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Table 5 Perceived determinants of sustainability (factors that may affect sustainability of A&T programs post-Phase 1) according to key stakeholders

From: Can complex programs be sustained? A mixed methods sustainability evaluation of a national infant and young child feeding program in Bangladesh and Vietnam

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)
  1. A&T: Alive & Thrive
  2. IYCF: infant and young child feeding
  3. M&E: monitoring and evaluation