2012 indicated the prevalence of obesity and overweight were 67.6% and
90.7% respectively, and 98.7% of the population were at high or moderate risk of NCDs (World
Health Organization 2014). These issues are compounded by a nutrition transition towards
imported, easily accessible, and high calorie packaged and canned foods (Evans etal. 2002).
Despite this, a strong traditional culture is clearly visible in Tonga. For example, tradi-
tional ta’ovalas, or woven waist mats, are worn in the workplace; subsistence-based farming
still present in much of the country and Sunday a day of family and church enforced by law.
Tonga is also a country of strong religious faith, with 98% of the population identifying as
Christian (TDoS 2011). The nation’s Gross Domestic Product (GDP) per capita was USD
$3689 in 2016 (World Bank 2017). This figure includes a 30% contribution from remittances,
which is money sent home from Tongans living abroad (MPI 2011). Tourism is the largest
source of export earnings in Tonga, about five times that of agriculture and fisheries com-
bined (World Bank 2014).
Tonga also receives considerable foreign aid support, primarily from New Zealand,
China, Japan and Australia (MIC 2018). Australia has a longstanding diplomatic relationship
with Tonga, assisting in a range of foreign, trade and development policies and programs
to reduce poverty, enhance regional stability and improve health outcomes. From 2018–
2019, Australia is projected to provide an estimated AUD $27.9 million in total official
development assistance (DFAT 2015a).
Due to the significant prevalence of physical inactivity, overweight and obesity; com-
munity-orientated social structures; high levels of gender-based violence; as well as a long
history as a sport-loving nation (World Health Organization 2014; UN Women 2013), there
is strong opportunity to target these issues through SfD programming. In Tonga, the
Australian Government provides funding and development resources to seven Tongan
national sporting federations (NSFs) under the PSP program (DFAT 2017).
A range of independent evaluations in the Pacific islands have been carried out on specific
SfD program components, mainly comprising small evaluations of isolated programs. These
included program reach (e.g. participation numbers) (Synergistiq 2015; Holden and Vella
SPORT IN SOCIETY 3
2018), health behaviour change (Richards etal. 2016), social impact (Sherry and Schulenkorf
2016) as well as partnership strengthening (Synergistiq 2015; Holden and Vella 2018). These
evaluations utilized a range of methods including quantitative longitudinal cohort studies,
before and after qualitative studies, participant reach evaluations, and in-depth interviews
and focus groups. Despite positive findings in specific aspects of the SfD sector in Tonga,
and surrounding Pacific Islands, the ability of the sport sector more broadly to contribute
to health and development priorities in the region continues to face challenges. These
challenges include a lack of governance, periodic mismanagement of funding, closure of
NSFs (Matangi Tonga 2013) and low human resource capacity to deliver programs
(Synergistiq 2015). This potentially indicates a need to examine implementation, and the
contribution of SfD to health and development priorities, at the national level.
The Commonwealth Secretariat, a supporting body of SfD in its 53-member states, has
reiterated this sentiment, publishing guidance for integrating SfD within national policies
and strategic documents in LMICs (Commonwealth Secretariat 2014). It referred to their
guidance as responding to ‘the most urgent debate among leading scholars and
practitioners’ – how SfD can move away from an individual project-based focus, towards
a multi-sectoral approach to increase its contribution to development outcomes. Further
to this, in Africa there is evidence of SfD research projects moving away from program
evaluation, towards examining national partnership and governance structures. For exam-
ple, Lindsey and Banda (2010) found the SfD sector lacked integration into more strategic
partnerships that addressed national health policy issues in Zambia. Building on this, Banda
(2017) also found that a lack of participation of NSFs in national strategic decision-making,
and lack of respect towards the sport sector in development priorities, hindered the ability
of SfD to shape health policy. This led to organizational fragmentation between stakeholders
and competition for foreign-based funding, which inhibited the development of partner-
ships aimed at cross-sectoral cooperation. Massey etal. (2015) argued that given the gap
between micro-level program successes and macro-level change, macro-level research could
be explored as a way to promote integration across various sectors of development work.
The aim of this paper is to address this paucity of SfD research at the macro-level, and
examine the factors underpinning the efficacy of integrating the Australian-funded PSP
program within national health and development priorities of Tonga. We also map where
the PSP program sits within local health and development priorities.
Methodology
To achieve this, we utilized a qualitative research design comprising direct observation,
in-depth semi-structured interviews and focus groups with stakeholders of the PSP program
in Tonga. We chose not to test any preconceived theoretical models due to limited evidence
on conceptual or cultural adaptation to the Tongan setting. However, we were informed by
the grounded theory research framework (Chun Tie, Birks, and Francis 2019), which is useful
to guide research in Tongan SfD, as it is most useful to apply to research questions with limited
existing evidence (Howell 2000, 2004, 2013; Boadu and Sorour 2015). Specifically, this guided
our research process of purposive sampling, collecting data, coding and theme generation.
Subheadings adapted from the grounded theory research framework (sampling, data collec-
tion, coding and analysis) are used to structure our methodology section.
4 L. KEANE ETAL.
Figure 1. Implementation model used for Australian Government Sport-for-Development investment
in Tonga.
