Sustainability of US-supported health, population, and nutrition programs in Zaire : 1972-1988

Four projects are examined -- maternal/child health (MCH) clinics administered by Mama Yemo Hospital, community health-integrated rural development implemented by the Salvation Army, and two projects (health systems development and malaria control) implemented by the Ministry of Health (MOH). All of the projects were completed at least three years prior to the study. Only two of the projects were sustained. The MCH project is still providing clinical and family planning services, and using the educational materials developed during the period of A.I.D. assistance. Most activities under the Salvation Army project are also continuing, with the majority of recurrent costs being covered by user fees. By contrast, the malaria project has been completely dismantled, and none of the direct activities of the health systems project are continuing. The report concludes that the sustainability of projects in Zaire is strongly affected by contextual factors, such as the country's weak, poorly funded, and corrupt state institutions; continuing economic crisis; and weak implementing institutions (e.g., the extremely fragmented MOH). However, while more effort is necessary to strengthen the economic and institutional contexts of projects in Zaire, several improvements could be made even in this difficult context to enhance the sustainability of future projects. These improvements include: (1) project integration into the normal administrative structure of implementing institutions; (2) the involvement of implementing agencies in the project design process; (3) strong training components; (4) increased community participation; (5) utilization of cost recovery and other alternative financing mechanisms; (6) demonstrated appropriateness and effectiveness of projects; and (7) high-quality technical assistance. Appendices include an assessment of the sustainability potential of current health projects. Also available are papers on the sustainability of health projects in Senegal (PN-AAX-245) and Tanzania (PN-AAX-243).