title: A methodological approach and framework for sustainability assessment in NGO-implemented primary health care programs.
abstract: An estimated 10.8 million children under 5 continue to die each year in developing countries from causes easily treatable or preventable. Non governmental organizations (NGOs) are frontline implementers of low-cost and effective child health interventions, but their progress toward sustainable child health gains is a challenge to evaluate. This paper presents the Child Survival Sustainability Assessment (CSSA) methodology--a framework and process--to map progress towards sustainable child health from the community level and upward. The CSSA was developed with NGOs through a participatory process of research and dialogue. Commitment to sustainability requires a systematic and systemic consideration of human, social and organizational processes beyond a purely biomedical perspective. The CSSA is organized around three interrelated dimensions of evaluation: (1) health and health services; (2) capacity and viability of local organizations; (3) capacity of the community in its social ecological context. The CSSA uses a participatory, action-planning process, engaging a 'local system' of stakeholders in the contextual definition of objectives and indicators. Improved conditions measured in the three dimensions correspond to progress toward a sustainable health situation for the population. This framework opens new opportunities for evaluation and research design and places sustainability at the center of primary health care programming.
authors.affiliation: ORC Macro International Inc., Child Survival Technical Support Project (CSTS), 11785 Beltsville Drive, Calverton, MD 20705, USA. eric.g.sarriot@orcmacro.com
authors.forename: Eric G
authors.initials: EG
authors.lastname: Sarriot
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Winch
authors.forename: Leo J
authors.initials: LJ
authors.lastname: Ryan
authors.forename: Janice
authors.initials: J
authors.lastname: Bowie
authors.forename: Michelle
authors.initials: M
authors.lastname: Kouletio
authors.forename: Eric
authors.initials: E
authors.lastname: Swedberg
authors.forename: Karen
authors.initials: K
authors.lastname: LeBan
authors.forename: Jay
authors.initials: J
authors.lastname: Edison
authors.forename: Rikki
authors.initials: R
authors.lastname: Welch
authors.forename: Michel C
authors.initials: MC
authors.lastname: Pacqué
mesh_terms: D002648:Child; D002669:Child Welfare; D003906:Developing Countries; D006801:Humans; D009938:Organizations; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation / Q000379:methods*; D016019:Survival Analysis; D014481:United States