Sampling
Two researchers were immersed in Tonga over a total 10-month period from 2017 and 2019
(LK and JR). A significant portion of this time was invested in relationship and partnership
building prior to research commencement. This length of time assists in building a close
rapport with participants in collectivist cultures (Hofstede 1980), to facilitate quality data
collection. Through initial local document analysis, the SfD sector in Tonga was separated
into five stakeholder groups, represented in Figure 1:
1. program funders: the Australian Government (Australian-based);
2. program managers: the managing government contractor (Australian-based);
3. program designers: the seven respective regional sporting organizations (RSOs) of
those Tongan NSFs: Netball Australia, Oceania Hockey Federation, International
Table Tennis Federation Oceania, Oceania Swimming Association, National Rugby
League, Federation International Football Association and Badminton Oceania
(Australia- or New Zealand-based)
4. program implementers: the seven Tongan NSFs who receive SfD funding (netball,
hockey, table tennis, swimming, rugby league, football (soccer) and badminton);
5. Tongan program participants.
A sixth SfD role of a ‘program contributor’ was later identified in-country after research-
ers communicated with the other five stakeholder groups. These were health- or sport-based
agencies in Tonga who provided ad hoc or periodic technical assistance and value in-kind
resources to SfD programming. The three program contributors identified were the Tongan
Government’s Ministry of Health and Ministry of Internal Affairs, and Tonga Health
Promotion Foundation (TongaHealth).
The documents analysed included the Tonga National Non-Communicable Disease
Strategy 2015–2020, Australian Sports diplomacy Strategy 2015–18, National Strategic Plan
for Sport and Active Recreation Development in Tonga 2015–2020, TongaHealth/Ministry
of Internal Affairs Fiefia Sports program and TongaHealth/Ministry of Internal Affairs
SPORT IN SOCIETY 5
Volunteer led program. To address reflexivity, the interplay between researcher and partic-
ipant, LK and JR do not identify as being of Pacific Island descent, and had no personal or
professional relationship with the organizations and study participants prior to their arrival.
Data collection
The researchers were primarily located on the main island of Tongatapu (70.1% of national
population). Tonga’s capital city Nuku’alofa is located on Tongatapu, and the majority of
SfD programs are implemented here. However, considerable fieldwork was undertaken in
both rural and urban settings on the island. LK spent one month in the remote Ha’apai
island group (6.2% of national population), and JR spent two weeks in Vava’u, (13.9% of
national population) (TDoS 2011) to interview key stakeholders in their respective setting.
Researchers took field notes at SfD planning meetings, community outreach pro-
grams, grassroots primary and secondary school programs, meetings with RSOs (see
Figure 1 for their role), evaluation meetings, during data collection undertaken by
research assistants, as well as during the delivery of PSP program components. LK and
JR collected data through local document analysis, interviews, focus groups, and direct
observation. These methods are aligned with relevant literature (Cody and Jackson
2014; Tak 2017) investigating the complex interplay between Government-level policy,
and organizational and individual behaviour. NL is a local author embedded within
various local Government structures and assisted with obtaining local documents,
facilitating attendance at key meetings/events, guidance on interview and focus group
participants and analysis.
For interviews and focus groups, we utilized a semi-structured interview guide covering
topics including the desired outcomes of SfD programs, how the organization evaluates
effectiveness of the programs to meet those outcomes, perceived barriers to effectiveness,
perceived facilitators/enablers of effective programs and policy/program changes that could
improve effectiveness. Interviews were conducted one on one. Focus groups were facilitated
on opportunistic occasions when stakeholders met for relevant matters. These included
two interviews with program funders/managers, four with program designers, six interviews
and five focus groups with program implementers (three focus groups had 7 participants,
and two had 6 participants), five interviews with health program contributors, five inter-
views with sport program contributors, and ten interviews with program participants. Due
to cultural and contextual intricacies, interviews and focus groups were not recorded, but
instead detailed notes were taken by interviewers. Specifically, this decision related to expe-
riences of the authors, where the added formality of recording interviews increased the
power distance (Hofstede 1997) between interviewers and interviewees, leading to decreased
data quality. In line with qualitative methodological and applied studies, notes were then
expanded upon through field notes taken in a reflective hour directly following the interview
(Phillippi and Lauderdale 2018; Smith etal. 2018).
Coding and analysis
Detailed notes were typed up on Microsoft Word and read through to ensure accuracy of
data and familiarization with content. Transcripts of detailed notes were then imported
into the NVivo 11 qualitative analysis software (QSR International Pty Ltd 2015).
6 L. KEANE ETAL.
Figure 2. Australian Sport-for-Development investment within the national health and development
priorities in Tonga.
Interviews and focus groups were used to elucidate key factors underpinning program
integration with local health and development priorities, which was then triangulated
where possible with data from local document analysis and field notes. Using the inductive
and iterative approach described by Braun and Clarke (2006), we identified themes from
the content of the interviews, rather than a priori. LK coded each piece of information
for either conceptualizing key underpinning factors (17 codes) or program mapping (2
codes). Over two meetings, LK, JR and NL iteratively mapped Tonga’s national develop-
ment priorities, Australian Aid flows, PSP program implementation model, as well as
how they intersect. These are presented diagrammatically in Figure 2. Over three meet-
ings, LK and JR iteratively refined codes, before developing five themes. These are dis-
cussed in the findings section, and shown diagrammatically in Figure 3. The study was
approved by the Government of Tonga’s National Health Ethics Research Committee
(Protocol number: 201,910,321 M).
Findings
Sport-for-development within national health and development systems of Tonga
As shown in Figure 2, Australian development funding to Tonga is provided through three
channels. The first is the Australia–Tonga Aid Partnership 2016–2019 (DFAT 2015a). This
channel provided an estimated $30.4 million in total official development assistance to
Tonga in the 2017–18 financial year. The partnership covers a range of health, economic
and infrastructure reforms shown in Figure 2, including the ‘Tongan Seasonal Worker
Program’ in Australia, and ‘Australian Award Scholarships’. This partnership represents the
primary form of aid provided by the Australian Government to Tonga.
