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

Example of TOOL 2 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 level.

Tool 2. Sustainability level of the Nutritional care unit
Concerning the program/project	Yes	No	Indicators (Justify your yes/no answers)
Memory (specific indicators)
Financial resources of the organization			No resources supplied by the hospital; very low budgetary allocation from the State to the hospital.
Human resources of the organization			No nomination by the State of civil servants required for the functioning.
FMaterial resources of the organization			No resources supplied by the hospital.
Other resources of the organization			No resources supplied by the hospital.
Adaptation (specific indicators)
Adaptation to the context			The management of severely underfed children is the responsibility of a referred hospital.
Adaptation to the effects			Tools are adapted to local capacities and to the context for follow-up and evaluation of the effects of the Unit.
Barriers to adaptation			Relevance of the Unit’s activities was not challenged.
Values (specific indicators)
Coherence with the organization’s objectives			Implicit sharing of objectives but absence of an established plan mentioning the Unit.
Symbols in the organization			Presence of a symbol for the Unit but it was the NGO’s logo.
Rituals in the organization			No formal meetings organized.
Specific language or jargon			Existence of specific technical jargon but limited to a few people with a low degree of familiarity.
Rules (specific indicators)
Nomination of a supervisor from the organization			No supervisor assigned to the coordination of all of hospital’s activities.
Inclusion in the organization’s planning			No real inclusion in the planning, but in the memorandum of understanding.
Tasks description			Very good task description for unit staff.
Written procedures			Existence of a practical guide for nutrition monitoring and many therapeutic protocols.

With the collected information presented in the above synthesis-table, it was estimated that the sustainability level of the Unit in the hospital was low (see the five levels table at the How to use Tool 2 section). Official hospital activities are derived from the Unit, but they don’t posses all of the characteristics required to qualify as routinized. They are not routinized because they can drastically change on a short term basis. A large number of activities derived from the NGO’s program are still carried out by the Unit. However, they are far from integrated in the hospital’s functioning.

There were notable achievements in relation to some characteristics of sustainability: adaptation to context, nutrition management procedures, tasks description, follow-up system (monitoring). However, the low level of sustainability can partly be explained by the Unit’s implementation and partly by the lack of activities or events favourable to routinization (see the Example of Tool 1 utilization section). The implementation of the Unit was the responsibility of the NGO. Activities were carried out in the hospital’s facilities but were financed, staffed and supplied by the NGO. In order to insure a higher level of sustainability, the hospital needs to take more organizational risks.