An Agenda for Research on the Sustainability of Public Health Programs

Abstract

Funders of programs in public health and community health are increasingly concerned about the sustainability of changes they initiate. Despite a recent increase in sustainability research and evaluation, this literature has not developed a widely used paradigm for conducting research that can accumulate into generalizable findings. We provide guidance for research and evaluation of health program sustainability, including definitions and types of sustainability, specifications and measurements of dependent variables, definitions of independent variables or factors that influence sustainability, and suggestions for designs for research and data collection. We suggest viewing sustainability research as a further stage in the translation or dissemination of research-based interventions into practice. This perspective emphasizes ongoing relationships with earlier stages of a broader diffusion framework, including adoption and implementation processes.

The dynamic of tuberculosis case finding in the era of the public–private mix strategy for tuberculosis control in Central Java, Indonesia

“…A health intervention program is considered advantageous, when continuous use of its intervention components and activities results in ongoing achievement of desirable health outcomes, within the population of interest [15]. An increasing trend is usually found in the initial implementation stage of the program, but the challenge to sustain the achievements of the program remains, especially in terms of implementation in the field [16].…”

Assessing the level of institutionalization of donor-funded anti-retroviral therapy (ART) programs in health facilities in Uganda: implications for program sustainability

“…There is support in the literature for the notion that differences in organizational capacity account for variations in program sustainability outcomes [39–41]. In an earlier seminal review, Shediac-Rizkallah and Bone [34] found that ‘’implementing organizations which were stable and mature were more likely to promote program institutionalization by providing a strong organizational base for new programs ‘‘.…”

Searching for sustainability within public health policy: insights from an injury prevention perspective

“…6,7 The global public health literature demonstrates a growing research interest into programme sustainability, 8 however, much of this originates from outside Europe. Programme sustainability does not occur automatically, 3,9 and is subject to the influence of a range of inter-related factors that may be amenable to intervention.…”

“…Programme sustainability does not occur automatically, 3,9 and is subject to the influence of a range of inter-related factors that may be amenable to intervention. 3,8,10 These factors may exert their effect: i) on the programme, ii) within the immediate setting, or iii) within the wider environment. These differing levels of influence have informed a socio-ecological conceptualisation of sustainability.…”

“…These differing levels of influence have informed a socio-ecological conceptualisation of sustainability. 2,8,10 It has been suggested that a supportive policy context in the wider environment may positively influence the sustainability of public health programmes. 7,10 Despite this, research to-date has focused primarily on influences that operate at the level of the programme or on the immediate setting, rather than those acting in this wider environment.…”