Toward the sustainability of health interventions implemented in sub-Saharan Africa: a systematic review and conceptual framework

Juliet Iwelunmor, Sarah Blackstone, Dorice Veira, Ucheoma Nwaozuru, Collins Airhihenbuwa, Davison Munodawafa, Ezekiel Kalipeni, Antar Jutal, Donna Shelley, Gbenga Ogedegebe, Juliet Iwelunmor, Sarah Blackstone, Dorice Veira, Ucheoma Nwaozuru, Collins Airhihenbuwa, Davison Munodawafa, Ezekiel Kalipeni, Antar Jutal, Donna Shelley, Gbenga Ogedegebe

Abstract

Background: Sub-Saharan Africa (SSA) is facing a double burden of disease with a rising prevalence of non-communicable diseases (NCDs) while the burden of communicable diseases (CDs) remains high. Despite these challenges, there remains a significant need to understand how or under what conditions health interventions implemented in sub-Saharan Africa are sustained. The purpose of this study was to conduct a systematic review of empirical literature to explore how health interventions implemented in SSA are sustained.

Methods: We searched MEDLINE, Biological Abstracts, CINAHL, Embase, PsycInfo, SCIELO, Web of Science, and Google Scholar for available research investigating the sustainability of health interventions implemented in sub-Saharan Africa. We also used narrative synthesis to examine factors whether positive or negative that may influence the sustainability of health interventions in the region.

Results: The search identified 1819 citations, and following removal of duplicates and our inclusion/exclusion criteria, only 41 papers were eligible for inclusion in the review. Twenty-six countries were represented in this review, with Kenya and Nigeria having the most representation of available studies examining sustainability. Study dates ranged from 1996 to 2015. Of note, majority of these studies (30 %) were published in 2014. The most common framework utilized was the sustainability framework, which was discussed in four of the studies. Nineteen out of 41 studies (46 %) reported sustainability outcomes focused on communicable diseases, with HIV and AIDS represented in majority of the studies, followed by malaria. Only 21 out of 41 studies had clear definitions of sustainability. Community ownership and mobilization were recognized by many of the reviewed studies as crucial facilitators for intervention sustainability, both early on and after intervention implementation, while social and ecological conditions as well as societal upheavals were barriers that influenced the sustainment of interventions in sub-Saharan Africa.

Conclusion: The sustainability of health interventions implemented in sub-Saharan Africa is inevitable given the double burden of diseases, health care worker shortage, weak health systems, and limited resources. We propose a conceptual framework that draws attention to sustainability as a core component of the overall life cycle of interventions implemented in the region.

Keywords: Health interventions; Implementations; Sub-Saharan Africa; Sustainability.

Figures

Fig. 1
Fig. 1
Conceptual framework: defining sustainability
Fig. 2
Fig. 2
PRISMA diagram of article selection
Fig. 3
Fig. 3
Conceptual framework of sustainability of interventions implemented in SSA

