ArticlePloS one2021
Program sustainability post PEPFAR direct service support in the Western Cape, South Africa.
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 citations in OpenAlex.
- Built to last? Barriers and facilitators of healthcare program sustainability: a systematic integrative review.Implementation science : IS · 2023Pooled it
- The sustainability of health interventions implemented in Africa: an updated systematic review on evidence and future research perspectives.Implementation science communications · 2025Review
- Shaping sustainable paths for HIV/AIDS funding: a review and reminder.Annals of medicine and surgery (2012) · 2025Review
- Evaluation of the impact of PEPFAR transition on retention in care in South Africa's Western Cape Province.South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde · 2023Article
- Stakeholders' Perspectives on the Financial Sustainability of the HIV Response in Nigeria: A Qualitative Study.Global health, science and practice · 2023Article
- Evaluation of the impact of PEPFAR transition on retention in care in South Africa's Western Cape.medRxiv : the preprint server for health sciences · 2023Article
- Sustainability of health services in refugee hosting districts: a qualitative study of health services in three west Nile refugee hosting districts, Uganda.Conflict and health · 2023Article
- Sustainability in global health: a low ceiling, a star in the sky, or the mountaintop?BMJ global health · 2022Article
- Collective insights of public-private partnership impacts and sustainability: A qualitative analysis.PloS one · 2021Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPublic health practitioners have little guidance around how to plan for the sustainability of donor sponsored programs after the donor withdraws. The literature is broad and provides no consensus on a definition of sustainability. This study used a mixed-methods methodology to assess program sustainability factors to inform donor-funded programs.
methodsThis study examined 61 health facilities in the Western Cape, South Africa, supported by four PEPFAR-funded non-governmental organizations from 2007 to 2012. Retention in care (RIC) was used to determine health facility performance. Sustainability was measured by comparing RIC during PEPFAR direct service (20072012), to RIC in the post PEPFAR period (2013 to 2015). Forty-three semi-structured in-depth interviews were conducted with key informants. The qualitative data were used to examine how predictor variables were operationalized at a health facility and NGO level.
resultsOur qualitative results suggest the following lessons for the sustainability of future programs: Sufficient and stable resources (i.e., financial, human resources, technical expertise, equipment, physical space)Investment in organizations that understand the local context and have strong relationships with local government.Strong leadership at a health facility levelJoint planning/coordination and formalized skill transferLocal positive perceived value of the programPartnerships.
conclusionSustainability is complex, context dependent, and is reliant on various processes and outcomes. This study suggests additional health facility and community level staff should be employed in the health system to ensure RIC sustainability. Sustainability requires joint donor coordination with experienced local organizations with strong managers before during and after program implementation. If the program is as large as the South African HIV effort some dedicated additional resources in the long term would be required.
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Registered trials
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