SPORT IN SOCIETY 7
Tonga’s National Strategy to Prevent and Control Non-Communicable Diseases
2015–2020 (TongaHealth 2016) was co-funded by the Governments of Tonga and
Australia. This represents the dominant health priority document. Australia’s support
to the strategy is part of its AU$10 million bilateral Tonga Health Systems Support
Program, classified under the Australia–Tonga Aid Partnership 2016–2019 (Waddington
and Dodd 2013). The strategy funding is managed by an independent national health
promotion body, TongaHealth, to combat the four primary risk factors of NCDs –
alcohol, tobacco, diet and physical inactivity (TongaHealth 2016). The funding allocated
to decreasing physical inactivity is provided jointly to the Ministry of Health, and the
Ministry of Internal Affairs – Sport Development Division, to design and implement
physical activity-based programming.
The Australian Government’s Pacific Sports Partnership program (DFAT 2017) is cur-
rently in its third phase (Phase 1: AU$15 million over 2009–2014, Phase 2: AU$14 million
over 2013–2017, Phase 3: on-going). As shown in Figure 1, through Tongan NSFs, programs
aim to increase youth participation in sport, promote disability inclusion and gender
equality, and combat NCD risk factors, primarily physical inactivity.
Factors underpinning integration
Through interviews, focus groups and direct observation, we elucidated critical factors
underpinning the efficacy of integrating Australian-funded SfD within the local health and
development priorities in Tonga. These are represented in Figure 3.
Figure 3. Factors underpinning the ecacy of integrating Australian-funded Sport-for-Development
within local health and development priorities in the Kingdom of Tonga.
8 L. KEANE ETAL.
Governance
The perceived governance strength of each Tongan NSF, and governance of the Tongan
sport sector more broadly, were key factors for increased program integration within broader
priorities. Governance was important for NSFs, as those that were perceived to have strong
governance attracted additional local funding, conducted consistent programming, received
invitations to take part in program components of Tonga’s national NCD strategy, and
attracted a strong volunteer base. Governance was important for the Tongan sport sector,
as the positioning of sport within a broader government ministry, left NSFs in a position
to have to compete for resources. Exemplifying the link between governance and funding
in Tongan NSFs, a staff member of a local program contributor (program contributor #1)
commented:
ey [NSFs] come to us for help oen, but we don’t help them too much. Once they got money
from another organisation and it just disappeared, no one knows what even happened to it.
This indicates poor governance directly hindered the ability of NSFs to receive funding
from Tonga’s national NCD strategy, and likely other funding sources, to supplement that
provided through the PSP program. Further to this, poor governance also affected the
consistency of program delivery. Although the majority of NSFs explained they had program
components across the three main island groups (Tongatapu, Ha’apai and Vava’u), several
program participants in rural villages disputed this, with one program participant (program
participant #1) commenting:
Sometimes they [all NSFs] come here, it’s really fun, but we don’t really know when they
come, they just turn up sometimes… I think they’re more concerned with delivering
programs around Tongatapu. In Ha’apai we really only see [one NSF also observed by
researchers to have good governance]. But we organise our own activities, and we have
the grounds down there.
One NSF (NSF #1) directly observed by researchers to have strong governance, limited
employees, and a presence at the majority of program components delivered under Tonga’s
national NCD strategy, was prompted to comment on this:
We have a lot of volunteers. You probably see them with their [colour] shirts out there. We
actually pay them once they’ve been with us for a while, a lot of the other sports [NSFs] don’t,
and so we’ve slowly built up like that.
The majority of Tongan NSF staff members also commented that sport in the Tongan
Government is situated within a broad and ‘busy’ ministry. This indicates Tongan NSFs felt
marginalized by the broader governing body, demonstrated by the quote (NSF #2):
Well we have to deal with MIA [Ministry of Internal Aairs], and they also run the high-per-
formance rugby program and then there are the other [seven] bureaus, so they have so much
going on at one time.
Communication
The strength of the communication and relationship between the Tongan NSFs and their
respective RSO was a key driver behind effective integration. This communication led to
SPORT IN SOCIETY 9
strengthened organizational capacity, which was characterized by knowledge transfer, stra-
tegic planning and mentorship that occurs during this process. This co-creation of strategic
plans likely leads to a higher degree of goal alignment between the two stakeholders, as
shown in Table 1. As one Tonga NSF staff member (NSF #1) commented referring to the
relationship with their RSO:
[they’ve] been an incredible mentor to us and has really worked to understand our culture and
way of life, and they’ve allowed us to do the work we’ve wanted to and just really supported
that in any way we’ve needed …. putting our strategic planning together for the year.
This same participant then elaborated on this:
en we’ve had access to all the resources of [RSO name], and [Tongan development ocer
name] was in Melbourne last year doing the [course run by RSO]
This strengthened organization capacity likely increases the ability for NSFs to contribute
to health and development priorities. A staff member from a NSF with strong communi-
cation with their RSO commented in reference to involvement in a national NCD
strategy-funded health program, ‘we’ve actually started managing parts of that program
and contributing some of our staff to run it’.
