1. Introduction to the Sustainability Framework Karl Blanchet, 2009 Adapted from Ricca J., 2009, CSTS

2. Why does sustainability matter? Public Health, social and economic Impact Changes in morbidity rates, productivity, inclusion of people with disabilities ….is related to  Relevance  Effectiveness  Efficiency  Equity  Sustainability Adapted from OECD 2007

3. Sustainability matters, but…  Are we clear about what we mean by sustainability?  Do we all agree on our vision for sustainability?  Who are “we”?  Do we have unrealistic expectations?  Do we know how to measure it?  Do we know what is likely to achieve this outcome (i.e. what are best practices)?

4. Sustainability in context  Planning is based on a linear model: input → process → outputs → outcomes  Actual development processes fit a much more complex pattern: Multidimensionality Non-linear cause and effect relationship Unpredictability

5. A definition of sustainability Sustaining health benefits to the beneficiary population after project end Shediac-Rizkallah, 1998; CORE-CSTS Sustainability Initiative 2002 $, £, € Public health benefits T Activities

6. Sustainability: What are we trying to measure? Individuals, communities and local organizations constitute a local system within their environment. It is ultimately the coordinated social interactions and efforts of actors that will lead to lasting health impact.

7. Project Who makes sustainability happen? Local System Local system sustainability Project contribution

8. Sustainability Framework Model (CSTS, 2008)

9. Component 1: Health Outcomes Who? Population in project area What is it? Summary measure of the health outcomes achieved in the intervention areas of the project How do we measure it? Project Monitoring of Outcomes

10. Component 2: Health Services Delivery Who? Providers of formal health services What is it? Access & Quality - Inputs (trained workers, supplies, meds, vaccines), processes (health worker performance, supervision), outputs (numbers of clients seen, etc.) How do we measure it? Rapid Health Facilities Assessment focused on community level

11. Component 3: Ministry Organizational Capacity & Viability Who? The organization responsible for institutional support for health service delivery What is it? Administration, Planning, Budget management, Guidelines/Norms, Training, Supervision, Data for decision-making, Financial Resources, Coordination with key actors (civil society, donors, technical agencies) How do we measure it? Rapid Health Facilities Assessment focused on services providers

12. Component 4: Local NGO Organizational Capacity & Viability Who? The organization responsible for institutional support for the activities in the community necessary to demand services and for household behaviors related to relevant health outcomes What is it? Governance and legal structure, Human resources and HR management, Management systems and practices, Financial management, Technical capacity, M&E/ Organizational learning, Organizational leadership, Equity and empowerment, Organizational performance, Resource mobilization, Networking and external relations, Institutionalization of key competencies How do we measure it? Organizational Capacity Indicators (OCI) Tool

13. Component 5: Community Capacity Who? Main community actors engaged (DPOs, CBOs, Village Health Committees, Village Development Committees, Volunteer Groups, etc.) What is it? Community Organization for Disability, Participation/ Mobilization, Key Attitudes (fatalism, resilience, openness to change), Awareness/Knowledge, Programmatic Involvement, Linkages, Resource Mobilization How do we measure it? Community Capacity Indicators (CCI) Tool

14. Component 6: Enabling Environment Who? These are factors often outside purview of project What? Health, social and disability policy, Governance and stability, Human development, Natural environment How do we measure it? Often from secondary data (MOH stats, HDI, Corruption Index, etc.)

15. “Ideal scenario” for implementing the six steps of a sustainability assessment

16. The six steps to apply for initial project planning and measurement

17. First exercise: What do we mean by sustainability? How do we define non-sustainability? Dimension by dimension