AOS 2 – Ensuring the sustainability of programs

1. AOS 2 – Ensuring the sustainability of programs Appropriateness, Affordability, Equity

2. Knowledge and skills • Key Knowledge • ways to ensure sustainability of programs including elements of appropriateness, affordability, equity; • Key Skills • interpret and analyse data; • analyse and evaluate aid programs in terms of their contribution to health and sustainable human development.

3. Sustainable programs • For aid programs to be effective they need to focus on: • Promoting sustainable development • Being an affordable and long-term program • Being appropriate and addressing the needs of the community • Equitable: meet the needs of all people • Resulting in independence • Ensure sustainability • Community involvement and ownership

4. Sustainable programs • In order for a country to improve the health status and human development and give individuals a chance to lead a productive and full the underlying causes of ill health must be addressed (poverty, education, access to health care, environmental sustainability etc.) the implemented programs must also be sustainable.

5. When aid workers leave the communities in which they are working, it is important the programs continue. This is often achieved by involving the local people, implementing ongoing arrangements for funding, or the capacity to raise the required funds, and ensuring that the needs of the people are continuing to be addressed.

6. Sustainability means that implemented programs are developed to ensure that they can be continued. In order to ensure sustainability, programs must include the elements of appropriateness, affordability and equity.

7. Appropriateness • Must address the needs specific to the community / population being targeted • This is achieved through 5 key elements • Involve the people • Choose the right aid to reach poor people • Focus on involving and educating women • Focus on education • Ensure the cultural sensitivity of programs

8. Appropriateness cont. • Involve the people • Involve local people in the design, implementation and evaluation of programs • With locals involved in the decision making the program is more likely to meet the needs of the community • More likely to continue and be a sustainable long term program • Choose the right aid to reach poor people • Address the specific needs eg: clean water and sanitation, education, access to health care

9. Appropriateness cont. • Focus on involving and educating women • Gender equality is a massive issue in developing countries and needs to be addressed • Empowering women significantly improves the development of a community • Focus on education • Education is one of the keys to health • Educated individuals have more chance to be employed and earn money an access health care and understand and have knowledge of health promotion • Ensure cultural sensitivity programs • Must be culturally sensitive to the communities eg; male/female, religion etc

10. Affordability • People living in poverty unable to access health care and development programs if they have to pay for them • Programs must be funded and allow free access to be effective • They must have a long term funding source or plan for the revenue to be created if they are to be sustainable • Infrastructure is very expensive to develop and almost always requires funding through aid programs (Bi lateral, Multi-lateral and non government aid)

11. Affordability cont. • Ways of funding the health care system must be developed so that individuals who can not afford health care are able to access it. Financing a health care program: • Revenue collection: (taxes, insurance scheme, private health and out of pocket payments and donations • Pooling of resources: spreading the accumulated revenue across the total spread of the health care system to ensure cost is shared by all. • Purchasing of interventions: Using funds generated to purchase health care / resources from a health care provider • The WHO says this strategy is key to removing pay per use health care

12. Equity • Must meet the needs of all of the population and its groups eg: women, disabled and remote communities • Four primary health goals help to ensure equity of programs • Universal coverage • People centred programs • Healthy public policy • Leadership

13. Equity cont. • Universal coverage • All people have access to health care based on need not ability to pay • People centred services • Need to be accessible to the public • Embedded in the community • People shouldn’t need to travel large distances to access health care • Healthy Public Policy • Strong and effective rules and laws set out by the government of the country that take into account health in all decision making eg education, environment and trade • Leadership • Effective leadership will help ensure all people’s needs are being met now and in the future

14. What you need to be able to apply • Use the three elements of Appropriateness, Affordability and Equity to analyse whether the program is sustainable • Analyse and evaluate aid programs in terms of their contribution to health and sustainable human development

15. How will we practice this • Analysing programs that we look at in from key agency's such as; AusAid, The UN, The WHO and non government organisations • Be aware that you could be asked to apply this knowledge and skill (AAE) across any program from unit 3 and 4 (eg last years exam)

16. Complete Apply your knowledge p. 363 q. 5-7

17. Example Answer • A program could be set up in Africa to combat HIV/AIDS. Local people could be trained to educate others about safe sex and the benefits of having a minimal number of sex partners. This could be done by using local language, which makes it accessible and appropriate to the community (appropriate).Local schools could be engaged to develop plays that involve song and dance which educate people about the risks of HIV/AIDS. This ensures that schoolchildren learn these valuable lessons at a young age and they can perform their show without charge for locals, which also educates them at no cost. (equity and affordability)

18. Complete Handouts • HEV • Page. 131 • Page. 132 • Page. 136 – use the case studies provided to answer if internet not available – 2b sustainability of a program (world vision)