It was directly observed by researchers that Tongan NSF staff members that communi-
cated regularly with locally based sport and health SfD program contributors, also tended
to be perceived in a more positive manner within those stakeholders. This occurred between
NSF #3 and sport program contributor #2. Researchers directly observed that close rela-
tionships and regular communication led to benefits such as invitations to contribute to
national NCD strategy-funded health programs and large-scale events (e.g. International
Day of Sport for Development and Peace), and more favourable budgetary allocation from
health and sport stakeholders.
Champions
The involvement of development ‘champions’ was another factor underpinning the inte-
gration of SfD with local health and development priorities. Champions (also referred to
as change agents in other fields) are local staff members, who through unique personal
characteristics, provide a form of human capital crucial to building the capacity of pro-
gramming (Thakhathi 2018; Ward, House, and Hamer 2009; Vail 2007; Hazel etal. 2013).
Researchers directly observed champions within the organizational structure of two
Tongan NSFs (NSF #1 and #4), and one program contributor (program contributor #2).
These three champions were also identified during interviews, as a majority of participants
would mention them in a positive manner by name. This was exemplified by references
such as ‘[they are] really good, we’re actually trying to work more with [them]’ and ‘[they
are] amazing, [they] work so hard’. Similar comments were made about the champions in
other interviews. Activities of SfD champions directly observed by researchers in these two
NSFs included managing Government sporting projects beyond what is formally required
in their job description, being the genesis for large-scale cross-sectoral health and sport
events, as well as proactively forming partnerships with health and development stakehold-
ers. Further to this, a staff member of a locally based program contributor (program
10 L. KEANE ETAL.
contributor #2) explained that proactively seeking external funding was another behaviour
of champions:
You’ll notice when the sports all meet, everyone looks to [the champion] for guidance,
[they are] almost like a mentor to them…. [they] go around and look for funding every-
where, and sometimes they get it because people know they won’t just steal it, they make
use of it well.
Capacity
The capacity of the SfD implementation base was also a critical factor underpinning inte-
gration of programs with health and development priorities. This included the number of
staff members in each Tongan NSF; capacity of NSFs to cover the administration, SfD
programming and high-performance programming; and high-staff turnover. Researchers
directly observed Tongan NSFs to have between one and six staff members. This resulted
in a variance of capacity to deliver PSP program components, as well as conduct adminis-
tration duties and high-performance programs. Local document analysis found this had
occurred with the Tonga Cricket Association, who were suspended by the International
Cricket Council following a prolonged period of ‘sub-standard’ administration practices
(Matangi Tonga 2013). Despite the significant and sustained financial investment by program
funders, planning and resource investment from RSOs and health and sport contributors,
NSFs with limited employee numbers are often the solitary program implementation bodies.
Staff members from two NSFs (NSF #3 and #4) explained this narrow implementation base:
It’s hard, we only have funding for [small number] sta members, you know, what can we
really achieve being so small, we need other assistance.
The second NSF staff member built on this by commenting:
We really needed an administration ocer badly, I moved some funding from programs
and asked around for some sponsorship, and now we’ve just scraped together enough to get
someone on.
This indicates the number of staff members in this NSF was only sufficient to undertake
their regular administration duties, rather than implement programs contributing to health
or development priorities. Adding to this issue of capacity, RSO #5 commented on the issue
of having high-staff turnover, ‘you train people up, or give them a scholarship and then
they go work for a bank or something’. While an NSF staff member (#5) added, ‘it’s really
all about trying to get the right people in the right jobs’. This indicates high-staff turnover,
or inadequate numbers of trained staff, compounded the issue of limited capacity at the
implementation base, decreasing the likelihood of their NSF playing a role in national health
or development programs.
Alignment
Alignment was a multi-faceted and complex factor that included three dimensions: 1) the
alignment of SfD program objectives at the macro-level (between the six stakeholder
groups), 2) alignment of program objectives at the micro-level (within Tongan NSFs)
and3) the alignment of stakeholder’s evaluation activities with their program objectives.
SPORT IN SOCIETY 11
Alignment of outcomes at macro-level
As shown in Table 1, it is important to explore the objectives of the six SfD stakeholder
groups. This is done by using both local document analysis and interviews. The objectives
of the SfD program funders are to ‘enhance development and public diplomacy activities
by providing high quality, high-impact SfD programs that link identified development
outcomes with Australia’s diplomatic goals’ (DFAT 2015b). Their managing consulting firm
(program manager) mimic these objectives. Local health based program contributors
TongaHealth and Ministry of Health state that their objective is to deliver programs that
address the four NCD risk factors – alcohol, diet, tobacco and physical inactivity amongst
targeted high-risk groups (TongaHealth 2016). This is due to TongaHealth being the sec-
retariat of ‘Tonga’s National Strategy to Prevent and Control Non-communicable Diseases
Table 1. Through interviews and local document analysis, objectives and evaluation designs were
elucidated for each stakeholder.
