Sustainability is a complex issue. Are we concerned about the sustainability of the programme or of its achievements? In broad terms, sustainability can be defined as the ability to maintain the positive impact of a programme, once that programme has achieved its objectives. But maintenance of the positive impact may not be all that you want to do. If, for example, your programme has achieved its objective of reducing malnutrition by 20 percent, you may want to achieve a further 20 percent reduction in the future. Maintenance of the positive impact of a programme, or making further improvements, can be achieved in a variety of ways:
We suggest the Assessment Team devote a session to discussing the issue of sustainability, not simply in programme terms, but also in terms of maintaining and further improving the nutritional well-being of the population, namely setting the foundations for good nutrition in generations to come.
|Achieving sustainability: some alternatives|
|FAO's in-depth study of nine programmes (2003) gives these examples:|
|“Mexico's PROGRESA programme aims to break the cycle of poverty, .... [to] .... allow development to take place. If.......the programme achieves its aim, arguably then the sustainability of the programme itself is not an issue. It will have served its purpose of ‘jumpstarting’ the development process, and support to this process would then need a different approach. Along similar lines, Sri Lanka's Samurdhi programme sees itself as a transition from a welfare approach to a development approach. If the transition is successful, the programme will have done its job. Honduras’ PROLESUR programme, on the other hand, focuses on a transfer of technology..... It has clearly succeeded in transferring the technologies, and these appear now to be institutionalized and hence sustainable.....”|
A key element of success, perhaps the most important one, is real political commitment to achieving the nutritional well-being of the population, and a recognition of nutrition as both an input to and an outcome indicator of national development. Political instability or a new government can threaten the sustainability of this commitment, but if public opinion has been harnessed, then the chances of maintaining commitment are enhanced.
Many of the factors you have been assessing in Sections I, II and III have implications for sustainability. A supportive macroenvironment, the availability of good technical expertise, communities’ access to adequate basic services and a high level of participation are all examples of factors that will promote sustainability. In this section, we bring together some outstanding issues that you need to address. These are:
A programme draws upon a number of resources: financial and human resources as well as logistic support. Funding itself is a vexed issue. Few national nutrition budgets are adequate to cover the real needs of nutrition activities in the country. Even if they represent a respectable proportion of the national budget, the actual amount may be too small, especially in a poor country where the prevalence of malnutrition is likely to be highest. Securing external funding therefore becomes an essential part of funding arrangements. In some very poor countries, reliance on external funding is high and will continue so for the foreseeable future. But whatever the need for external funding, you need to be sure that there is in place a schedule for progressive handing over of the funding to the national government, however long-term this may be. Adequate human resources are often scarce in poor countries. If this is not addressed through an adequate programme of human resource development, then the programme will become unsustainable when external technical expertise is withdrawn.
As a part of its discussion on sustainability, the Assessment Team should address the following questions:
Are funding arrangements sufficient to ensure sustainability of the programme and/or its achievements?
If the programme receives external funding, is there a planned schedule of handing over of funding responsibility, and has it been adhered to? Or have other funding arrangements been made?
Is funding provided by non-governmental organizations and by the communities? Do you assess that this is likely to continue?
Is there a clear understanding, on the part of the donor(s) and government, that nutrition improvement programmes require long-term investment, most likely beyond one political mandate? If this was understood at the outset of the programme, then funding should have been secured for a long period (ten years or more is often recommended).
If your programme has taken an intersectoral approach as recommended, it may be possible to secure the sustainability of some components at least through the assumption of responsibility of these components by other sectors34. There will however be a continuing need for specific nutrition activities which must remain the responsibility of a nutrition unit in whichever ministry it is located. The programme, either as a whole or as its component parts, must become an accepted part of routine sectoral activities: it must seek to become ‘institutionalized’. Furthermore, its community base must become institutionalized within communities: if the participatory approach has been successful, communities should have a sense of ownership of the programme.
Based on all assessments thus far, the Assessment Team should discuss the following questions:
Has the programme become institutionalized? If so, in which Ministry or organization?
Have components been ‘adopted’ by relevant sectors? If so, are mechanisms in place to oversee implementation? Are these adequate?
Do communities have a sense of ownership of the programme, such that they can insist on its continuation?
Future needs are often unpredictable. They may relate to emergencies, such as drought or civil unrest or to emerging disease conditions. A good nutrition programme should be able to respond to these needs, with or without external assistance: it should be seen as part of a country's disaster preparedness plan. Other future needs relate to an increase in demand for basic services, as communities improve their health-seeking behaviour for example, or to a changing profile of nutrition in the country35. Programme flexibility is needed too, to accommodate events as diverse as increasing decentralization and new scientific knowledge and new technologies.
|Responding to emergencies|
|“The [Honduras] project PROLESUR began in 1988 as an emergency programme in response to severe drought and food insecurity in the southern municipalities of the Department of Lempira.......... It is [now] primarily a rural development programme with the objective of improving the quality of life of households through new soil conservation and agricultural techniques and employment opportunities...... The programme appears to have had a major impact on food production (maize and beans) and food storage capacity, such that the region was able to withstand the devastating impact of Hurricane Mitch and actually export food to other areas of Honduras after the hurricane.”|
|Quote from FAO's in-depth study of nine programmes (2003).|
Based on information gathered throughout the assessment exercise, the Assessment Team should discuss and answer the following questions:
Are good basic services available, responsive to community needs?
Can you be reasonably sure that future needs for basic services and technical expertise, in nutrition and related areas, can be met?
Is the programme flexible enough to accommodate future events and changes in nutrition problems and priorities?
Are plans in place to undertake future assessments?
|“…if community participation is successful, demand for such services will rise and the insistence upon quality will also rise: better access to good health care and nutrition services, education, access to markets, safe water supply and good sanitation..… Community participation will fail if community demands and needs consistently remain unmet. The programmes of Brazil and Mexico mention the threat of increasingly unmet demand for services.”|
|Quoted in FAO's in-depth study of nine programmes (2003).|
You now have gathered the information you need to make an assessment of sustainability. Turn now to the Summary Report provided in Annex 1, and answer the questions in Section IV. Then carry out a SWOC analysis.
Sustainability is an important issue: many accounts exist of programmes and projects whose achievements disappear once the programme ends. At best, they will have had an impact on one generation of the country's children and at worst they represent wasted resources, external or national. You should now list all identified actions and see if there are any outstanding in view of the assessment of sustainability you have undertaken. One important action is setting a date for the next assessment.
Here are the strengths, weaknesses, opportunities and constraints in relation to sustainability, identified by FAO's in-depth study of nine programmes (2003):
excessive dependence on non-governmental organizations and/or external funding.
Constraints (and threats):
34 These components should still be viewed as part of the nutrition programme, subject to overseeing by an intersectoral committee on food and nutrition and subject also to routine monitoring and evaluation.
35 Examples of such changes include the impact on nutrition of events such as the AIDS epidemic, urbanization, meeting the needs of a growing population of elderly people, increasing prevalence of diet-related chronic disorders.