1. Handicap International © Éric Martin / Le Figaro / Handicap International Introduction to the Sustainability Framework Nepal, 24-29 January 2013 Dorothy Boggs, OT, MScPH Knowledge Management Unit

2. Introduction to The Sustainability Framework (SF) Sustainability -Concept -Definition -Measurement Sustainability Actors The Sustainability Framework -6 components SF resources for working group exercises …

3. Concept of Sustainability Public health, social and economic impact is related to … –Relevance –Effectiveness –Efficiency –Equity –Sustainability Adapted from OECD 2007

4. Concept of Sustainability (2) 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)?

5. Concept of Sustainability (3) Sustainability in context –Development planning is based on a linear model input → process → outputs → outcomes –In reality … actual development processes fit a much more complex pattern Multidimensionality Non-linear cause and effect relationship Unpredictability

6. Defining Sustainability (1) Sustaining health benefits to the beneficiary population after project end Shediac-Rizkallah, 1998; CORE-CSTS Sustainability Initiative 2002 $, £, € Public health benefits T Activities

7. Defining Sustainability (2) 4 definitions of sustainability Sustainability as the continuity of health benefits Sustainability as institutional and organisational capacity Sustainability as community capacity A multidimensional and systemic approach to sustainability

8. Measuring 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.

9. Sustainability actors Who makes sustainability happen? –Actors of the Local System –For example actors in a local rehabilitation system might include: People with disabilities and their families Disabled people’s organisations (DPOs) Service providers Authorities (National, Regional) International organisations

10. The Sustainability Framework Based on holistic and multidimensional view of sustainability

11. The Sustainability Framework (2) Focuses on the system

12. The Sustainability Framework (3) Sarriot E., J. Ricca, J. Yourkavitch, L. Ryan (2008)

13. Component 1: Health outcomes Who? –Population of the local health system What is it? –Summary measure of the health, rehabilitation and social outcomes achieved

14. Component 2: Health services delivery Who? –Providers of formal health, rehabilitation and social services What is it? –Access & Quality Inputs - trained workers, supplies, meds, vaccines Processes - health worker performance, supervision Outputs - numbers of clients seen, etc.

15. Component 3: Ministry Organizational Capacity & Viability Who? –The national or provincial authority responsible for the stewardship of services What is it? –Includes: administration, planning, budget management, guidelines/norms, training, supervision, data for decision-making, financial resources, coordination with key actors (civil society, donors, technical agencies)

16. Component 4: Local NGO or service providers Organizational Capacity & Viability Who? –The organization responsible for institutional support for the activities in the community necessary to demand services and for facilities delivering services What is it? –Includes: 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

17. Component 5: Community Capacity Who? –Main community actors engaged (DPOs, CBOs, Village Health Committees, Village Development Committees, Volunteer Groups, etc.) What is it? –Includes: community organizations for disability, participation/ mobilization, key attitudes (fatalism, resilience, openness to change), awareness/knowledge, programmatic involvement, linkages, resource mobilization

18. Component 6: Enabling Environment Who? –All contextual factors that may have an impact on the local system What? –Health, social and disability policy, governance and political and economic context and stability, human development, natural environment

19. SAP Guide –Overview of SF and six components (pgs.16-18) –Six components specific to rehabilitation sector (pgs. 40-41) –Reference bibliography (pgs. 86-89) Sustaining Ability website www.sustainingability.org www.sustainingability.org –SF overview –Six components table –Online reference bibliography SF resources for working group exercises …

20. Thank you! Questions and answers …