Stakeholder position Stakeholder Primary objectives Evaluation design
Program Funders Australian Government (1) Target NCD risk factors
(physical inactivity)
Independent evaluation
(2) Spor ts diplomacy Internal evaluation
Program Managers Contracted consulting
rm
(1) Increase participation in sport Participant reach evaluation
(2) Spor ts diplomacy Internal evaluation
Health-based program
contributor
Tonga Health Promotion
Foundation
(1) Target NCD risk factors
(physical inactivity)
WHO STEPS data collection
(2) Ensuring accountable and
transparent funding use
Financial reporting
Health-based program
contributor
Ministry of Health –
Health Promotion Unit
(1) Target NCD risk factors
(physical inactivity)
WHO STEPS data collection
(2) Target Government workers
in programs
Participant reach evaluation
Sport-based program
contributor
Ministry of Internal Aairs
– Sport Development
Division
(1) Increase participation in sport Participant reach evaluation
(2) Target Government workers in
programs
Participant reach evaluation
(3) Develop in-country high-
performance programs
Competition numbers
Program designers Regional Sporting
Organizations
(1) Increase participation in sport Participant reach evaluation
(2) Develop in-country high-
performance programs
Competition numbers
(3) Ensuring accountable and
transparent funding use
Financial Reporting
(4) Tongan NSF governance
strengthening
Perceived governance
strength
(5) Increase international
rankings and participation
Rankings/competition
involvement
Program Implementers Tongan National Sporting
Federations
(1) Increase participation in sport Participant reach evaluation
(2) In-country high-performance
programs
Competition numbers
(3) Increase international
rankings and participation
Rankings/competition
involvement
Program participants Tongan population (1) Increase participation in sport Internal evaluation
(2) In-country high-performance
programs
Competition numbers
(3) Increase international
rankings and participation
Rankings/competition
involvement
12 L. KEANE ETAL.
2015–2020’ (TongaHealth 2016), co-funded by the Governments of Tonga and Australia.
The Ministry of Internal Affairs Sport Development Division, is the governing body of
sport-for-health and Tongan NSF development, and therefore termed a ‘sport-based con-
tributor’ to the PSP program in this study. Together, the Ministry of Health and Ministry
of Internal Affairs jointly manage the ‘physical activity’ component of the strategy to design
and deliver programs utilizing the strategy funding provided by TongaHealth (TongaHealth
2016). Recognizing the need for alignment with Tonga’s National NCD strategy to gain
resources and increase the reach of programs, one Tongan NSF staff member (#6)
commented:
It’s good to work with the Sport Development Division because they’ve got more money [from
the NCD strategy] than us and we can use their transport, equipment and music players at
community events.
Further to this, despite sport-for-all being one of the seven best investments for decreas-
ing population-level physical inactivity (Trost, Blair, and Khan 2014), a clearly defined role
for the PSP program (DFAT 2017) is largely absent in the physical inactivity component of
Tonga’s national NCD strategy (TongaHealth 2016). Although both the strategy and PSP
program targeting risk factors for NCDs (see Table 1), Australian Government funding for
the national NCD strategy, and PSP program, are provided largely independent of each
other. The two funding schemes are only tenuously linked through periodic and opportu-
nistic involvement of NSFs, funded through the PSP program, in physical activity programs
implemented under the national NCD strategy. Program manager (#1) commented on the
weaknesses of limited collaboration between PSP programs and sport and health
contributors:
We’re all getting this funding and running our own programs, but everyone seems to be
doing different things, what’s it all about? What are we even trying to do?
This indicates that misaligned outcomes were causing the fragmentation of the SfD
sector in national health and development priorities. In most cases, RSOs (program
designers) are based in Australia or New Zealand, and have a pre-existing relationship
with Tongan NSFs (program implementers). Local document analysis and interviews
described their priorities as developing high-performance programs, Tongan NSF gov-
ernance and increasing participation in their sport. Tongan NSF priorities are building
in-country high-performance programs, increasing national representative participation,
and increasing quality participation within their sport. Having these two stakeholders
responsible for designing and implementing health- and social-based programs is mis-
aligned with their strengths and objectives. Outlining this misalignment of expertise, one
staff member from an RSO (#2) commented they were ‘going to put some money aside
for evaluation, it will be interesting to see if the programs actually have any effects on
health’. This exemplifying a lack of confidence in their ability to design and implement
effective health programs.
Compounding this issue, Tongan NSFs are encouraged by the PSP program to dedicate
human and time resources to design and deliver these population-level health and devel-
opment PSP programs. Their limited knowledge of the skill-set required was shown by one
Tongan NSF staff member (#2) commenting, ‘We run programs for women out in the
villages to lose weight, it’s good fun, I don’t know if it does anything’.
SPORT IN SOCIETY 13
One NSF staff member (#2) explained that undertaking the regular duties of their NSFs,
as well as implementing PSP-funded health and development programs, could be mutually
exclusive:
We’re trying to get funding to go to the Pacic Games, we’ve got the funding [PSP program
funding], but we’re not allowed to use the money from Australia, we have to use that on our
community programs, hopefully we can get the money we need for the Pacic Games from
somewhere or we can fundraise.
This misalignment is likely to affect program sustainability, with low-capacity NSFs
balancing their high-performance programs with PSP programming. This misalignment
of objectives also decreases the resources and political ‘buy-in’ provided by local program
contributors to SfD programs and the cohesion between stakeholders. In Tonga, one staff
member from a health-based program contributor (#1) outlined this lack of political buy-in
and cohesion:
We should be doing more with the [program contributor] people, because we both do physical
activity stu, but we don’t really have much to do with them.
Alignment of outcomes at the micro-level
Within Tongan NSFs there was debate surrounding the proportion of PSP funding to be
allocated between high-performance sport, and PSP programming aligned within local
health and development priorities. This debate often occurred between management staff,
and board members of the NSF. With boards encouraged to be largely independent from
the federation, a disconnect can occur in perceived benefits of the two program types. This
occurred in Tonga in several NSFs receiving PSP funding, with the NSF board wanting to
use funding for travel to international competitions, and management staff wanting to
support health- and development-based SfD programs, or vice versa. One NSF staff member
(#1) that had avoided this pitfall, but recognized it as an issue, commented:
You always want your board involved and understanding [your decisions] so we send them
reports all the time, and they come to our events so they can see what we do through PSP
[Australian SfD funding].
