Perceptions from governance committees on how fully-furnished community run mother’s shelters in rural Zambia could be sustained


Master's Thesis, 2018
68 Pages

Excerpt

Contents

CHAPTER ONE: INTRODUCTION TO THE STUDY
1.1 INTRODUCTION
1.2 SUSTAINABILITY PERSPECTIVES
1.3 Defining sustainability
1.4 A HISTORICAL PERSPECTIVE OF MATERNITY WAITING HOMES
1.5 Maternity waiting Homes in Zambia
1.6 Ministry of Health policy on Mother’s Shelters
1.7 The Mothers’ shelter project and sustainability design
1.7.1 Mothers’ Shelter components and design
1.8 STATEMENT OF THE PROBLEM
1.9 RESEARCH OBJECTIVES
1.9.1 PURPOSE OF THE STUDY
1.9.2 SPECIFIC OBJECTIVES
1.10 RESEARCH QUESTIONS
1.11 SCOPE OF THE STUDY
1.12 SIGNIFICANCE OF THE STUDY
1.13 ORGANIZATION OF THE THESIS

CHAPTER TWO: LITERATURE REVIEW
2.1 INTRODUCTION
2.2 Project sustainability at a global glance
2.3 FACTORS AFFECTING PROJECT SUSTAINABILITY
2.4 Literature analysis
2.5 Conclusion

CHAPTER 3: THEORETICAL AND CONCEPTUAL FRAMEWORK
3.0 INTRODUCTION
3.1 THEORETICAL PERSPECTIVES ON SUSTAINABILITY
3.1.1 Participatory theory
3.1.2 Empowerment theory
3.2 CONCEPTUAL FRAMEWORK OF SUSTAINABILITY
3.2.1 Conceptual framework of sustainability of public health programs
3.2.2 Whether benefits or outcomes for consumers, clients, or patients are continued (when the intervention provides services to individuals)
3.2.3 Continuing the program activities or components of the original intervention
3.2.4 Maintaining community-level partnerships or coalitions developed during the funded program
3.2.5 Maintaining new organizational practices, procedures, and policies that were started during program implementation
3.2.6 Sustaining attention to the issue or problem
3.2.7 Program diffusion and replication in other sites
3.3 Conceptual Framework for the Sustainability of fully furnished Mother’s Shelters
3.3.1 The social environment
3.3.2 The economic and political environment
3.3.3 Factors of the intervention
3.4 Conclusion

CHAPTER 4: RESEARCH METHODOLOGY
4.1 INTRODUCTION
4.2 STUDY DESIGN
4.2.1 RESEARCH TYPE
4.2.2 RESEARCH PHILOSOPHY
4.2.3 Research design
4.2.4 Study context
4.2.5 Research Population
4.2.6 Sampling design
4.2.7 Sample size
4.2.8 Data Collection
4.2.9 Data Analysis
4.3 ETHICAL CONSIDERATIONS
4.4 QUALITY CRITERIA
4.5 CONCLUSION

CHAPTER 5: PRESENTATION OF FINDINGS AND EMPIRICAL ANALYSIS
5.1 INTRODUCTION
5.2 PURPOSE OF THE STUDY
5.3 STUDY GOVERNANCE COMMITTEES
5.4 DEMOGRAPHIC CHARACTERISTICS OF STUDY SUBJECTS
5.4.1 PROPORTION OF RESPONDENTS BY GENDER
5.4.2 RESPONDENTS BY POSITION IN THE GOVERNANCE COMMITTEES
5.4.3 RESPONDENTS LEVEL OF EDUCATION
5.4.4 N0. OF IDIs PER SITE
5.5 EMERGING THEMES
5.5.1 THEME ONE: ROLES OF GOVERNANCE COMMITTEE MEMBERS
5.5.2 THEME TWO: MOTHERS’ SHELTER SUCESSES
5.5.3 THEME THREE: CHALLENGES OF MOTHER’ SHELTERS
5.4 THEME FOUR: SUSTAINABILITY OF MOTHERS’ SHELTER THROUGH THE LENS OF GOVERNANCE COMMITTEE MEMBERS
5.5 Summary of findings
5.5.1 Roles of governance committee members
5.5.2 Mothers’ successes:
5.5.3 Mothers’ challenges
5.5.4 Sustainability of MS through the lens of governance committee members

