Introduction to the Sustainability Framework

Karl Blanchet, 2009

Adapted from Ricca J., 2009, CSTS

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

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)?

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

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

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.

Project

Who makes sustainability happen?

Local System

Local system sustainability

Project contribution

Sustainability Framework Model(CSTS, 2008)

Component 1: Health OutcomesWho?

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

Component 2: Health Services DeliveryWho?

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

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

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

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

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.)

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

1 2MONITORING & EVALUATION

STEPS

LOCAL SYSTEM

Who needs to sit at the table to

define and pursue the common

VisionVISION

What is the common

good we pursue? What is the

Sustainability Scenario?

What are the key strategies that will be used to

attain the Vision, within the

SUSTAINABILITY SCENARIO?

How will progress be MEASURED?

Measure indicators and

PRESENT INFORMATION

DEVELOP PROGRAM RESPONSE (project &

stakeholders)

In an “ideal scenario,” early design focuses on the local system, its vision, sustainability scenario and situation initial sustainability assessment. Project contribution (work planning) follows.

Identify the key strategies partners will employ within the Sustainability Scenario.

1 Define the local system to be assessed, its long-term vision and the ‘sustainability scenario’ to reach that vision.

3Adapt standard SF tools to measure progress on key strategies .

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6

4

Map indicators along the 0-100 scales of the six components of the SF.

Measure the value of the indicators by applying tools to measure each of the six SF components.

Review results and propose programmatic intervention (including specific project objectives) or policies for improving the status of each of the components.

The six steps to apply for initial project planning and measurement

Define the local system to be assessed, its long-term vision and the ‘sustainability scenario’ that local stakeholders believe will to be the path to reaching that vision.

Identify the key strategies needed to improve local system functioning so as to reach the local system’s vision and sustainability scenario.

Adapt standard SF tools to measure progress toward the local system’s vision and sustainability scenario.

Measure the value of indicators for each of the components of the SF , using the locally adapted tools.

Map the measured values of indicators onto standard 0 – 100 scales. Then combine these scaled indicators into indices for each of the components of the SF.

Review results and propose programmatic interventions or policy changes (both for project partners and other stakeholders in local system) for improving the status of the indicators.

Sustainability Assessment Step for Project Planning Emphasis

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Planning Measuring

First exercise: What do we mean by sustainability?

How do we define non-sustainability?Dimension by dimension