This disconnect between board and NSF was directly observed by researchers, leading
to the replacement of a key staff member, and halting of their PSP programs until a replace-
ment could be found. There were also several cases where NSFs, funded under the PSP
program, had misused it on high-performance programs and international tournament
costs. One Tongan NSF in the Pacific region had even been shut down (Matangi Tonga
2013), as this had constituted a breach of funding rules.
Alignment of evaluation outcomes
The evaluation methods also differed throughout the six stakeholder types. For program
funders, evaluation primarily assesses the contribution of the program to the goals of inter-
national development (i.e. participant numbers), as well as commissioned independent
qualitative process evaluations describing the efficacy of the program delivery model
(Synergistiq 2015; Holden and Vella 2018).
14 L. KEANE ETAL.
Local document analysis revealed that for Tonga’s health-based program contributors,
participant reach evaluations are the primary method utilized, with participant numbers
and demographic information collected during programs (TongaHealth 2016). This is sup-
plemented by the World Health Organization STEPS data collection monitoring progress
on combating NCDs (WHO 2014). Researchers directly observed that reach evaluations
were also the most commonly used method used by Tonga’s sport-based program contrib-
utors. This is likely responsive to their mandate of increasing sport participation, the low
cost of collecting such data, as well as the ease of data analysis. Direct observation by
researchers during data collection found that similarly to health contributors, sport con-
tributors likely lacked the human resource capacity to evaluate health behaviour change in
physical activity programs.
Interviews found Australia and New Zealand-based RSOs used ‘participation reach’,
‘national rankings’ and ‘[governance] reputation of [their respective] Tongan NSFs as eval-
uation measures. Direct observation also found that due to limited staff members and
capacity, Tongan NSFs had limited resources to conduct their own evaluation activities.
Pragmatic methods for evaluating the effectiveness of their organization included ‘regional
rankings’, ‘reputation’, ‘participation reach’ and the ability to attract ‘sponsorship’ and ‘other
funding’.
Despite limited attention to evaluation, one exception was Netball Australia who
had budgeted part of their PSP funding to independent program evaluation. The find-
ings from these evaluations led Tonga Netball to successfully apply for supplementary
program funding from program managers and contributors, and expand piloted pro-
grams aligned with national health and development priorities nationally (e.g. into
remote island group). These evaluations were also published in peer-reviewed journals
(Richards etal. 2016; Sherry and Schulenkorf 2016; Schulenkorf, Sherry, and Rowe
2016), adding to the sparse SfD evidence base in the Pacific islands, and SfD more
broadly.
Discussion
The factors underpinning the efficacy of integrating SfD within local health and develop-
ment priorities in Tonga present opportunities for discussion on their practical implications,
linkages with existing literature and development of strategies leveraging their potential
benefits in programming.
Governance
We found that Tongan NSFs who had governance weaknesses (or a history of), and gover-
nance weaknesses in Tonga’s sport sector more broadly, negatively impacted funding oppor-
tunities for the sector, integration with national NCD programming, as well as their own
programming consistency and volunteer base. These interconnected negative externalities,
combined with Tongan NSFs closing down due to ‘sub-par administration’ (Matangi Tonga
2013), indicates that improving governance across the sector must become a priority for
integrating SfD within local health and development priorities. This finding is supported
by Lindsey (2017), who found the lack of attention towards issues of governance in global
SPORT IN SOCIETY 15
SfD policy and literature is largely inept when compared to the significance accorded to
such issues in international development. The development of this governance appears to
be the key role that RSOs play in SfD in Tonga. As Tongan NSFs are the primary SfD imple-
mentation bodies, RSOs assisting NSFs to develop quality financial reporting, local staff
member mentoring and strategic planning guidance (e.g. aligning outcomes with health
and development priorities) is crucial for aligning PSP programs with national priorities.
Communication
Our finding of cross-stakeholder ‘communication’ as a key factor is also supported by lit-
erature examining partnerships in sport and health priorities. Baker, Ansari, and Crone
(2016) for example, found that sustaining a positive benefits-to-costs relationship, estab-
lishing an effective communication and partnership strategy, and demonstrating impact,
were predictive of the four intermediary partnership outcomes. As culture in the Pacific
Islands is grounded in respectful and close relationships (Hofstede 1980), foreign-based
stakeholders who invest inadequate time in-country building these close personal relation-
ships and developing effective communication, jeopardise their ability to integrate programs
with those of key local health and sport bodies, who govern health and development policy.
Champions
Adding to this, our finding of development ‘champions’ being a key factor for integrating
SfD within local health and development priorities, is also consistent in relevant literature.
The concept of a ‘champion’ occurs in a range of fields (Ward, House, and Hamer 2009;
Thakhathi 2018; Hazel etal. 2013; Vail 2007). SfD program funders and designers must
proactively identify key champions, and utilize them as a mechanism for activating the shift
from planning the integration of SfD outcomes with health and development priorities,
into ‘on the ground’ practice. This again only appears achievable through investment in
in-country face-to-face time, building rapport and communication channels with local
stakeholders, and decreasing staff turnover.
