Sustainability science: an integrated approach for health-programme planning
Abstract
Planning for programme sustainability is a key contributor to health and development, especially in low-income and middle-income countries. A consensus evidence-based operational framework would facilitate policy and research advances in understanding, measuring, and improving programme sustainability. We did a systematic review of both conceptual frameworks and empirical studies about health-programme sustainability. On the basis of the review, we propose that sustainable health programmes are regarded as complex systems that encompass programmes, health problems targeted by programmes, and programmes' drivers or key stakeholders, all of which interact dynamically within any given context. We show the usefulness of this approach with case studies drawn from the authors' experience.
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The sustainability of CbPs may affect the sustainability of host organizations.
“The sustainability of CbPs is also important for the host organization, since it may also affect their sustainability [13].”
From Community-Based Healthcare Programs Sustainability Impact on the Sustainability of Host Organizations: A Structural Equation Modeling Analysis (2019) · cites this paper as [13]
During sustainment, changes in the system or population served by that system may also necessitate changes.
“Additionally, during sustainment, changes in the system or population served by that system may also necessitate changes [7, 44, 45].”
From The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions (2019) · cites this paper as [45]
Large variation in practices and care can be seen across similar services when initiatives that initially demonstrate improved patient outcomes fail to maintain their gains.
“Large variation in the practices and care can be seen across similar services when initiatives which initially demonstrate improved patient outcomes fail to maintain their gains [7, 8].”
From Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare (2018) · cites this paper as [7]
Initiatives that fail to sustain are extremely wasteful of human and monetary investments.
“Initiatives that fail to sustain are extremely wasteful of human and monetary investments [7, 8].”
From Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare (2018) · cites this paper as [7]
All definitions identified in the review represent interrelated facets of what sustainability means in practice.
“All definitions identified in the review represent interrelated facets of what sustainability means in practice; therefore, those working in this field should explore the breadth of available sustainability domains in order to accurately represent the sustainability process and account for its full complexity and possible outcomes [7].”
From Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare (2018) · cites this paper as [7]
Sustainability has been increasingly conceptualized as a more dynamic construct that allows for adaptation and capacity building in response to new evidence, policies, or other influences.
“Sustainability has been increasingly conceptualized as a more dynamic construct that allows for adaptation and capacity building in response to new evidence, policies, or other influences (23, 58, 66, 72).”
From The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care (2018) · cites this paper as [58]
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Welsh, J. A., Chilenski, S. M., Johnson, L., Greenberg, M. T., & Spoth, R. L. (2016) · The Journal of Primary Prevention · doi:10.1007/s10935-016-0421-z · Cited by 17 · see citing works
Sustainability of Evidence-Based Practices for HIV Prevention among Female Sex Workers in Mexico
Palinkas, L. A., Chavarin, C. V., Rafful, C. M., Um, M. Y., Mendoza, D. V., Staines, H., Aarons, G. A., & Patterson, T. L. (2015) · PLOS ONE · doi:10.1371/journal.pone.0141508 · Cited by 14 · see citing works
Chew, B.-H., Fernandez, A., & Sazlina, S.-G. (2018) · Psychology Research and Behavior Management · doi:10.2147/prbm.s117224 · Cited by 14 · see citing works
“It is equally important that the administration validates the efforts of their staff and acknowledge appropriate recognition of such services.(130) Consequently, nurses and doctors conducting the program can experience lesser or no clashes with other clinic duties or with other colleagues.”
Ceptureanu, S. I., & Ceptureanu, E. G. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16204035 · Cited by 7 · see citing works
“The sustainability of CbPs is also important for the host organization, since it may also affect their sustainability [13].”
Background
- Authors
- Gruen, R. L., Elliott, J. H., Nolan, M. L., Lawton, P. D., Parkhill, A., McLaren, C. J., & Lavis, J. N.
- Affiliations
- The Royal Melbourne Hospital (AU)
- Burnet Institute (AU)
- Northern Territory Health Services (AU)
- UNSW Sydney (AU)
- McMaster University (CA)
- Corresponding author
- Gruen, Russell L
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2008-11
- Volume
- 372
- Issue
- 9649
- Pages
- 1579-1589
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2107568324
- Cited by
- 395
- References
- 75
- Citations by year
- 2026: 6 · 2025: 20 · 2024: 17 · 2023: 38 · 2022: 24 · 2021: 25 · 2020: 34 · 2019: 32 · 2018: 28 · 2017: 26 · 2016: 17 · 2015: 24 · 2014: 29 · 2013: 27 · 2012: 15
- FWCI
- 2.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Rare & Special e-Zone (The Hong Kong University of Science and Technology) (submittedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- Funders
- Medical Research Council
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Keywords
- program planning, complex systems, stakeholder interaction, low- and middle-income countries, health and development, operational framework, sustainability measurement
- MeSH terms
- Developing Countries, Health Planning, Health Promotion, Humans, Primary Health Care, Public Health, Total Quality Management
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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