Sustainability science: an integrated approach for health-programme planning

Gruen, Russell L.; Elliott, Julian; Nolan, Monica; Lawton, Paul; Parkhill, Anne; McLaren, Cameron; Lavis, John N.

doi:10.1016/s0140-6736(08)61659-1

Cited by 328 publications

(405 citation statements)

References 60 publications

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“…Relatively few empirical studies are published in this area (7,22,23,27) and the health interventions often fail to consider the programme as complex systems that operate dynamically with the programme, the key stakeholders and the broader community environment (11,12,28) .…”

Section: Discussionmentioning

confidence: 99%

Long-term sustainability of a worksite canteen intervention of serving more fruit and vegetables

Thorsen

Lassen

Tetens

et al. 2010

Public Health Nutr.

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Objective: To analyse the 5-year sustainability of a worksite canteen intervention of serving more fruit and vegetables (F&V). Design: Average F&V consumption per customer per meal per day was assessed in five worksite canteens by weighing F&V served and subtracting waste. Data were collected by the canteen staff during a 3-week continuous period and compared to data from the same five canteens measured at baseline, at end point and at 1-year follow-up. The intervention used a participatory and empowering approach, self-monitoring and networking among the canteen staff, management and a consultant. The method focused on providing ideas for increased F&V for lunch, making environmental changes in the canteens by giving access to tasteful and healthy food choices and reducing the availability of unhealthy options. Setting: Five Danish worksites serving from 50 to 500 meals a day: a military base, an electronic component distributor, a bank, a town hall and a waste-handling facility. Subjects: Worksite canteen managers, canteen staff. Results: Four of the five worksite canteens were able to either maintain the intervention or even increase the consumption of F&V. The average increase from baseline to 5-year follow-up was 95 g per customer per meal per day (18, 144, 66, 105 and 141 g, respectively). On average, the five canteens at the long-term follow-up had an F&V consumption of 208 g/meal per customer. Conclusions: The present study indicates that sustainability of F&V is possible in worksites where the participatory and empowering approach, self-monitoring, environmental change, dialogue with suppliers and networking among worksite canteens are applied.

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Section: Discussionmentioning

confidence: 99%

Long-term sustainability of a worksite canteen intervention of serving more fruit and vegetables

Thorsen

Lassen

Tetens

et al. 2010

Public Health Nutr.

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“…(Easterly 2006) We are however witnessing a growing interest in complex, non-linear models of intervention and study. This interest is born from (1) the realization that health and development programs are confronted with complex and disorderly patterns (Paina and Peters 2011;Gasparatos et al 2007;Sarriot et al 2004), (2) repeated failures in attempting to sustain achievements due to vexing problems (Hafner and Shiffman 2013;Lafond 1995), and (3) increasing attempts of global health interventions to not only deliver discrete results but also strengthen entire systems of care, build capacity, as well as achieve ownership and sustainability (Baser and Morgan 2008;Brinkerhoff and Morgan 2010;de Savigny and Adam 2009;Gruen Gruen 2008;Paina and Peters 2011;Ubels et al 2010).…”

Section: Introductionmentioning

confidence: 99%

Community Health Systems as Complex Adaptive Systems: Ontology and Praxis Lessons from an Urban Health Experience with Demonstrated Sustainability

Sarriot

Kouletio

2014

Syst Pract Action Res

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The global health and development field, which has been reasonably dominated by linear models of planning, is witnessing increased interest in complexity, non-linear processes, and systems thinking. This welcome interest is challenged by both language and ability to discern whether complex development phenomena are discussed from the perspective of the nature of particular health systems (ontology), from the identification of more fitting intervention modalities (praxis), or from our approach to learning and evidence (epistemology). This paper is an experience-based contribution to the first two perspectives. Two Bangladeshi municipal health systems provide an example of how sustainable outcomes were achieved through complex adaptive system behaviors, during and after intervention by Concern Worldwide, Inc. (Concern). Concern provided support to the Municipal Health Departments and then assessed the sustainability of health achievements several years after its intervention. We examine complexity in municipal health systems behavior, and the nonlinearity of project effects. We identify ways in which Concern's program, beyond technical design, followed recommendations on leading complex systems towards positive sustainable outcomes. We conclude on the necessity for global community health planners and practitioners to (1) better understand the complexity of the context and issues they are facing, (2) make more reasonable assumptions about the ''shock to the system'' caused by projects both when they start and when they end, and (3) learn to balance strategic designs with respect for self-organization principles.

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“…The importance of addressing human resources for health constraints in order to attain ART scale-up targets in resource-limited settings is consistent in the literature [22,49,58]. However, there are mounting calls for funders of public health interventions to adopt ‘whole-of-system’ approaches which utilize ‘systems thinking’ as opposed to fragmented approaches which focus on individual building blocks of the health system [25,44,45,59]. …”

Section: Discussionmentioning

confidence: 93%

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

Zakumumpa

Kwiringira

Rujumba

et al. 2018

Global Health Action

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Background: In the context of declining international assistance for ART scale-up in Sub-Saharan Africa, the institutionalization of ART programs through integrating them in the organizational routines of health facilities is gaining importance as a program sustainability strategy. Objective: The aims of this study were; (i) to compare the level of institutionalization of ART programs in health facilities in Uganda and (ii) to explore reasons for variations in the degree of program institutionalization. Methods: In Phase One, we utilized Level of Institutionalization Scales developed by Goodman (1993) to measure the degree of institutionalization of ART interventions in 195 health facilities across Uganda. The 45-item questionnaire measured institutionalization based on four sub-systems (production, maintenance, supportive, managerial) theorized to make up an organization assessed against two levels of institutionalization; routines (lowest) niche saturation (highest). In Phase Two, four health facilities were purposively selected (2 with the highest and 2 with the lowest institutionalization scores) for a multiple case-study involving semi-structured interviews with ART clinic managers(n = 32), on-site observations and document review. Results: The two highest scoring health facilities had a longer HIV intervention implementation history of between 8 and 11 years. The highest scoring cases associated intervention institutionalization with sustained workforce trainings in ART management, the retention of ART-trained personnel and generating in-house ART manuals. The turnover of ART-proficient staff was identified as a barrier to intervention institutionalization in the lowest-ranked cases. Significant differences in organizational contexts were identified. The two highest-ranked health facilities were well-established, higher-tier hospitals while the lowest scoring health facilities were lower-level health facilities. Conclusions: The level of institutionalization of ART interventions appeared to be differentiated by level of care in the Ugandan health system. Interventions aimed at strengthening program institutionalization in lower-level health centers at the level of human resources for health could enhance ART scale-up sustainability.

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Sustainability science: an integrated approach for health-programme planning

Cited by 328 publications

References 60 publications

Long-term sustainability of a worksite canteen intervention of serving more fruit and vegetables

Long-term sustainability of a worksite canteen intervention of serving more fruit and vegetables

Community Health Systems as Complex Adaptive Systems: Ontology and Praxis Lessons from an Urban Health Experience with Demonstrated Sustainability

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

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