Capacity, alignment and cross-sectoral partnerships
There was a lack of ‘alignment’ in program outcomes between the six SfD stakeholder
groups identified in Figure 1. Due to their key role in managing Tonga’s national NCD
strategy, program contributors have explicit objectives of addressing the four risk factors
for NCDs (Figure 3). However, as shown in Table 1, this objective of combating NCDs
isnot present in the skill-set of SfD program designers (RSOs) or implementation bodies
(NSFs). This misalignment of objectives between sport, health and development bod-
iescould be partially explained by Marsh and Rhodes (1992), who found the level of
resources of a stakeholder in cross-sectoral activities determines the level of hierarchy
within networks, or involvement in those networks at all. Marsh and Rhodes explained
that as NSFs often receive limited funding from the government, they have been unable
to frequently interact with higher-funded health-based stakeholders in health policy nego-
tiations (e.g. Tonga’s national NCD strategy). This limited the influence SfD could have
16 L. KEANE ETAL.
in advocating their role, and being allocated health funding, in health and development
priorities in Tonga.
Further to this, the limited capacity of NSFs shows a weakness of the model currently
used to deliver the PSP program, to achieve population-level changes. Although an intuitive
assumption that at the heart of SfD are the local NSFs, with the level of funding provided
through SfD initiatives unmatched by local capacity (e.g. human and time) to deliver pro-
gramming, investment could focus on strengthening local grassroots systems further prior
to program delivery. These limitations also support the case for integrating SfD within local
health and development priorities, which could assist in broadening the implementation
base and limiting the reliance of SfD delivery on just one to six employees at the grassroots
level. This limited integration was apparent in Tonga, with SfD largely operating outside
the activities of the sport-based program contributors. As these program contributors design
programming to decrease physical inactivity within Tonga’s National NCD strategy, dis-
tancing them from the SfD funding model could weaken their ability to advocate for increas-
ing the role of the PSP program in health and development priorities.
One example of cross-sectoral collaboration in Tonga is the Ministry of Health and
Ministry of Internal Affairs co-managing the physical activity component of Tonga’s national
NCD strategy (TongaHealth 2016). The partnership between sport and health program
contributors allows sport to be used as a resource in the strategic planning of Ministry of
Health activities. For example, sport-based program contributors can provide access to
sporting infrastructure, human resources and equipment, and health-based program con-
tributors can provide health promotion planning and implementation expertise. This is a
crucial step towards the development of the cross-sectoral collaboration necessary for posi-
tioning SfD as a tool for contributing to Tonga’s health and development priorities. Further
to this, as Tonga is a member of the Commonwealth, this step is aligned with implemen-
tation strategies for increasing the effectiveness of SfD made by the Commonwealth
Secretariat (2014). The Commonwealth Secretariat state that sport by itself is insufficient
to make beneficial change, and that a well-co-ordinated multi-sectoral approach is necessary.
Despite this finding, there is disagreement in relevant literature regarding the role of
Government sport ministries in SfD. For example, the Commonwealth Secretariat (2014) also
found that in many countries the management of SfD is delegated to sport ministries, such
as the Ministry of Internal Affairs in Tonga. While many of these actors are highly supportive
of SfD, they have to balance high-performance sport and SfD priorities (Commonwealth
Secretariat 2014). SfD is therefore in the position of having to compete for funding from an
already overstretched resource pool. These contrasting findings potentially indicates the
appropriateness of sport ministries playing a hand in SfD programs, comes down to an analysis
of the specific context within each setting. This finding is also supported by Houlihan and
Lindsey (2008), who advocate for partnerships that balance having adequate numbers of
actors to bring skillsets and the pooling of resources (e.g. cross-sectoral frameworks and
programs), with avoiding the ‘too many cooks spoil the broth’ paradox.
Evaluation
From the program funders’ perspective, evaluations of program reach (i.e. participant num-
bers) and case studies were the key approaches to assessing the investment in the SfD sector
in Tonga. In contrast, Tongan NSFs seemed to prioritise participant numbers to a lesser
SPORT IN SOCIETY 17
degree. This reflects a disconnect between the evaluation approach, and their own objectives
of improved rankings, developing administrative and governance strength, and strength-
ening high-performance programs (Table 1). Health contributing bodies also placed a low
priority on increasing sport participation numbers, as they have a specific mandate to
address risk factors for NCDs (TongaHealth 2016). To address these risk factors (primarily
physical inactivity), programs need to target sustainable health behaviour change amongst
high-risk NCD groups. Evaluations typically carried out by program funders, which include
assessments of reach that did not differentiate the quality of participation, fail to evaluate
the potential effect of programs and do not address key metrics for the health sector (i.e.
frequency and intensity of participation) (Armstrong and Bull 2006).
This fragmented approach to SfD implementation and evaluation is well documented in
international literature (Lindsey 2017; Jeanes and Lindsey 2014), where several explanations
are posed. Firstly, that the types of information that may be beneficial to improving practice
within the SfD sector (e.g. evidence of underlying mechanisms or ‘best-buy’ strategic policy
recommendations), would not likely be the same as those that would convince external policy
makers and funders of the merits of SfD (e.g. reach evaluations and diplomacy outcomes).
More generally, an explanation could be that each stakeholder is engaging in the evaluation
outcomes necessary to justify their own involvement in the sector, rather than to improve
programming. Secondly, that the decentralized, individual project-based SfD model used in
Tonga, causes this movement towards each stakeholder evaluating in isolation.