References

    1. HIV/AIDS, J.U.N.P.O . Global report: UNAIDS report on the global AIDS epidemic 2013. Geneva, Switzerland: UNAIDS; 2013. p. 2014.
    1. WHO . World malaria report 2013. Geneva: World Health Organization; 2014.
    1. Organization, W.H., Global tuberculosis report 2013. 2013: World Health Organization.
    1. BeLue R, et al. An overview of cardiovascular risk factor burden in sub-Saharan African countries: a socio-cultural perspective. Glob Health. 2009;5(1):10. doi: 10.1186/1744-8603-5-10.
    1. Young F, et al. A review of co-morbidity between infectious and chronic disease in Sub Saharan Africa: TB and diabetes mellitus, HIV and metabolic syndrome, and the impact of globalization. Glob Health. 2009;5(1):9. doi: 10.1186/1744-8603-5-9.
    1. Dalal S, et al. Non-communicable diseases in sub-Saharan Africa: what we know now. Int J Epidemiol. 2011;40(4):885–901. doi: 10.1093/ije/dyr050.
    1. Miranda J, et al. Non-communicable diseases in low-and middle-income countries: context, determinants and health policy. Tropical Med Int Health. 2008;13(10):1225–34. doi: 10.1111/j.1365-3156.2008.02116.x.
    1. Peck RN, et al. Hypertension-related diseases as a common cause of hospital mortality in Tanzania: a 3-year prospective study. J Hypertens. 2013;31(9):1806. doi: 10.1097/HJH.0b013e328362bad7.
    1. Kengne AP, Mayosi BM. Readiness of the primary care system for non-communicable diseases in sub-Saharan Africa. The lancet global health. 2014;2(5):e247–e248. doi: 10.1016/S2214-109X(14)70212-8.
    1. Murray CJ, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013;380(9859):2197–223. doi: 10.1016/S0140-6736(12)61689-4.
    1. Mayosi BM. The 10 ‘Best Buys’ to combat heart disease, diabetes and stroke in Africa. Heart. 2013;99(14):973–4. doi: 10.1136/heartjnl-2013-304130.
    1. Ziraba AK, Fotso JC, Ochako R. Overweight and obesity in urban Africa: a problem of the rich or the poor? BMC Public Health. 2009;9(1):465. doi: 10.1186/1471-2458-9-465.
    1. Shigayeva A, Coker RJ. Communicable disease control programmes and health systems: an analytical approach to sustainability. Health Policy Plan. 2015;30(3):368–85. doi: 10.1093/heapol/czu005.
    1. Scheirer MA, Dearing JW. An agenda for research on the sustainability of public health programs. Am J Public Health. 2011;101(11):2059. doi: 10.2105/AJPH.2011.300193.
    1. Bossert TJ. Can they get along without us? Sustainability of donor-supported health projects in Central America and Africa. Soc Sci Med. 1990;30(9):1015–23. doi: 10.1016/0277-9536(90)90148-L.
    1. Chambers DA, Glasgow RE, Stange KC. The Dynamic Sustainability Framework: addressing the paradox of sustainment amid ongoing change. Implement Sci. 2013;8(1):117. doi: 10.1186/1748-5908-8-117.
    1. Katz I, et al. Lessons learned from stakeholder-driven sustainability analysis of six national HIV programmes. Health Policy Plan. 2014;29(3):379–87. doi: 10.1093/heapol/czt024.
    1. Jha A, et al. Accelerating achievement of the sustainable development goals. BMJ. 2016;352:i409. doi: 10.1136/bmj.i409.
    1. Proctor E, et al. Sustainability of evidence-based healthcare: research agenda, methodological advances, and infrastructure support. Implement Sci. 2015;10(1):88. doi: 10.1186/s13012-015-0274-5.
    1. Scheirer MA. Is sustainability possible? A review and commentary on empirical studies of program sustainability. Am J Eval. 2005;26(3):320–47. doi: 10.1177/1098214005278752.
    1. Shediac-Rizkallah MC, Bone LR. Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy. Health Educ Res. 1998;13(1):87–108. doi: 10.1093/her/13.1.87.
    1. Stirman SW, et al. The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implement Sci. 2012;7(17):1–19.
