Toward the sustainability of health interventions implemented in sub-Saharan Africa: a systematic review and conceptual framework
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BACKGROUND: Sub-Saharan Africa (SSA) is facing a double burden of disease with a rising prevalence of non-communicable diseases (NCDs) while the burden of communicable diseases (CDs) remains high. Despite these challenges, there remains a significant need to understand how or under what conditions health interventions implemented in sub-Saharan Africa are sustained. The purpose of this study was to conduct a systematic review of empirical literature to explore how health interventions implemented in SSA are sustained. METHODS: We searched MEDLINE, Biological Abstracts, CINAHL, Embase, PsycInfo, SCIELO, Web of Science, and Google Scholar for available research investigating the sustainability of health interventions implemented in sub-Saharan Africa. We also used narrative synthesis to examine factors whether positive or negative that may influence the sustainability of health interventions in the region. RESULTS: The search identified 1819 citations, and following removal of duplicates and our inclusion/exclusion criteria, only 41 papers were eligible for inclusion in the review. Twenty-six countries were represented in this review, with Kenya and Nigeria having the most representation of available studies examining sustainability. Study dates ranged from 1996 to 2015. Of note, majority of these studies (30 %) were published in 2014. The most common framework utilized was the sustainability framework, which was discussed in four of the studies. Nineteen out of 41 studies (46 %) reported sustainability outcomes focused on communicable diseases, with HIV and AIDS represented in majority of the studies, followed by malaria. Only 21 out of 41 studies had clear definitions of sustainability. Community ownership and mobilization were recognized by many of the reviewed studies as crucial facilitators for intervention sustainability, both early on and after intervention implementation, while social and ecological conditions as well as societal upheavals were barriers that influenced the sustainment of interventions in sub-Saharan Africa. CONCLUSION: The sustainability of health interventions implemented in sub-Saharan Africa is inevitable given the double burden of diseases, health care worker shortage, weak health systems, and limited resources. We propose a conceptual framework that draws attention to sustainability as a core component of the overall life cycle of interventions implemented in the region.
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A recent review of 41 studies across 26 countries in sub-Saharan Africa suggests that community engagement, community resources, and mobilization may be unique influences on sustainability in such contexts.
“A recent review of 41 studies across 26 countries in sub-Saharan Africa suggests that community engagement, community resources, and mobilization may be unique influences on sustainability in such contexts (63).”
From The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care (2018) · cites this paper as [63]
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- Authors
- Iwelunmor, J., Blackstone, S., Veira, D., Nwaozuru, U., Airhihenbuwa, C., Munodawafa, D., Kalipeni, E., Jutal, A., Shelley, D., & Ogedegbe, G.
- Affiliations
- University of Illinois Urbana-Champaign (US)
- New York University (US)
- Saint Louis University (US)
- World Health Organization Regional Office for Africa (CG)
- West Virginia University (US)
- Corresponding author
- Iwelunmor, Juliet
- ORCID
- Venue
- Implementation Science
- Published
- 2015-12
- Volume
- 11
- Issue
- 1
- Pages
- 43-43
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC4804528
- OpenAlex
- W2305876132
- Cited by
- 219
- References
- 79
- Citations by year
- 2026: 19 · 2025: 17 · 2024: 25 · 2023: 28 · 2022: 23 · 2021: 30 · 2020: 27 · 2019: 23 · 2018: 13 · 2017: 8 · 2016: 4 · 2015: 1 · 2014: 1
- FWCI
- 1.56
- Type
- journal article
- Language
- en
- Update notices
- correction (2016-04-18)
- Open access
- gold
- doi.org
- Licence
- Locations
- Implementation Science (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Fogarty International Center (R03TW010081)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
- Keywords
- sub-Saharan Africa, community ownership, community mobilization, HIV/AIDS, malaria, double burden of disease, non-communicable diseases, health care system, conceptual framework, barriers to sustainability
- MeSH terms
- Chronic Disease, Delivery of Health Care, Health Resources, Humans, Cost of Illness, Africa South of the Sahara
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