Development assistance and health programs : issues of sustainability

has placed increasing emphasis on creating health sector programs which are sustainable, that is, capable of being continued by the developing countries themselves and of providing benefits lasting beyond the period of A.I.D.'s technical, managerial, and financial support. This review of the literature on the health programs of A.I.D. and other large donors such as UNICEF and the World Bank intends to generate larger and deeper discussion of the issue of sustainability. Five factors key to sustainability are identified: financing, host country policy, community participation, program type, and management issues of resource allocation and information collection systems. The author finds that programs are most likely to be sustained: when they are affordable by the country and the community, and include provisions for cost recovery or private sector participation; when beneficiaries have a role in planning and managing them; when simple, but effective management systems are in place, including information, monitoring, and evaluation subsystems; and when they are focused on but not limited to a single intervention, i.e., when they offer an "integrated" range of services and do not attempt too much with too few resources. Attempts have been made to incorporate these lessons into A.I.D.'s present emphasis on the four major child survival interventions (immunization, oral rehydration therapy, birth spacing, and nutrition) which combines the strengths of both the single target programs of the 1950's and the integrated programs of the 1970's. The paper includes a review of A.I.D.'s health policy history as well as 7 pages of references.