    1. Bhardwaj S, et al. Implementation research for the prevention of mother-to-child HIV transmission in sub-Saharan Africa: existing evidence, current gaps, and new opportunities. Curr HIV/AIDS Rep. 2015;12(2):246–55. doi: 10.1007/s11904-015-0260-1.
    1. Kiwanuka SN, et al. What lessons for sustainability of maternal health interventions can be drawn from rural water and sanitation projects? Perspectives from Eastern Uganda. J Manage Sustain. 2015;5(2):p97.
    1. Kalipeni E, Semu LL, Mbilizi MA. The brain drain of health care professionals from sub-Saharan Africa: a geographic perspective. Prog Dev Stud. 2012;12(2-3):153–71. doi: 10.1177/146499341101200305.
    1. Gilson L. The lessons of user fee experience in Africa. Health Policy Plan. 1997;12(3):273–85. doi: 10.1093/oxfordjournals.heapol.a018882.
    1. Heller RF, et al. Critical appraisal for public health: a new checklist. Public Health. 2008;122(1):92–8. doi: 10.1016/j.puhe.2007.04.012.
    1. Iwelunmor J, Newsome V, Airhihenbuwa CO. Framing the impact of culture on health: a systematic review of the PEN-3 cultural model and its application in public health research and interventions. Ethnicity Health. 2014;19(1):20–46. doi: 10.1080/13557858.2013.857768.
    1. Sarriot EG, et al. Qualitative research to make practical sense of sustainability in primary health care projects implemented by non-governmental organizations. Int J Health Plann Manag. 2004;19(1):3–22. doi: 10.1002/hpm.743.
    1. Johnson K, et al. Building capacity and sustainable prevention innovations: a sustainability planning model. Eval Program Plann. 2004;27(2):135–49. doi: 10.1016/j.evalprogplan.2004.01.002.
    1. Mutale W et al., Application of systems thinking: 12‐month postintervention evaluation of a complex health system intervention in Zambia: the case of the BHOMA. J Eval Clin Pract, 2015.
    1. Wilson PT, et al. Aftermath of a clinical trial: evaluating the sustainability of a medical device intervention in Ghana. J Trop Pediatr. 2014;60(1):33–9. doi: 10.1093/tropej/fmt074.
    1. Amazigo U, et al. Performance of predictors: evaluating sustainability in community-directed treatment projects of the African programme for onchocerciasis control. Soc Sci Med. 2007;64(10):2070–82. doi: 10.1016/j.socscimed.2007.01.018.
    1. Blanchet K, et al. Advancing the application of systems thinking in health: analysing the contextual and social network factors influencing the use of sustainability indicators in a health system—a comparative study in Nepal and Somaliland. Health Res Policy Syst. 2014;12(1):46. doi: 10.1186/1478-4505-12-46.
    1. Rashed S, et al. Sustaining malaria prevention in Benin: local production of bednets. Health Policy Plan. 1997;12(1):67–76. doi: 10.1093/heapol/12.1.67.
    1. Mbanefo EC, et al. Onchocerciasis in Anambra State, Southeast Nigeria: clinical and psychological aspects and sustainability of community directed treatment with ivermectin (CDTI) Postgrad Med J. 2010;86(1020):573–7. doi: 10.1136/pgmj.2010.100248.
    1. Osawa E, Kodama T, Kundishora E. Motivation and sustainability of care facilitators engaged in a community home-based HIV/AIDS program in Masvingo Province, Zimbabwe. AIDS Care. 2010;22(7):895–902. doi: 10.1080/09540120903499196.
    1. Roura M, et al. Barriers to sustaining antiretroviral treatment in Kisesa, Tanzania: a follow-up study to understand attrition from the antiretroviral program. AIDS Patient Care STDS. 2009;23(3):203–10. doi: 10.1089/apc.2008.0129.
    1. Aubel J, Samba-Ndure K. Lessons on sustainability for community health projects. World Health Forum. 1996;17(1):52–7.
    1. Eliason R. Towards sustainability in village health care in rural Cameroon. Health Promot Int. 1999;14(4):301–6. doi: 10.1093/heapro/14.4.301.
    1. Ghiron L, et al. Beginning with sustainable scale up in mind: initial results from a population, health and environment project in East Africa. Reprod Health Matters. 2014;22(43):84–92. doi: 10.1016/S0968-8080(14)43761-3.