The role of sport in health and development priorities
Tasking RSOs, whose core business is high-performance sport, with designing health- and
social-based SfD programming appears counterintuitive due to the importance of specialized
knowledge in the design of these programs, and complexity of health promotion more broadly
(Rutter 2018; Rutter etal. 2017). In this model, neither organization is contributing to SfD
within their area of expertise, and are attempting to achieve objectives they are not fundamen-
tally set-up to address. Similar misalignments in SfD delivery structures have been noted in
other LMICs. In Zambia, Banda (2017) identified a lack of engagement of Zambian NSFs at
strategic decision-making level, caused by the marginalization of sport by other sectors. This
had left NSFs unable to shape health policy and their role in it. Banda (2017) added that the
sport sector needs to integrate with planning for development outcomes at the national level,
and with mainstream development agencies, in order to make effective contributions. This is
relevant in Tonga, as the Australian Government plays a role in both formulating health policy
(through development and NCD strategy funding), and SfD programming. This common
stakeholder providing a foundation to facilitate the integration of SfD within health policy.
This would likely allow for better alignment of outcomes and evaluation measures between
SfD, and health and development priorities. Without this prerequisite of higher-level priority
alignment of SfD with health stakeholders, sport stakeholders and national health and devel-
opment priorities (e.g. National NCD strategy), such programs are unlikely to affect sustainable
health behaviour change. This finding is supported by Lindsey (2017), who found the com-
monality of narrow, project-based approaches in SfD as predominantly seen in Tonga, con-
tributes to excessive donor influence, fragmentation, competition and limits both impact and
sustainability.
18 L. KEANE ETAL.
Researchers noted during local document analysis that the Australian Government funding
for the PSP program, and funding of Tonga’s national NCD strategy, were only tenuously linked.
The importance of this is discussed in relevant literature investigating the integration of SfD
within the national health and development priorities in Zambia. In this setting, Lindsey and
Banda (2010) found that the SfD sector lacked integration into more high-level strategic part-
nerships that addressed their targeted outcome of HIV/AIDS awareness and education. This
was due to a lack of understanding of the SfD sector as a whole by national HIV/AIDS bodies,
lack of alignment between the program outcomes of SfD practitioners and those identified
within the National HIV/AIDS Strategic Framework, and a lack of alignment between the
evaluation styles of SfD programs and HIV/AIDS programs. Specifically, Zambian national
HIV/AIDS targets are based upon measurable and quantitative outputs, while SfD tended to
focus on outcomes of personal and social development, which are harder to measure quanti-
tatively. Darnell and Black (2011) added that an enduring challenge in SfD is how to situate
the topic of sport more explicitly within the field of international development. In Tonga, this
lack of alignment is a key barrier in allowing SfD programs to be tailored by health and sport
stakeholders, and used as tools to contribute to local health and development priorities.
Moving towards a more eective SfD delivery and evaluation model
A potential alternative model for SfD used in developed settings is the cross-sectoral
framework in the United Kingdom (UK). The foundation for this model are partnerships
and objective alignment formed between Public Health England and Sport England (Sport
England 2016). This alignment shifts the definition of sport away from structure and
high-performance, towards a broader definition of becoming a vehicle to promote health
and physical activity. This model prioritises cross-seeding expertise between sectors; cre-
ating common cross-sectoral language; proactively engaging the least active in society;
strengthening delivery systems and infrastructure (e.g. the implementation base); engaging
but not relying on NSFs to implement programs; as well as the design of a standardized
evaluation framework and increased investment in rigorous evaluation (Sport England
2016). Sport England increasing collaboration with Public Health England does not just
bring unique skillsets into the field, but also new evaluation methods, perspectives and
evidence from which to design, implement and evaluate models. For example, the field of
health systems strengthening is designed and evaluated around the principles of ‘systems
theory’ (Savigny and Adam 2009). Systems theory places strong consideration on the wider
influences in cross-sectoral programming, rather than an individual project-based per-
spective (Massey etal. 2015; Whitley, Massey, and Wilkison 2018). The field of obesity
prevention, to which Public Health England is responsible, has also incorporated the
principles of systems theory into delivery models of programming (Rutter 2018, Rutter
etal. 2017). Lessons from this model in the UK, and resulting lessons learned in the years
ahead, will be critical for settings such as Tonga to consider.
Conclusion
We found ‘governance’, ‘communication’, ‘capacity’, ‘champions’ and ‘alignment’ to be the factors
underpinning the efficacy of integrating Australian-funded SfD within local health and
SPORT IN SOCIETY 19
development priorities in Tonga. Due to the dynamic, complex and low-resourced setting in
which they operate, and compounded by the presence of a wide array of stakeholder groups
and funding sources, these factors warrant strong consideration by foreign SfD funders and
managers during program design, delivery and evaluation. Findings directly relevant for prac-
tice surround the need to ensure alignment of program outcomes and evaluation activities
between the SfD sector and local health and development priorities. This is achieved through
building the governance strength of SfD implementation bodies through in-country mento-
ring and support, strong communication channels across stakeholder groups and the identi-
fication of ‘development champions’ to increase program effectiveness. These factors ensure
organizational and resource ‘buy-in’ from local health and sport stakeholders in SfD, leading
to the potential for programs to be scaled-up and contribute to local health and development
priorities. Future research trajectories assisting this integration include an increased emphasis
on systems theory, for the design and evaluation of cross-stakeholder system-based interven-
tions, rather than those that are individual project-based.
If there is no shift towards integrating SfD within local health and development priorities,
SfD risks being confined to fragmented and decentralized program components, that will
struggle to attract supplementary resources, contribute to broader outcomes, or achieve
sustainability and population-level effect.
Disclosure statement
No potential conict of interest was reported by the authors.
Funding
is research was primarily funded by a Sydney Medical School – early career research scholarship.
ORCID
L. Keane http://orcid.org/0000-0002-6693-8419
J. Negin http://orcid.org/0000-0002-2016-311X
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