Sustaining Child Survival

The Child Survival projects operated by Private Voluntary Organizations (PVOs) under the United States Agency for International Development (USAID) Child Survival Grants Program (CSGP) address child mortality in some of the poorest countries and regions of the world. Private Voluntary Organisations (PVOs) have been implementing child survival (CS) projects in developing countries through the CSGP since 1985.

Excerpts from the Executive Summary follow:

The CORE-CSTS+ Sustainability Initiative...included the following steps:

• A systematic review of the literature,
• Content analysis of 21 interviews led with leading CS practitioners in the PVO community,
• A questionnaire - the Critical Issues survey - administered to 50 CS professionals associated with CORE or the PVO community,
• A project sustainability self-assessment questionnaire sent to two groups of CS project managers.

Results of the informant interviews and survey on critical issues

Strategies and results

Working through partnerships and building capacity are central strategies for US-based PVOs trying to achieve sustainable health results. Three primary types of partners are essential to consider - Ministry of Health (MoH) structures, local Non Governmental Organizations (NGOs), and communities (including community structures)...

Ninety percent (90%) of respondents believe that "building vision and commitment" in local NGO partners is "equally or more crucial to the prospects of sustainability" than developing technical and managerial capacity.

But capacity building for partner organizations in and of itself does not summarize sustainability...

Capacity building plays its part along with other developmental changes: Developing accountability between service providers and communities, for example, is a condition for improving the sustainability of interventions through supply and demand mechanisms (e.g. improving the quality of services). With this, comes a strong consensus on the fact that building relationships between stakeholders justifies a specific allocation of resources.

Improving the viability of local organizations is another important element influencing CS work in the long term. This relates to financial viability, but also to other issues defining a dependency profile of these organizations: organizational linkages and relationships for support, advocacy, access to information and technical assistance, etc...

In terms of working with communities, our study participants - informants and respondents - generally convey agreement about four main ideas:

1. That whatever the level of enthusiasm for community participation may be, "buy-in" and ownership by the community is essential to sustaining efforts in Child Survival interventions.
2. That development in non-health sectors creates conditions favorable to sustainable health.
3. That communities are more likely to support health interventions strategies that are linked to their perceived development needs, health related or not.
4. That the development of community capacity, through community organizing and development, is essential to maintaining individual healthy behaviors and community engagement behind health issues.

There is a large consensus on the idea that using community participation to gather support for project activities without a true community development approach can be just as unsustainable as any other approach....

Community participation and ownership are mentioned numerous times in our interviews and are generally considered essential to the effectiveness and sustainability of interventions...

Overall, 84% of our respondents supported community organizing as an approach more important (58%) or as important (26%) to sustainability than IEC (information education and communication) efforts to promote the adoption of appropriate health behaviors...

Results of the self-assessment

The Child Survival Project Self-Assessment Survey (SA survey) is the third and final component of the Sustainability Initiative. It targeted CS projects for which an evaluation phase was planned. Responses came back from 22 projects out of 42 (52.4 % response rate). Its aim was also exploratory, to examine project managers' expectations about the sustainability of their intervention, and the perceived achievements on pertinent intermediary results...

Eighteen out of 22 projects recognize a strong commitment to the project by the MoH...

In terms of strategies, all participating projects consider a wide range of stakeholders with a direct responsibility or supportive role for sustaining their accomplishments...

The maintenance of activities beyond the grant period relies heavily on governmental structures and, in equal proportion, on local NGOs or CBOs. An important supportive role is given to social networks and community structures (cooperatives, schools, etc.) for maintaining the health gains. The role of these different structures is, however, mutually supportive and complementary, often sharing the responsibility of the activities in the long run...

Conclusion: applicable lessons from the study

...[S]ustainability can be defined as a contribution to the advancement of certain conditions which enable actors of a local system to negotiate roles and responsibilities in order to achieve lasting health gains.

The individuals, communities and local organizations constitute a local system with their environment, and it is ultimately their coordinated social interactions and efforts, based on the understanding of their own health and development, which will lead to lasting health impact...

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Source:

Child Survival Technical support site.