    1. Somassé YE, et al. Sustainability and scaling-up analysis of community-based management of acute malnutrition: lessons learned from Burkina Faso. Food Nutr Bull. 2013;34(3):338–48. doi: 10.1177/156482651303400306.
    1. Rasschaert F et al. Sustainability of a community-based anti-retroviral care delivery model—a qualitative research study in Tete, Mozambique. Journal of the International AIDS Society. 2014:17.().
    1. Harpham T, Few R. The Dar Es Salaam Urban Health Project, Tanzania: a multi-dimensional evaluation. J Public Health. 2002;24(2):112–9. doi: 10.1093/pubmed/24.2.112.
    1. Humphries D, Gomez L, Hartwig K. Sustainability of NGO capacity building in southern Africa: successes and opportunities. Int J Health Plann Manag. 2011;26(2):e85–101. doi: 10.1002/hpm.1029.
    1. Le Gargasson J-B, et al. Sustainability of National Immunization Programme (NIP) performance and financing following Global Alliance for Vaccines and Immunization (GAVI) support to the Democratic Republic of the Congo (DRC) Vaccine. 2013;31(15):1886–91. doi: 10.1016/j.vaccine.2013.02.024.
    1. Sebotsa MLD, et al. Assessment of the sustainability of the iodine-deficiency disorders control program in Lesotho. Food Nutr Bull. 2007;28(3):337–47. doi: 10.1177/156482650702800310.
    1. Swain JD, et al. Partnership for sustainability in cardiac surgery to address critical rheumatic heart disease in sub-Saharan Africa: the experience from Rwanda. World J Surg. 2014;38(9):2205–11. doi: 10.1007/s00268-014-2559-2.
    1. Torpey K, et al. From project aid to sustainable HIV services: a case study from Zambia. J Int AIDS Soc. 2010;13(1):19. doi: 10.1186/1758-2652-13-19.
    1. Sharma A., et al. Building sustainable organizational capacity to deliver HIV programs in resource-constrained settings: stakeholder perspectives. Global Health Action, 2013. 6(0 % U ).
    1. Vamos S, et al. Translation and sustainability of an HIV prevention intervention in Lusaka, Zambia. Translat Behav Med. 2014;4(2):141–8. doi: 10.1007/s13142-013-0237-9.
    1. Wandeler G, et al. Outcomes of antiretroviral treatment programs in rural Southern Africa. JAIDS J Acquir Immune Defic Syndr. 2012;59(2):e9–16. doi: 10.1097/QAI.0b013e31823edb6a.
    1. Okeibunor J, Bump J, Zouré HG, Sékétéli A, Godin C, Amazigo UV. A model for evaluating the sustainability of community-directed treatment with ivermectin in the African Program for Onchocerciasis Control. Int J Health Plann Manag. 2012;27:257–71. doi: 10.1002/hpm.2108.
    1. Zullig LL, et al. Sustainability of cancer registration in the Kilimanjaro Region of Tanzania—a qualitative assessment. World Health Population. 2014;15(1):21–30. doi: 10.12927/whp.2014.23721.
    1. Teguete I, et al. Can visual cervical screening be sustained in routine health services? Experience from Mali, Africa: sustained cervical cancer prevention effort in Mali. BJOG: An International Journal of Obstetrics & Gynaecology. 2012;119(2):220–6. doi: 10.1111/j.1471-0528.2011.03122.x.
    1. Walsh A, et al. “The problem is ours, it is not CRAIDS’”. Evaluating sustainability of Community Based Organisations for HIV/AIDS in a rural district in Zambia. Glob Health. 2012;8(1):40. doi: 10.1186/1744-8603-8-40.
    1. Fonck K, et al. Syphilis control during pregnancy: effectiveness and sustainability of a decentralized program. Am J Public Health. 2001;91(5):705–7. doi: 10.2105/AJPH.91.5.705.
    1. Maticka-Tyndale E, Wildish J, Gichuru M. Thirty-month quasi-experimental evaluation follow-up of a national primary school HIV intervention in Kenya. Sex Education. 2010;10(2):113–30. doi: 10.1080/14681811003666481.
