Table 5 Perceived determinants of sustainability (factors that may affect sustainability of A&T programs post-Phase 1) according to key stakeholders
Factor | Bangladesh | Vietnam |
|---|---|---|
Program/project-specific factors | ||
Clear goal(s) | Clear goals of A&T have been diffused after Phase 1 | Less awareness around specific goals post-Phase 1; urgent priorities (e.g., emergency situations) now distract focus |
Perceived effectiveness | Phase 1 activities were highly effective but not sustained | |
Financing | Challenging to raise funds after Phase 1; new donor priorities shape focus of activities; reduced incentives for health workers affect service quality | Reduced IYCF funding which affects post-Phase 1 activities; concerns about national and sub-national budgets; workers are seeking alternative sources of income (e.g., selling supplements, charging for services) |
Training | Refresher trainings and supportive supervision were seen as essential to Phase 1 success, but have been eliminated/reduced, which affects service quality | |
Evaluation/ assessment | Rigor & focus of M&E has declined post-Phase 1 | |
Leadership | Government should lead for sustainability | Government leadership seen as critical during and after Phase 1 (national and local); weaker convening power post-Phase 1 |
Organizational factors | ||
Local-level modifiability | Small adaptations to communication and training materials post-Phase 1; health workers modified counseling materials & content to reflect available resources and client preferences | |
Initiative−/Donor- client/−community interactions | (Did not emerge as a theme) | |
Project champion | High turnover of government officials in leadership positions | Champion role needs to expand/shift agencies post-Phase 1 which is challenging |
Integration | Integration of IYCF programs into existing programs seen as essential; but disagreements about whether a dedicated workforce is needed | Advantages and challenges of franchises versus routine services (including competing demands on health workers); integration needs money and commitment from all levels of government |
Institutional strength/capacities | Availability of skilled personnel, both frontline workers and leadership, is an ongoing challenge; media campaign capacity is weak post-Phase 1 | High staff turnover affects sustainability; hard to ensure ongoing quality of community support group leaders |
Contextual factors | ||
Concurrent projects/ activities | Other IYCF programs have shifted priorities (from government to workers) post-Phase 1 | Many IYCF programs and donors, but overall perceived decline in priority |
Community characteristics | Certain messages (handwashing) require repeated messaging which is challenging to sustain | Hard-to-reach communities (working mothers, geographic terrain) affects ongoing implementation; partnerships can help |
Political, economic and cultural characteristics | Certain cultural beliefs perceived as continuing to inhibit IYCF behavior change | Lack of IYCF and antenatal services within national health insurance scheme may affect long-term sustainability (both financial support and demand for services), amplified by increasing female labor force participation (limited time to access care) |