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.

Background & objectives: Identifying the impacts of COVID-19 on patients’ and practitioners’ access to legal assisted dying and euthanasia (AD&E) services is vital to informing service continuity in an ongoing pandemic. Methods: An anonymous online survey collected qualitative and quantitative data from health practitioners and agencies providing legal AD&E services ( n = 89), complemented by semi-structured interviews with 18 survey respondents who volunteered. Results: Following governments’ responses to the dynamic pandemic context, rates of AD&E inquiries and requests fluctuated across and within jurisdictions, based on a complex interaction of factors affecting patient access to AD&E agencies and assessors as services were disrupted. Service flexibility and nimbleness became key elements in continuing service availability and included calculated ‘rule-breaking’ considered justifiable to adhere to established bioethics. Making innovative adjustments to usual practice led to reviewing the effectiveness of AD&E services and laws, resulting in providers now improving services and lobbying for legislative change.

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e now have two years' experience in providing voluntary assisted dying to terminally ill patients in Victoria. Western Australian legislation will come into force on 1 July 2021; Tasmanian legislation has received Royal assent, and the early stages of implementation are underway. The South Australian Voluntary Assisted Dying Bill has been passed by both Houses and may have been sent for Royal assent by the time this article is published. The Queensland Law Reform Commission report and draft bill 1 were tabled in parliament on 18 May 2021; a bill is expected to be tabled in the New South Wales parliament in late 2021. There have been calls for the Commonwealth to repeal the Euthanasia Laws Act 1997 to reinstate Australian territories' rights to debate voluntary assisted dying legislation.