CHAPTER 6: DISCUSSION AND INTERPRATATION OF RESULTS
6.1 INTRODUCTION
6.2 PURPOSE OF THE STUDY
6.3 SECTION 1a: RESEARCH QUESTION ONE A
6.3.1 Resource mobilization
6.3.2 Policy and Strategy Development
6.3.3 Oversight and Supervisory Function
6.3.4 Coordination
6.4 SECTION 1B: RESEARCH QUESTION ONE B
6.5 SECTION TWO: RESEARCH QUESTION 2:
6.5.1 Linkages, integration and institutionalization of MS services
6.5.2 Maintenance and repair of MS structure and assets
6.5.3 Continuous utilization of the shelter
6.5.4 Leadership and systems
6.5.5 Income Generating Activities (IGA)
6.5.6 Community support and participation
6.6 SECTION 3: RESEARCH QUESTION
6.7 SUMMARY DISCUSION OF RESEARCH FINDINGS

CHAPTER 7: CONCLUSION AND RECOMENDATIONS
7.1 INTRODUCTION
7.2 PURPOSE OF THE STUDY
7.3 SUMMARY OF STUDY
7.4 RECOMMENDATIONS FOR FUTURE RESEARCH
7.5 RECOMMENDATIONS FOR FUTURE PRACTICE
7.6 STUDY LIMITATIONS
7.7 Conclusion

References

CHAPTER ONE: INTRODUCTION TO THE STUDY

1.1 INTRODUCTION

This chapter presents a historical and global perspective of the research question and discourse of project sustainability beyond donor-phase out. The chapter introduces the concept of sustainability in its diversity in order to create a framework within which the research unfolds. The rationale for the research has also been discussed by highlighting the degree of the phenomena of development sustainability and how it impacts policies, programing and decisions for both development practitioners and the citizenry. Finally, the chapter develops objectives that form a logical methodological discourse on the sustainability determinants of mothers’ shelters. The general assumption that participatory projects have the efficacy to achieve sustainability in contexts where there is a transition from interventions to adaptation, integration and localisation of development is postulated.

1.2 SUSTAINABILITY PERSPECTIVES

The shift towards a sustainable society, with sustainable health and development projects, is one of the central challenges of our times. Recently, development sustainability has become a new buzzword in development circles, arising from the situation of donor fatigue and changing priorities. Historically, development has emphasised planning orientation and implementation orientation without much concern for the post-donor period of the projects. This has created a gap in programming that has led to abject poverty continuing to ravage the poor in aid-receiving countries such as Zambia (Chambers, 2009). Development assistance is often offered on a temporary basis and projects typically have finite timeframes. Yet, the impacts of the assistance and projects are intended to be lasting. As a result, a challenge for international development is to achieve long-term sustainability of projects. Research and development therefore, has a significant role to play in achieving the Sustainable Development Goals (SDGs) defined by the recently adopted 2030 Agenda for Sustainable Development.

Historically, many projects have failed to achieve their intended sustainability goals (Bishop 2001). Multiple factors contribute to this phenomenon. One key factor is the manner in which projects are planned and executed. It is critical to the success of a project that various elements of sustainability be considered throughout each stage of the project process.

This is particularly true where outside involvement is discontinued after project closure, as is the case for much international development work. Sustainability should also be mirrored within time and changing social, economic and political contexts. According to Williams, (2003), sustainability is reflected in the capacity of the community to cope with change and adapt to new situations. A project that is seen as worth sustaining today may not be so in future. Notwithstanding, substantial resources have been allocated to developing and maintaining community-based programs for children, youth and families, relatively little is known about how these programs are sustained and what factors lead to their failure. Quite often, the typical community-based program has a relatively short life once its original funding base expires (Schorr, 1997). Inadequate information and understanding of what sustains community based programs has led to various studies focusing on how community projects can be sustained past their initial funding base and increase their longevity in addressing the needs of the community.

1.3 Defining sustainability

The roots of the concept of sustainable development can be found in the emerging environmental consciousness of the 1960s and in the identification of the link between economic development and environmental degradation and pollution (WECD, 1987). This development was closely related to the replacement of the optimism about the creation of a modern technological utopia with a new understanding of the forces contributing to the world’s problems (ibid). Sustainable Development (SD) was used for the first time in the 1980 IUCN Report, World Conservation Strategy: Living Resources for Sustainable Development. Today, the word sustainability is frequently used in many platforms using different combinations such as sustainable development, sustainable growth, sustainable community, sustainable industry, sustainable economy, and sustainable agriculture. Sustainability is drawn from the root word “sustain” which means to provide conditions in which something can happen (A & C Black Publishers, 2007).

