Qualitative research to develop a framework for evaluating the sustainability of community-based child health programs implemented by non-governmental organizations

Private Voluntary Organizations (PVOs1) have been implementing Child Survival projects in developing countries through USAID's Child Survival Grants Program (CSGP) since 1985. In spite of recognized achievements, these programs face questions about their sustainability and potential for large-scale implementation. Progress on a research agenda has been hampered by a lack of consistency about definitions and evaluation parameters.; Our study aim was to develop a framework for evaluating the sustainability of PVO child survival programs. Semi-structured interviews and questionnaire-surveys were conducted with PVO staff to explore how they define sustainability and what they see as its different dimensions.; Despite wide variation in the context and strategies of program implementation, PVOs share key values and concepts concerning sustainability.; Sustainability in Child Survival refers to a combination of outcomes and processes improving conditions critical to maintaining child health gains. Based on these findings, sustainability in Child Survival can be defined as a combination of outcomes and processes that improve conditions critical to maintaining child health gains.; The advancement of these conditions can be represented within a framework---the Child Survival Sustainability Assessment (CSSA) framework. Sustainability planning and evaluation start with the consideration of a "local system" expected to own the process of improving health. Through the CSSA, PVOs can contextually define objectives for progress toward sustainability, within dimensions of evaluation shared across projects.; The CSSA consists of three main dimensions: (1) The first dimension refers to health outcomes and the delivery of PHC services. This is generally addressed through traditional project evaluation. (2) The second dimension refers to the capacity and viability of local partner organizations. (3) The third relates to the "competence" or capacity of the community within its environment.; The last two dimensions are, so far, rarely integrated within a systematic project evaluation plan and will require continued progress in evaluation methodologies.; The CSSA offers a systematic methodology for sustainability assessment in CS projects, to improve planning, evaluation and accountability.; 1The term PVO refers to US-based Non Governmental Organizations (NGOs).