Chasing the Elusive Concept of Sustainability
In the fields of global health and development, a very popular topic of conversation is sustainability — sustainability of projects, sustainability of funding, sustainability of foreign aid. It is a buzzword thrown out in just about every meeting, interview, and networking event in the development sector. In 2015, we saw the transition from the Millennium Development Goals to the Sustainable Development Goals. The world is infatuated with finding ways to ensure all of the work being done in development not only has a positive influence, but a sustainable impact.
But what does sustainability really look like? Is there any one clear-cut path to achieving it?
My gut, along with my experience studying and working in this field for the past five years, tells me true sustainability is context specific. Just like crafting the best programs to solve problems around the world, it is essential to take into account the needs of a community when determining if and how a project can actually become sustainable.
As a Global Health Corps fellow, I have been working with the international NGO VillageReach in Malawi since July 2015. The majority of my time with VillageReach has focused on the Pharmacy Assistant Training Program, a project that was started in 2012 to address the shortage of trained pharmacy personnel in the most rural health centers across Malawi. Like many other low- and middle-income countries, Malawi has a critical shortage of pharmacy personnel. The majority of government health centers have no trained pharmacy personnel on staff, which means that unqualified personnel often have to manage medicines. This lack of training impacts patient care and safety as well as availability of medicines. The Pharmacy Assistant Training Program is a two-year academic program housed at the Malawi College of Health Sciences (MCHS) that puts a strong emphasis on supply chain management and hands-on learning.
My co-fellow and I were hired to design and conduct a needs assessment of the Pharmacy Assistant Training Program. The initial project was set to run for three years, with VillageReach’s financial and technical assistance scheduled to conclude in July 2016. This assessment aimed to determine current strengths and weaknesses, as well as to inform final capacity building and transition activities to promote the continued success and sustainability of the program. Data were collected from all major stakeholders and participants of the program, providing a comprehensive view of the successes and challenges the program had experienced. The assessment also presented valuable insight into the areas of the program that were most dependent on the support provided by VillageReach.
When analyzing the data we collected, and forming recommendations for a transition plan, there were a number of critical components to consider. First, we considered how to prioritize tasks that would have the greatest impact in building the capacity of MCHS and the Ministry of Health (MOH) to eventually carry out this program independently. Second, we looked at how to fill noticeable gaps that would be left in the absence of VillageReach support and that MCHS and the MOH would not have the capacity to address. Finally, and perhaps most importantly, we considered how to balance recommendations that were feasible and realistic with what was viewed as an ideal outcome. We had a lot to think about.
Essentially, all of these discussions boiled down to one larger question — how can we make the Pharmacy Assistant Training Program sustainable in Malawi?
The results of the needs assessment informed recommendations in two main areas: program operations and strategic planning. Operationally, we focused on creating materials to aid the implementation of the program by current or new partners; developing a plan to increase staff capacity at MCHS; and liaising with current partners to improve logistics and expectations of various aspects of the program. Strategically, we directed our attention to the expansion of the program to additional training institutions and continued work towards institutionalization of the program into standard government course offerings.
Earlier this year, VillageReach hosted a dissemination meeting with over 35 program stakeholders to discuss the results of the needs assessment and to determine a strategy for maintaining the work of the Pharmacy Assistant Training Program. The outcomes of this meeting were extremely positive. Various donors and partners, both new and old, expressed their interest and ideas for supporting the growth and continued work of the program. Multiple partners are exploring options for sustained support of capacity building at MCHS, sponsorship of students participating in the program, and expansion to new training institutions. VillageReach will continue to support the Pharmacy Assistant Training Program by consulting and collaborating with these additional partners, allowing the transition to be gradual and comprehensive of all lessons learned throughout the first three years of the program.
At the program’s inception, the MOH identified the need for a trained pharmacy assistant in every health center, which totals more than 650 nationally. As of June 2016, the Pharmacy Assistant Training Program has graduated 135 students who are able to begin filling these gaps in pharmacy personnel around Malawi. While there is still a lot of work to be done to achieve the goal set by the Ministry and to maintain the program beyond this next round of funding and partnerships, it is encouraging to see the signs of budding sustainability.
So… did we do it? Is the Pharmacy Assistant Training Program on the path to true sustainability?
It would be premature to say that with one transition plan successfully underway the program has proven it’s sustainable. However, VillageReach was mindful of a few key factors that I believe led to the existing achievements of the program and bode well for future success. First, this program was created at the request of the MOH based on existing needs and priorities in Malawi, which helped to secure buy-in from the government and other key stakeholders from the get-go. Second, the Pharmacy Assistant Training Program was designed to put students in real-world environments throughout their training, which provided exposure to both the students and other health care workers. Experiencing the positive impact a student could have in a district pharmacy or health center created additional advocates of the program throughout the health care system. And finally, having transparent and practical communication with the MOH regarding the employment of graduates and inclusion of the program in the Ministry’s strategic plan was essential to opening the dialogue about institutionalization of the program. Being clear about expectations for the eventual transition of the program allowed for more constructive and realistic conversations throughout the entire process.
Although it may be too soon to declare complete sustainability of the Pharmacy Assistant Training Program, its growth so far demonstrates how sustainable solutions cannot be one size fits all in the world of development. Determining the best way forward for a particular program, at a particular time, in a particular context can make all the difference between sustained or fleeting success. Additionally, it is essential to consider how a program may achieve sustainability when designing and implementing that program. Seeing VillageReach and the Pharmacy Assistant Training Program achieve this milestone has been a very rewarding experience, and I will strive to emulate it in future chapters of my career.
You can visit VillageReach’s website and blog to learn more about the design and continued success of the Pharmacy Assistant Training Program.