In 1987 the World Commission on Environment and Development defined sustainable development as development that meets the needs of current generations without compromising on the ability of future generations to meet their needs. It contains within it two key concepts: the concept of needs, in particular the essential needs of the world’s poor to which overriding priority should be given; and the idea of limitations imposed by the state of technology and social organization on the environment’s ability to meet present and future needs (WCED, 1987). EU (2004) defines sustainability as “the likelihood of a continuation in the stream of benefits produced by the project after the period of external support has ended.” Mulwa (2010) noted that project sustainability concerns itself with the continuity of a project until it attains its set objectives. Sustainability is the continued use of program components and activities for the continued achievement of desirable program and population outcomes. Other terms that have been used by previous researchers in this domain include continuation, confirmation, maintenance, durability, continuance, and institutionalization. There are some nuanced differences among these terms, but they all usually refer to the continued use of program components and activities beyond their initial funding period and sometimes to continuation of desired intended outcomes; this is what we mean by sustainability (Sheirer, 2011).

Like other development approaches, sustainable development is about improvement of the human condition, yet unlike many of the others, it does not only emphasize economic growth, it stresses the importance of a balance between economic growth and environmental protection. The general understanding of Sustainable Development (SD) compromise two dimensions: the notion of development (to make better) and sustainability (to maintain). SD is classically explained as the balancing between environmental, economic and social aspects of development (Daly, 1996). These three aspects are frequently defined as the pillars of sustainable development.

1.4 A HISTORICAL PERSPECTIVE OF MATERNITY WAITING HOMES

Maternity waiting homes are not a new idea. Since the early 20th century, waiting homes have existed in the United States and Europe, particularly in remote rural areas where women have limited access to an obstetric facility. Maternity waiting homes began to be introduced into developing countries in the 1960s. Though the World Health Organization has provided broad guidelines of what should be included in maternity waiting homes, significant variation exists in how they have been implemented. Setups range from traditional-style huts (Millard. P et al, 1991; Povan et al, 1991) to modern houses (Knowles JK, 1988) to old hospital wards (Wilson JB et al, 1997) Waiting homes have also differed in terms of whether food, water, and other necessities are supplied, and whether family members are also accommodated (Wild K et al, 2012). Historically, maternity waiting homes have been part of a maternal mortality reduction strategy focused on risk screening to identify women who should receive facility-based intrapartum care. In this model, women at high risk for complications (e.g. previous postpartum hemorrhage, previous cesarean section, age > 35 years) are encouraged to stay in a waiting home built near a hospital with emergency obstetric care several weeks before the onset of labor (WHO, 1996). One rationale for risk screening is that it prevents hospitals from being overwhelmed with patients who could safely be managed at the health center level.

Mothers’ shelters (maternity waiting homes (MWHs) are residential dwellings located near health facilities where women in the late stages of pregnancy stay to await childbirth and receive immediate postpartum services (World Health Organisation, 1996).These shelters help overcome distance and transportation barriers that prevent women from receiving timely skilled obstetric care. The purpose of maternity waiting homes is to provide a setting where women who live far away from the facility can be accommodated during the final weeks of their pregnancy near a hospital with essential obstetric facilities. Some maternity waiting homes have expanded their purpose to include not only decreased maternal mortality but also improved maternal and neonatal health (Ibid). In these homes additional emphasis is put on education and counselling regarding pregnancy, delivery and care of the newborn infant and family.

