Sustainability of US-supported health, population, and nutrition programs in Tanzania : 1971-1988

Activities that were sustained included all the urban water projects, the health components of the MCH aides training project, the curative aspects of the cancer control project, and the village health services component of the Hanang project. However, even most of these efforts were having difficulties in continuing to provide services. The water projects were all continuing to provide services, although maintenance was weak and future demand could not be met with present capacity. The MCH aides who were trained were still providing services although there was some deterioration of services. The hospital-based cancer control center was fully operational and gaining an international reputation. The village health worker program was still active in many villages although there had been a significant dropout of trained workers. The continuation of project activities was negatively affected by a significant decline in Tanzania's economy, which has severely limited the government's ability to continue project funding and import necessary medical and transportation supplies and equipment. On the other hand, sustainability has been supported by the political environment, which is characterized by a broad- based and strong ideological commitment to the poor, as well as a very high level of donor coordination. The success of the sustained projects underscores the importance of the following design and implementation characteristics: (1) the integration of project activities into existing administrative structures and the avoidance of vertical project design; (2) a high or increasing level of project funding through national sources (e.g., budgetary and cost recovery mechanisms); and (3) the provision of visible services and demonstrated effectiveness of project activities to develop demand among provider and beneficiary groups.