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Can they get along without us? Sustainability of donor-supported health projects in Central America and Africa

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  • Bossert, Thomas J.

Abstract

This article presents a synthesis of five country studies of the sustainability of U.S. government-funded health projects in Central America and Africa. The studies reviewed health projects with a comparative framework to determine which project activities had continued after the donor funding ceased. This review found that health projects in Africa were less firmly sustained than those in Central America. The studies then evaluated context factors and project characteristics that were related to the sustainability of the projects. The weak economic and political context of the African cases was found to inhibit sustainability in those countries, suggesting that broader development issues be addressed before donors expect significant sustainability of health projects in Africa. Even in Central America it was found that the strength of the institution implementing the project was an important variable for sustainability, suggesting that donor attention also be shifted toward strengthening institutional development in order to assure sustainability. In addition to context factors, several project characteristics were related to sustainability in most cases and suggest sustainability guidelines for project design and implementation. The article concludes that projects should be designed and managed so as to: (1) demonstrate effectiveness in reaching clearly defined goals and objectives; (2) integrate their activities fully into established administrative structures; (3) gain significant levels of funding from national sources (budgetary and cost-recovery) during the life of the project; (4) negotiate project design with a mutually respectful process of give and take; and (5) include a strong training component.

Suggested Citation

  • Bossert, Thomas J., 1990. "Can they get along without us? Sustainability of donor-supported health projects in Central America and Africa," Social Science & Medicine, Elsevier, vol. 30(9), pages 1015-1023, January.
    • Handle: RePEc:eee:socmed:v:30:y:1990:i:9:p:1015-1023
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    1. Bennett, Sara & Ozawa, Sachiko & Rodriguez, Daniela & Paul, Amy & Singh, Kriti & Singh, Suneeta, 2015. "Monitoring and evaluating transition and sustainability of donor-funded programs: Reflections on the Avahan experience," Evaluation and Program Planning, Elsevier, vol. 52(C), pages 148-158.
    2. Bailie, Ross S. & Robinson, Gary & Kondalsamy-Chennakesavan, Srinivas N. & Halpin, Stephen & Wang, Zhiqiang, 2006. "Investigating the sustainability of outcomes in a chronic disease treatment programme," Social Science & Medicine, Elsevier, vol. 63(6), pages 1661-1670, September.
    3. Stella Nordhagen & Khadidjatou Thiam & Souleymane Sow, 2019. "The sustainability of a nutrition-sensitive agriculture intervention: a case study from urban Senegal," Food Security: The Science, Sociology and Economics of Food Production and Access to Food, Springer;The International Society for Plant Pathology, vol. 11(5), pages 1121-1134, October.
    4. Stockmann, Reinhard, 1997. "The sustainability of development projects: An impact assessment of German vocational-training projects in Latin America," World Development, Elsevier, vol. 25(11), pages 1767-1784, November.
    5. Aga, Deribe Assefa, 2016. "Factors affecting the success of development projects : A behavioral perspective," Other publications TiSEM 867ae95e-d53d-4a68-ad46-6, Tilburg University, School of Economics and Management.
    6. Sabbat, Jolanta, 1997. "International assistance and health care reform in Poland: barriers to project development and implementation," Health Policy, Elsevier, vol. 41(3), pages 207-227, September.
    7. Belay Simane & Benjamin F. Zaitchik, 2014. "The Sustainability of Community-Based Adaptation Projects in the Blue Nile Highlands of Ethiopia," Sustainability, MDPI, vol. 6(7), pages 1-18, July.
    8. Khan, Mishal S. & Pullan, Rachel & Okello, George & Nyikuri, Mary & McKee, Martin & Balabanova, Dina, 2019. "“For how long are we going to take the tablets?” Kenyan stakeholders’ views on priority investments to sustainably tackle soil-transmitted helminths," Social Science & Medicine, Elsevier, vol. 228(C), pages 51-59.
    9. Grindle, Merilee S., 1997. "Divergent cultures? When public organizations perform well in developing countries," World Development, Elsevier, vol. 25(4), pages 481-495, January.
    10. Harro Maat & Dina Balabanova & Esther Mokuwa & Paul Richards & Vik Mohan & Freddie Ssengooba & Revocatus Twinomuhangi & Mirkuzie Woldie & Susannah Mayhew, 2021. "Towards Sustainable Community-Based Systems for Infectious Disease and Disaster Response; Lessons from Local Initiatives in Four African Countries," Sustainability, MDPI, vol. 13(18), pages 1-18, September.
    11. Ebert, Cara & Flörchinger, Daniela & Frohnweiler, Sarah & Ihring, Stephanie & Rosadio Cayllahua, Karen Micaela, 2021. "Employment and income effects of skills development interventions: An impact evaluation of three employment promotion measures in Eastern Africa within GIZ's employment and skills for development prog," RWI Projektberichte, RWI - Leibniz-Institut für Wirtschaftsforschung, number 251877.
    12. Toledo Romani, Maria E. & Vanlerberghe, Veerle & Perez, Dennis & Lefevre, Pierre & Ceballos, Enrique & Bandera, Digna & Baly Gil, Alberto & Van der Stuyft, Patrick, 2007. "Achieving sustainability of community-based dengue control in Santiago de Cuba," Social Science & Medicine, Elsevier, vol. 64(4), pages 976-988, February.
    13. Rosenberg, Alana & Hartwig, Kari & Merson, Michael, 2008. "Government-NGO collaboration and sustainability of orphans and vulnerable children projects in southern Africa," Evaluation and Program Planning, Elsevier, vol. 31(1), pages 51-60, February.
    14. Richard A. Cash & James R. Potter, 2014. "Effectiveness of International Aid for Diarrheal Disease Control and Potential for Future Impact," WIDER Working Paper Series wp-2014-016, World Institute for Development Economic Research (UNU-WIDER).
    15. Johnson, Knowlton & Hays, Carol & Center, Hayden & Daley, Charlotte, 2004. "Building capacity and sustainable prevention innovations: a sustainability planning model," Evaluation and Program Planning, Elsevier, vol. 27(2), pages 135-149, May.
    16. Stella Nordhagen & Abdoulaye Traoré, 2022. "Group-based approaches to nutrition-sensitive agriculture: insights from a post-project sustainability study in Côte d’Ivoire," Food Security: The Science, Sociology and Economics of Food Production and Access to Food, Springer;The International Society for Plant Pathology, vol. 14(2), pages 337-353, April.
    17. Cash, Richard A. & Potter, James R., 2014. "Effectiveness of international aid for diarrheal disease control and potential for future impact," WIDER Working Paper Series 016, World Institute for Development Economic Research (UNU-WIDER).
    18. Dr. John Cheluget (MUA) & Ngari Caroline Wamuyu (MUA), 2020. "Sustainability of Donor Funded Projects in Public Hospitals in Kenya: A Case of HIV/Aids Projects at “N†County Referral Hospital," International Journal of Research and Innovation in Social Science, International Journal of Research and Innovation in Social Science (IJRISS), vol. 4(8), pages 140-150, August.
    19. Souha El Khanji, 2022. "Donors’ Interest in Water and Sanitation Subsectors," The European Journal of Development Research, Palgrave Macmillan;European Association of Development Research and Training Institutes (EADI), vol. 34(2), pages 611-654, April.
    20. Deribe Assefa Aga & N. Noorderhaven & B. Vallejo, 2018. "Project beneficiary participation and behavioural intentions promoting project sustainability: The mediating role of psychological ownership," Development Policy Review, Overseas Development Institute, vol. 36(5), pages 527-546, September.

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