“The problem is ours, it is not CRAIDS’ ”. Evaluating sustainability of Community Based Organisations for HIV/AIDS in a rural district in Zambia

Abstract

BackgroundWhile sustainability of health programmes has been the subject of empirical studies, there is little evidence specifically on the sustainability of Community Based Organisations (CBOs) for HIV/AIDS. Debates around optimal approaches in community health have centred on utilitarian versus empowerment approaches. This paper, using the World Bank Multi-Country AIDS Program (MAP) in Zambia as a case study, seeks to evaluate whether or not this global programme contributed to the sustainability of CBOs working in the area of HIV/AIDS in Zambia. Lessons for optimising sustainability of CBOs in lower income countries are drawn.MethodsIn-depth interviews with representatives of all CBOs that received CRAIDS funding (n = 18) and district stakeholders (n= 10) in Mumbwa rural district in Zambia, in 2010; and national stakeholders (n=6) in 2011.ResultsFunding: All eighteen CBOs in Mumbwa that received MAP funding between 2003 and 2008 had existed prior to receiving MAP grants, some from as early as 1992. This was contrary to national level perceptions that CBOs were established to access funds rather than from the needs of communities. Funding opportunities for CBOs in Mumbwa in 2010 were scarce.Health services: While all CBOs were functioning in 2010, most reported reductions in service provision. Home visits had reduced due to a shortage of food to bring to people living with HIV/AIDS and scarcity of funding for transport, which reduced antiretroviral treatment adherence support and transport of patients to clinics.Organisational capacity and viability: Sustainability had been promoted during MAP through funding Income Generating Activities. However, there was a lack of infrastructure and training to make these sustainable. Links between health facilities and communities improved over time, however volunteers’ skills levels had reduced.ConclusionsWhilst the World Bank espoused the idea of sustainability in their plans, it remained on the periphery of their Zambia strategy. Assessments of need on the ground and accurate costings for sustainable service delivery, building on existing community strengths, are needed before projects commence. This study highlights the importance of enabling and building the capacity of existing CBOs and community structures, rather than creating new mechanisms.

Community Based Programs Sustainability. A Multidimensional Analysis of Sustainability Factors

“…Community based programs are increasingly scrutinized in the literature literature [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] in the broader context of non-profit sector sustainability [16,17]. There are several reasons why program sustainability is important: (1) terminating an effective program leads to negative effects for both the community involved and for host organization; (2) program initiation costs are high; and (3) community experiencing unexpected program termination lose trust when future programs are to be introduced [18].…”

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

“…South Africa, Nigeria and Uganda account for nearly half of all new HIV infections in SSA [8]. In Uganda, an estimated 85% of the national HIV response is externally funded principally through PEPFAR and The Global Fund which have supported ART scale-up since June 2004 [9,10]. National ART roll-out commenced at a relatively higher-level of care starting at major tertiary hospitals in Uganda [4].…”

“…ART services were subsequently decentralized to lower-level health facilities including in small for-profit clinics [4]. The goal of ART scale-up was to expand coverage through commissioning multiple sites with the aim of extending service delivery beyond large tertiary hospitals [9]. It is therefore imperative to assess the degree of institutionalization of ART interventions in lower-level health facilities in order to determine long-term program sustainability outcomes in primary care health facilities and to inform further ART scale-up efforts.…”

“…There are persistent reports of a decline in international assistance for further ART scale-up in SSA [7,9]. Against this background, the sustainability of the implementation of ART scale-up in SSA has come into critical focus [1,4,9–11].…”

“…Against this background, the sustainability of the implementation of ART scale-up in SSA has come into critical focus [1,4,9–11]. The institutionalization or integration of interventions in the organizational routines of health service organizations is considered an important indicator of long-term program sustainability [12–16].…”