Triangulating Transition: Conceptual, Practical, and Ethical Considerations for Sustaining Program Impact through Transitions to Local Ownership

sustainability;local ownership;Public Health Studies

Paul, AmyBeyrer, Chris ;

Johns Hopkins University

关键词: sustainability;    local ownership;    Public Health Studies;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/60553/PAUL-DISSERTATION-2015.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Objectives: As donor investments in HIV/AIDS decline, transitioning programs to local ownership has become a key strategy to enhance the sustainability of donor investments in programming implemented in parallel to existing health systems.Many health systems, however, face constraints that may limit the extent to which transitions result in sustainability. This study aimed to 1) develop a candidate conceptual model of program sustainability that is consistent with transition goals and the process of transitioning ownership, 2) understand the challenges associated with transitioning to host-country health systems and potential threats to sustainability, and 3) explore the ethical responsibilities of donor agencies relevant to the process of transition.Methods: Empirical aims were investigated through a case study of the transition of the Avahan Initiative from the Bill & Melinda Gates Foundation to local actors in India. Key informant interviews were conducted and data analysis employed qualitative techniques including descriptive coding, pattern coding, and explanation building. The normative aim employed standard techniques for investigating responsibilities.Results: The candidate model of program sustainability reflects two dimensions: Continuous Service Delivery and Maintained Program Quality. These dimensions represent transition outcomes achieved when local actors effectively fulfill the responsibilities associated with five roles: Leadership, Resource Allocation, Implementation, Strategic Program Management, and End-User Engagement.Challenges associated with program transition to local ownership included aligning to a lower costing structure, having more limited flexibility, and adjusting to differences in support for community-oriented activities.These challenges contributed to several programmatic changes; limited flexibility to adapt and diminished support for community-oriented activities were perceived as the greatest threats to long-term sustainability.Normative analysis identified a compelling basis for the claim that donor agencies are in part responsible for ensuring that threats to the basic well-being of end-users that have been averted by their programs remain averted after exit. Conclusions: Transition can sustain program outcomes and constitute a morally responsible exit if donors make an effort to understand how their programming averts threats to the basic well-being of end-users and support capacity-building and advocacy efforts sufficient to ensure that local actors are willing and able to effectively avert these threats after transition.