    1. Maticka-Tyndale E. Sustainability of gains made in a primary school HIV prevention programme in Kenya into the secondary school years. J Adolesc. 2010;33(4):563–73. doi: 10.1016/j.adolescence.2009.03.003.
    1. Shiell A, Hawe P, Gold L. Complex interventions or complex systems? Implications for health economic evaluation. BMJ. 2008;336(7656):1281–1283. doi: 10.1136/.
    1. Sarriot E, et al. A causal loop analysis of the sustainability of integrated community case management in Rwanda. Soc Sci Med. 2015;131:147–55. doi: 10.1016/j.socscimed.2015.03.014.
    1. Airhihenbuwa CO. Health and culture: beyond the Western paradigm. Thousand Oaks, Calif: Sage; 1995. p. 152.
    1. Airhihenbuwa C. Healing our differences—the crisis of global health and the—politics of identity. Lanham, Maryland: Rowman & Littlefield Publishers; 2007.
    1. Airhihenbuwa C, et al. Stigma, culture, and HIV and AIDS in the Western Cape, South Africa: an application of the PEN-3 cultural model for community-based research. J Black Psychol. 2009;35(4):407–32. doi: 10.1177/0095798408329941.
    1. Dutta MJ, Basu A. Health among men in rural Bengal: Exploring meanings through a culture-centered approach. Qual Health Res. 2007;17(1):38–48. doi: 10.1177/1049732306296374.
    1. Ahluwalia IB, et al. Sustainability of community-capacity to promote safer motherhood in northwestern Tanzania: what remains? Glob Health Promot. 2010;17(1):39–49. doi: 10.1177/1757975909356627.
    1. Akogun O. Sustainable development and malaria illness experience among Nigerian nomads. In: Amoeda R, Lira S, Pinheiro C, editors. Heritage 2010: Heritage and Sustainable Development, Vols 1 and 2. 2001. pp. 1257–61.
    1. Ajayi IO, Jegede SA, Falade CO. Sustainability of intervention for home management of malaria: the Nigerian experience. Am J Trop Med Hyg. 2014;83(5):369–70.
    1. Blanchet K, James P. Can international health programmes be sustained after the end of international funding: the case of eye care interventions in Ghana. BMC Health Serv Res. 2014;14:77. doi: 10.1186/1472-6963-14-77.
    1. Abbey M, et al. Factors related to retention of community health workers in a trial on community-based management of fever in children under 5 years in the Dangme West District of Ghana. Int Health. 2014;6(2):99–105. doi: 10.1093/inthealth/ihu007.
    1. Amo-Adjei J. Perspectives of stakeholders on the sustainability of tuberculosis control programme in Ghana. Tuberc Res Treat. 2013;2013:419385.
    1. Torpey K, et al. Increasing the uptake of prevention of mother-to-child transmission of HIV services in a resource-limited setting. BMC Health Serv Res. 2010;10:29. doi: 10.1186/1472-6963-10-29.
    1. Kachur SP, et al. Maintenance and sustained use of insecticide-treated bednets and curtains three years after a controlled trial in western Kenya. Trop Med Int Health. 1999;4(11):728–35. doi: 10.1046/j.1365-3156.1999.00481.x.
    1. Kuyini A, Alhassan A, Mahama F. The Ghana community-based rehabilitation program for people with disabilities: what happened at the end of donor support? J Soc Work Disabil Rehabil. 2011;10(4):247–67. doi: 10.1080/1536710X.2011.622981.
    1. Lindblade KA, et al. Sustainability of reductions in malaria transmission and infant mortality in western Kenya with use of insecticide-treated bednets: 4 to 6 years of follow-up. JAMA. 2004;291(21):2571–80. doi: 10.1001/jama.291.21.2571.
    1. Hutchinson C, et al. Exploring the sustainability of obstetric near-miss case reviews: a qualitative study in the South of Benin. Midwifery. 2010;26(5):537–43. doi: 10.1016/j.midw.2010.05.016.
    1. Rosenberg A, Hartwig K, Merson M. Government-NGO collaboration and sustainability of orphans and vulnerable children projects in southern Africa. Eval Program Plann. 2008;31(1):51–60. doi: 10.1016/j.evalprogplan.2007.08.005.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir