Sarriot Eric G, Kouletio Michelle, Jahan Dr Shamim, Rasul Izaz, Musha Akm
Director, ICF International Center for Design and Research in Sustainable Health and Human Development (CEDARS), 530 Gaither Road Suite 500, Rockville, MD 20850, USA.
Health Res Policy Syst. 2014 Aug 26;12:45. doi: 10.1186/1478-4505-12-45.
Starting in 1999, Concern Worldwide Inc. (Concern) worked with two Bangladeshi municipal health departments to support delivery of maternal and child health preventive services. A mid-term evaluation identified sustainability challenges. Concern relied on systems thinking implicitly to re-prioritize sustainability, but stakeholders also required a method, an explicit set of processes, to guide their decisions and choices during and after the project.
Concern chose the Sustainability Framework method to generate creative thinking from stakeholders, create a common vision, and monitor progress. The Framework is based on participatory and iterative steps: defining (mapping) the local system and articulating a long-term vision, describing scenarios for achieving the vision, defining the elements of the model, and selecting corresponding indicators, setting and executing an assessment plan,, and repeated stakeholder engagement in analysis and decisions . Formal assessments took place up to 5 years post-project (2009).
Strategic choices for the project were guided by articulating a collective vision for sustainable health, mapping the system of actors required to effect and sustain change, and defining different components of analysis. Municipal authorities oriented health teams toward equity-oriented service delivery efforts, strengthening of the functionality of Ward Health Committees, resource leveraging between municipalities and the Ministry of Health, and mitigation of contextual risks. Regular reference to a vision (and set of metrics (population health, organizational and community capacity) mitigated political factors. Key structures and processes were maintained following elections and political changes. Post-project achievements included the maintenance or improvement 5 years post-project (2009) in 9 of the 11 health indicator gains realized during the project (1999-2004). Some elements of performance and capacity weakened, but reductions in the equity gap achieved during the project were largely maintained post-project.
Sustainability is dynamic and results from local systems processes, which can be strengthened through both implicit and explicit systems thinking steps applied with constancy of purpose.
自1999年起，国际关怀组织（Concern Worldwide Inc.，简称“关怀组织”）与孟加拉国的两个市政卫生部门合作，以支持孕产妇和儿童健康预防服务的提供。一项中期评估发现了可持续性方面的挑战。关怀组织在重新确定可持续性的优先次序时隐含地依赖系统思维，但利益相关者还需要一种方法，一套明确的流程，来指导他们在项目期间及之后的决策和选择。
关怀组织选择了可持续性框架方法，以激发利益相关者的创造性思维，创建共同愿景，并监测进展情况。该框架基于参与性和迭代性步骤：定义（绘制）当地系统并阐明长期愿景，描述实现愿景的情景，定义模型要素并选择相应指标，制定并执行评估计划，以及利益相关者反复参与分析和决策。在项目结束后长达5年（2009年）的时间里进行了正式评估。
通过阐明可持续健康的集体愿景、绘制实现和维持变革所需的行动者系统以及定义不同的分析组成部分，为该项目的战略选择提供了指导。市政当局引导卫生团队致力于以公平为导向的服务提供工作，加强病房卫生委员会的功能，在市政当局与卫生部之间进行资源整合，并降低背景风险。定期参考愿景（以及一套指标（人口健康、组织和社区能力））减轻了政治因素的影响。选举和政治变革后，关键结构和流程得以维持。项目结束后的成果包括，在项目（1999 - 2004年）期间实现的11项健康指标改善中，有9项在项目结束后5年（2009年）得以维持或改善。一些绩效和能力要素有所减弱，但项目期间实现的公平差距缩小在项目结束后基本得以保持。
可持续性是动态的，源于当地系统流程，通过持续应用隐含和明确的系统思维步骤可以加强这些流程。
