Sustainability: The Elusive Dimension of International Health Projects

• Published in: Canadian journal of public health 2006-01, Vol.97 (1), p.45-49
• Main Authors: Edwards, Nancy C., Roelofs, Susan M.
• Format: Article
• Language: English
• Subjects: Adult; Canada; Child; Child Health Services - organization & administration; China; Community health; Community Health Planning - organization & administration; Community Health Workers; Diffusion of Innovation; Ethnic Groups; Female; Health Plan Implementation; Health services; Humans; Innovations; International Cooperation; International development; Maternal Health Services - organization & administration; Medical personnel; Minority Groups; Nursing; Planning; Practice; PRACTICE/PRATIQUE; Program Development; Program Evaluation; Prosperity; Public health; Public Health Administration; Quality of life; Socioeconomic Factors; Sustainability assessments; Sustainable communities; Sustainable development; Time Factors; Training; Training devices; Villages
• ISSN: 0008-4263; 1920-7476
• DOI: 10.1007/BF03405214

Objective: The Canada-China Yunnan Maternal and Child Health Project (1997-2003) sought to improve the quality of village life and promote development of productivity and social prosperity in Yunnan province, China. Participants: The project targeted grassroots maternal and child health workers: new and in-service village doctors; traditional village midwives; doctors at township health centres; doctors at county maternal and child health hospitals; and provincial health staff. Setting: Ten impoverished counties (population 2.2 million) in Yunnan province with high proportions of ethnic minority populations. Intervention: There were three major innovations: training grassroots maternal and child health workers in participatory and community-based approaches and clinical skills; designing a model comprehensive referral system including provision of basic equipment; and introducing participatory monitoring and evaluation methods. Strategies to support sustainability were built into the project from the outset. Outcomes: Over 4,000 village, township, and county health workers received training. Maternal, infant, and under-five mortality rates declined over 30% in project counties. Project innovations were disseminated throughout the province, into other donor-funded initiatives, and integrated into national health projects by local partners. Conclusion: Maintaining the long-term benefits of international health interventions depends on sustaining innovations beyond short project timelines. Achieving sustainability poses a conundrum to implementing agencies. Three mechanisms influenced uptake in the Yunnan project: maintaining a good fit between core project elements and the existing health system; developing adequate organizational supports; and creating a handover plan from the outset. This project highlights some of the ways in which sustainability can be operationalized. Objectif : Le Programme sino-canadien de santé des mères et des enfants du Yunnan (1997-2003) visait à améliorer la qualité de vie dans les villages et à promouvoir le développement de la productivité et de la prospérité sociale dans la province chinoise du Yunnan. Participants : Le programme s'adressait aux travailleuses et aux travailleurs locaux de la santé maternelle et infantile : les nouveaux médecins et les médecins en exercice dans les villages; les sages-femmes traditionnelles dans les villages; les médecins des centres sanitaires de district; les médecins des hôpitaux pour femmes