Sustainability assessment of the Africa child survival initiative (ACSI) combatting childhood communicable diseases (CCCD) project, Nigeria, 1992

Contextually, potential sustainability is affected negatively by both political and economic factors. The proliferation of local governments in Nigeria, while giving communities unprecedented fiscal control, has generated a high level of political instability. On the economic front, the dwindling proportion of the federal budget allocated to health since 1980 weighs heavily against the ultimate sustainability of many of the CCCD components. At the programmatic level, however, ASCI-CCCD"s perceived effectiveness and the Nigerian sense of ownership of the project both augur well for sustainability, as does the project"s integration into the national primary health care program, its effective training program, and its strategy of building constituencies through mutually respectful negotiations. Overall, the Expanded Program on Immunization and the project"s training and information system components seem most likely to be sustained, while the Control of Childhood Diarrhea program and the routine data aspects of the Monitoring and Evaluation system are in jeopardy of not being sustained. A key lesson is that responsibility for assuring progress toward sustainability should be negotiated as part of the project process. This should include a negotiated process for local absorption of project costs in proportion to the community"s ability to pay.