Can they get along without us? Sustainability of donor-supported health projects in Central America and Africa
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.
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Studies in low- and middle-income countries indicate the importance of strategic partnerships and the impact of broader social context and health system weaknesses as influences on sustainability.
“Such studies indicate the importance of strategic partnerships (89, 112) and the impact of the broader social context and of health system weaknesses (15, 63) as important influences on sustainability.”
From The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care (2018) · cites this paper as [15]
The empirical literature suggests that important categories of factors influence sustainability across settings and are dynamically related: outer contextual factors, inner contextual/organizational factors, processes, intervention characteristics, and implementer characteristics.
“To date, the empirical literature suggests the existence of important categories of factors that influence sustainability across settings and are dynamically related. They are outer contextual factors (e.g., sociopolitical context, funding environment), inner contextual or organizational factors (e.g., financial resources, leadership, program champions, organizational support, staff stability, po”
From The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care (2018) · cites this paper as [15]
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- Authors
- Bossert, T. J.
- Affiliations
- Harvard University (US)
- Corresponding author
- Bossert, Thomas J.
- ORCID
- Bossert, Thomas J.
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 1990-01
- Volume
- 30
- Issue
- 9
- Pages
- 1015-1023
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W1969806209
- Cited by
- 195
- References
- 6
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 6 · 2023: 7 · 2022: 5 · 2021: 11 · 2020: 6 · 2019: 8 · 2018: 10 · 2017: 13 · 2016: 11 · 2015: 8 · 2014: 23 · 2013: 6 · 2012: 10
- FWCI
- 20.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Topics
- Social Sciences › Development › International Development and Aid
- Social Sciences › Political Science and International Relations › Public health and occupational medicine
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
- Keywords
- Central America, Africa, institutional development, project design, national funding, cost recovery, health system integration, political and economic context
- MeSH terms
- Africa, Capital Financing, Central America, Developing Countries, International Cooperation, Medical Missions
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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