A tool-kit for the evaluation of sustainability processes and
sustainability levels of public health programs and projects

Example of TOOL 1 utilization.

This tool was used in different contexts, specifically in Canada and Haiti. The following is an example of its utilization in a health project in Haiti.

Centre for nutritional recuperation (Haiti)

« Terre des hommes » Foundation is a Swiss nongovernmental organization (NGO) that has been working in Haiti since 1989. This NGO is concerned with nutrition and providing direct aid to children. In 1997, the NGO implemented a unit to manage severe acute malnutrition in children. Five years later, after an evaluation conducted by the NGO and local health authorities, the Unit was altered to focus on issues of moderate malnutrition.

In 2003, the NGO was responsible for the Unit, and began to transfer this responsibility to the paediatrics service of the departmental hospital. To aid in this transition the NGO organized activities to increase the sustainability processes of the Unit in the hospital. At the end of 2004, the Unit was functioning within the hospital. Between 2005 and 2007, the NGO’s goal was to pass on sole responsibility of the Unit to the hospital. It is in this context that the NGO decided to perform an initial evaluation of the sustainability processes started in 2003. This evaluation was undertaken to promote necessary adjustment for the Unit’s sustainability.

Concerning the program/project Events (e.g. actions taken) Favourable Unfavourable
Specific sustainability events
Stabilization of organizational resources
  • The actual capabilities of the State and its failure to keep its promises during a project in 1999 are not taken into account.
  • Unlike what was planned, the NGO still pays the Unit salaries instead of giving the hospital a grant before official agents are nominated.


Organizational risk-taking
  • Two entities function separately in only one building.
  • Staff reduction in the Unit and asking parents to compensate.

Joint sustainability and implementation events
Incentives or benefits for people involved
Adaptation of the activities  Good reputation of the NGO concerning the quality of nutrition projects via past activities in this area of the country.
Objectives fit with those of the organization  Signing of a memorandum of understanding.
Transparent communication between people involved
  • Consultation for the writing of the protocol.
  • Setting up of a committee (board).
  • Lack of follow-up with the newly assigned Minister of Health.
  • Not enough meetings with all the hospital staff.





Sharing of culture and artefacts with the organization
Integration of rules into those of the organization  Hospital routines not taken into account (staff turnover).
Specific implementation events
Investment of adequate resources to complete the activities
  • Construction of a building; material supplies.
  • Training and practical training of nurses in two entities (NGO and hospital).
  • No practical training for hospital support staff.




Technical or practical compatibility of the activities with those of the organization  Addition of a joint building to the hospital with its staff.


With the information presented in the above synthesis-table, it was estimated that the sustainability process was moderate to low. In fact, more unfavourable events than favourable ones were mentioned during the evaluation process. The synthesis-table also shows that no “specific sustainability events” identified as favourable were mentioned.

It was also important to know the perspective of key people in relation to what immediate actions may be taken to promote the sustainability process of the Unit. The stabilization of resources and the operational imbrications of the Unit and the hospital were mentioned. The importance of collaboration between members of the Unit and the hospital was also stressed. This type of integration could be accomplished by sharing staff and material resources with greater transparency and confidence possible. Also, the NGO provided significantly more human and material resources to the Unit in comparison to the hospital. In order to make the Unit sustainable, the hospital needs to take more risks.