Presentation by Mathieu Seppey (Université de Montréal). Global Health Workshop: Methods For Implementation Science in Global Health. http://www.equitesante.org/implementation-science-methods-in-global-health/

1. A case study approach to comprehend
sustainability's framework
METHODS FOR IMPLEMENTATION SCIENCE
IN GLOBAL HEALTH
April, 20th. 2017
McGill University
Workshop co-organised by REALISME Chair and McGill of Global Health Programs
Mathieu Seppey

2. • Health financing in Africa
• Incomprehension of what sustainability means
• Results-Based Financing (RBF) now in Mali
Primary health
care
Decentralised
Health system
Exemption
Programs
Results-Based
Financing
Context

3. Objectives of the study
To assess what is the level of sustainability of the pilot project and to better
understand what is its process:
1. Identify sustainability’s different determinants
2. Evaluate sustainability’s process through stakeholders’ perspectives

4. Method
• Conceptual framework
• Data collection
– Interview guide
– Sampling (sites & participants)
• Iterative process
– 2 data collection phases
– Validation of information
• Deductive and inductive
analysis

5. Results
Sustainability level:
Weak
Activities officially continue,
but do not systematically show
the determinants of a routine
and can easily disappear in the
short term
In Support
Long term investments
Corresponding objectives
Corresponding tasks
Project responds to felt
needs at many levels
Community implication
Increased team work
Going Against
Low level of pre-investment
Lack of stable resources
Values only linked to results
Few new procedures sustained
Few modifications made to the
procedures
Sites specificities not taken into
account
Community implication through
discontinued activities
Communication axed on results
Institutionalisation over
sustainability
Lack of sustainability’s planning

6. Lessons learned for
implementation
science in global
health
To remain critical
of the different
perspectives
encountered
Strengths
• Exhaustivity of the points of view
(participants)
• Use of a conceptual framework
(systematic point of view)
Limits
• Difficulty to measure accuratly a complex
phenomenon such as sustainability
• Data collection tool (me)

7. To go further
• Pluye P, Potvin L, Denis J-L: Making public health programs last: conceptualizing
sustainability. Evaluation and Program Planning 2004, 27(2):121-133.
• Chambers D, Glasgow R, Stange K: The dynamic sustainability framework: addressing the
paradox of sustainment amid ongoing change. Implementation Science 2013, 8(1):117.
• Johnson K, Hays C, Center H, Daley C: Building capacity and sustainable prevention
innovations: a sustainability planning model. Evaluation and Program Planning 2004, 27(2):135-
149.
• Barnes A, Brown G, Harman S: Locating health diplomacy through African negotiations on
performance‐based funding in global health. Journal of Health Diplomacy 2015, 1(3):1-19.
• Soeters R, Habineza C, Peerenboom PB: Performance-based financing and changing the
district health system: experience from Rwanda. Bulletin of the World Health Organization 2006,
84(11):884-889.

8. Let’s discuss together!
Meet the experts
Thank you for your attention