As part of World Antimicrobial Awareness Week 2022 in November last year, Head of the Fleming Fund’s Expert Advisory Group Dr Catriona Waddington joined an esteemed panel of speakers from the AMR community at the symposium, ‘The rising tide of antimicrobial resistance – a high price to pay’ hosted by Ineos Oxford Institute, Oxford Martin School.
Common elements of good practice for sustainability
How likely are the Fleming Fund country level results to be sustained? This is one of six questions being pursued by our independent evaluator. In preparation, Itad looked to the literature on sustainability to identify any common elements of good practice.
Itad started by looking at the OECD/DAC definition of sustainability which stated that sustainability means being “concerned with measuring whether the benefits of an activity are likely to continue after donor funding has been withdrawn. Projects need to be environmentally as well as financially sustainable”(i). However, the reviewers discovered multiple definitions among the literature which contributed to a lack of available evidence on how to “do” sustainability or a consensus on what common factors may contribute to it. Itad also noted the importance of defining sustainability precisely and early on in a programme, as the definition chosen can influence the programme strategy (is the focus on sustaining project activities or its outcomes, for example?).
The process of planning for sustainability, transition or exit was well covered in the literature and Itad was able to draw out key elements of good practice, including:
- Consultation / partnership / ownership / trust / participation. Itad grouped together factors that relate to the nature of the relationships required to handover responsibility for activities or outcomes to another entity after an intervention ends. Evidence emphasises the importance of following a consultative process, with participation of relevant stakeholders in the spirit of partnership. The purpose of this is to build ownership and trust.
- Objectives/planning/fit. The literature also highlighted the importance of sustainability objectives being clearly articulated, that they drive sustainability plans, and fit with the values of the organisation that will take on responsibility for activities and outcomes. This maximises the chances of routinising or institutionalising relevant processes.
- Sequencing/phased transition /ongoing technical assistance. The literature recognised that the handover of responsibility from one organisation to another should happen over time with the goal of having the new responsible organisation ‘in the driving seat’ before the end of the project. This will enable identification of any issues while there is still time for correction. There is also evidence to support having resources available for ongoing technical assistance past the end of the project, to support the handover process. Few papers mentioned capacity building as part of transition but this may be due to technical and managerial capacity being noted as a prerequisite to sustainability, as highlighted below.
- Resources – money, materials and assets. The literature highlighted the importance of resources to sustainability although it was also recognised that this is necessary but not sufficient on its own.
The reviewers found less evidence on what conditions need to be in place to achieve sustainability. One key paper (ii) highlighted the importance of conditions that all need to be in place to achieve sustainability (iii) and these were supported by other papers in the review. These conditions were:
- Sustained source of resources. The financial and material resources required to cover the costs associated with project activities.
- Technical and managerial capacity. The availability of staff that have relevant skills and time to take forward the work needed to sustain project outcomes.
- Motivation of beneficiaries and providers. The behavioural aspects of sustainability, recognising that individuals (as providers or users) need to be motivated or incentivised to act, whether through financial incentives and in-kind benefits or through personal commitment, community service and prestige.
The key takeaways from this review for the Fleming Fund, and other grant programmes that aim to be sustainable, are:
- Ensure that the process of planning for sustainability is consultative, with clear objectives that translate into a phased, supported handover and start this planning as early as possible in the process.
- Give thought to how to ensure that the above conditions are in place among grantees early in the programme, or if these things are expected to take longer to put in place, and how to track progress along an overall strategy or pathway to achieving sustainability.
Itad has drawn on the above findings to develop a ‘best practice’ framework. They will use this as part of the evaluation to assess the Fleming Fund’s approach to sustainability, both to identify potential adaptation and to draw conclusions on whether the Fleming Fund’s country-level results are likely to be sustained.
(i) DAC Criteria for Evaluating Development Assistance
(ii) Coates Elizabeth Kegode Tina Galante Alexander Blau Gerald, J. J. (2016). Sustaining Development: Results from a Study of Sustainability and Exit Strategies among Development Food Assistance Projects - Kenya Country Study. Retrieved from the Food and Nutrition Technical Assistance Project
(iii) Based on projects in the authors’ sample.
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Knowledge Notes
From Knowledge Notes, Common elements of good practice for supporting One Health , Date: 05/08/2021
How does the Fleming Fund’s approach to One Health reflect good practice? How can One Health be evaluated? These are questions being considered by the Fund’s independent evaluator, [Itad](https://www.itad.com/). The evaluation team looked to the literature on One Health and multisector collaborations to identify any common elements of good practice.