Cited by 195International Development and AidPublic health and occupational medicineGlobal Health and Surgery

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Can they get along without us? Sustainability of donor-supported health projects in Central America and Africa

Bossert, Thomas J.·1990·Social Science & Medicine

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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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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)
DOI: 10.1016/0277-9536(90)90148-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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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

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Can they get along without us? Sustainability of donor-supported health projects in Central America and Africa

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