title: Challenges to achieving sustainable community health development within a donor aid business model.
abstract: OBJECTIVE
  This paper explores the paradox of donor aid being delivered through a business model through a case study in Papua New Guinea.
  
  
  METHODS
  A retrospective review of project implementation and an outcome evaluation provided an opportunity to examine the long-term results and sustainability of a large project. Analysis was informed by data collected from 175 interviews (national, provincial, district and village), 93 community discussions and observations across 10 provinces.
  
  
  RESULTS
  Problems with the business model of delivering aid were evident from implementation data and in an evaluation conducted two years after project completion (2006). Compounding the business model effect were challenges of over-ambitious project goals with limited flexibility to adapt to changing circumstances, a donor payment system requiring short-term productivity and excessive reporting requirements.
  
  
  CONCLUSIONS
  An overly ambitious project design, donor dominance within the business model and limited local counterpart capacity created problems in the community initiatives component of the project. Contractual pressures can negatively influence long-term outcomes that require development of local leadership and capacity. Future planning for donor project designs needs to be flexible, smaller in scope and have a longer timeframe of seven to 10 years.
  
  
  CONCLUSIONS
  Donor-funded projects need to be sufficiently flexible to apply proven principles of community development, build local ownership and allow adequate time to build counterpart knowledge and skills.
authors.affiliation: Northern Rivers University, Department of Rural Health, PO Box 740, Redcliffe, Queensland 4020. hashwell@bigpond.com.au
authors.forename: Helen
authors.initials: H
authors.lastname: Ashwell
authors.forename: Lesley
authors.initials: L
authors.lastname: Barclay
mesh_terms: D057191:Capacity Building; D002202:Capital Financing; D002648:Child; D002662:Child Health Services / Q000191:economics; D003132:Commerce; D018672:Community Health Planning / Q000191:economics*; D003159:Community-Institutional Relations; D003247:Conservation of Natural Resources; D005260:Female; D006284:Health Plan Implementation; D006801:Humans; D007391:International Cooperation; D008297:Male; D008427:Maternal Health Services / Q000191:economics; D010219:Papua New Guinea; D015397:Program Evaluation; D012189:Retrospective Studies