Sustainability of US-supported health, population, and nutrition programs in Honduras : 1942-1986

The authors differentiate between "immediate" outputs (e.g., personnel trained) and "replicating" outputs (e.g., schools to train personnel). It was found that once A.I.D. funding stopped, some immediate outputs were sustained with national funds, but that replicating outputs typically were supported by other donors' funds. An analysis of three cases of high degree of sustainability (auxiliary nurse training, rural water supplies, and latrine and pump projects) and three cases of low degree of sustainability (family planning, malaria eradication, and nutrition projects), revealed the following significant relationships. (1) National commitment to project goals was essential to the sustainability of project outputs and benefits. (2) Cooperative negotiations between A.I.D. and the Ministry of Health with regard to project objectives, design, and implementation contributed to sustainability. Projects viewed as imposed by A.I.D. were not well sustained. (3) Vertically organized projects often generated institutional resentment that jeopardized sustainability, whereas integrated projects tended to be better sustained, though at lower levels of effectiveness. Use of a multi-component matrix organization which combines several vertical components with an integrated managerial and planning structure might lead to higher levels of effectiveness. (4) Projects perceived as effective during the life of the project were more likely to be sustained than those which failed to achieve anticipated outputs. Effectiveness did not, however, guarantee sustainability. (5) Coordination among donors was important for sustainability. No clear relationship was found between sustainability and the size of A.I.D. funding relative to Honduran contributions to the project, national assumption of recurrent salary costs, cost recovery, or the proportion of the national health budget devoted to hospitals (versus primary health care). Similarly, the amount, type, and duration of technical assistance, training, and community participation were not significantly related to sustainability.