In 1996, the WHO published a report titled “Maternity Waiting Homes: A review of experiences” in the scope of the Safe Motherhood initiatives launched in 1987 by three UN Agencies in Nairobi. The report details some examples of MWHs from Africa, South Africa and the Caribbean still running when the document was published. As in the case of Talamanca, the review focused on three particular examples: Ethiopia, Cuba and Nicaragua (WHO,1996:2-4; Talamanca: 1996:1382-1384). In Ethiopia, a “Tukul” (the name by which a MWH is known in this country) was built in 1976 attached to Attat Hospital, a 55-bed rural community-based hospital in the centre of the country. The Hospital, 17 km from the nearest town, had a catchment area that contains 300 000 people. The admission criteria of the “Tukul” focused on women identified as being at high-risk, indentified by traditional birth attendants (TBAs) and community health workers selected by community committees. The facility was built in the style of a local house, costing US$ 1000 (labour and most of the materials were provided by village communities), with a total of 15 beds. Women supply their own food. The average length of stay was 15 days, and during this stay the women attend the antenatal clinic located at Attaat Hospital. In addition, a nurse visits the “Tukul” once a day. The records indicated that in 1987, 151 women, the majority at high risk, were admitted in the “Tukul”. The hospital registered 13 maternal deaths, not one of which was of a woman who first entered the “Tukul”. The Cuban experience is particularly interesting because of the comprehensive register of MWH services. Maternal mortality in the Caribbean country decreased, between 1962 and 1989, from 118 to 29 per 100,000. In this period, institutional delivery experienced a considerable increase from 63 % to 99 %. It is considered that the set up of MWHs that increased from 22 in 1970 to 148, in 1989 contributed significantly to these improvements. The MWHs network in Cuba is completely integrated within the National Health System. Referrals to MWHs are done by the family physician that provides prenatal care to pregnant women. All MWHs are built attached to a local hospital or within a reasonable distance. A particular characteristic of the Cuban experiences is the availability 34 of national health workers in MWHs, with an average of 0.8 full time health workers (nurses, auxiliaries and labourers) per bed. In addition, the staff also sometimes includes one or more full-time physicians or midwives. Medical care includes daily vital signs and blood pressure measurements done by a nurse, as well as at least one obstetric check-up twice a week by the physician. All the activities required to maintain the infrastructure in a good condition, including day activities such as cooking and cleaning are carried out by labourers. Educational and health promotion activities are o 35 delivery and, after delivery, stay for four to six days receiving information and health advices about newborn care. There was no cost for any services at the “Casa Materna”. No workers received salaries. The facility had twenty beds, and when WHO report was published, none of the mothers at the “Casa Materna” had died due to childbirth-related illness. The Director of the facility expressed that the main challenges to maintaining the service are the financial sustainability and the lack of financing. Talamanca (1996:1384) described another relevant experience of MWHs in Colombia, where in 1986 was instituted a “Casa Hogar” near the city of Cali. Women were referred by a health team or health promoter. MWH was built, following a local style with three bedrooms, by the community with local contributions, and in this case was located 1 km from the local hospital. Women paid a small fee to stay. Permanent staffs included two health promoters (salaries paid by the government) and, in addition, weekly hospital staff provide health care to users. The facility adopted an “open house” policy and all women were accepted. Health education was a key component of the “Casa Hogar” (with participation of teachers, educational programmes, etc). This experience is a clear practice of community intervention. In Ghana, Wilson et al (1997: 5165-5172) detailed the process of setting up of a MWH in the Nsawam district, after conducting preliminary studies and focus groups that identified distance as a major barrier to institutional deliveries. A ward was completely renovated (with eight beds) with government and cooperation funding, and was inaugurated in 1994. Posterior evaluation revealed that in one year just one woman attended and spent only one night. Focus group discussion with community members and hospital staff revealed that the associated cost of using the facility, distress at being away from home, distance from the hospital, lack of health staff, a deserted environment and lack of perceived need were the reasons for poor utilization. 36 More recent experiences have also been described. Friederike Amani Paul (UNFPA, 2007) provides some details about a “Chigonella” (meaning those waiting for delivery), a Maternity Waiting Home at the Dodoma regional Hospital running since 1992 in Tanzania. The publication highlights the importance of MWHs for high-risk women, specially primigravidas and older pregnant women. In addition, the author emphasizes the desperate situation of the facility and other MWHs around the country due to saturation of the services. MWHs, initially designed to accommodate 15 women are lodging 50 to 80 pregnant women. This indicator shows considerable utilization of the services. In Honduras, MWHs were introduced as part of a strategy to improve maternal health. TBA were trained in order to increase referrals and also to raise the identification of high-risk pregnant women. A study showed that hospitals with a MWHs compared to hospitals without MWHs registered more women who were older than 34 or had more than 4 deliveries. In this sense, the study suggested that MWHs contributed to identifying women with high-risk pregnancies and encouraged them to use MWHs and use health facilities to give birth (Lonkhuijzen et al, 2009:4).

1.5 Maternity waiting Homes in Zambia

Maternity waiting homes are referred to as mother’s shelters in Zambia. Though the World Health Organization has provided broad guidelines of what should be included in maternity waiting homes, significant variation exists in how they have been implemented and managed. Current scan of mother’s shelters across the country helped the researcher to arrive at three levels of model classifications namely high, medium and low standard shelters as discussed below:

1)High standard shelters

These are mostly associated with mission Hospitals such as Monze mission Hospital. In this model, shelters have water, good lighting system, good flushable toilets, beds and linens and are well secured. Services such as food and screening are provided by qualified personnel. The shelter is strictly for waiting mothers. The cleaning and maintenance of the shelters is done by permanent hospital staff. Repair and renovations of the shelter is planned and budgeted for in the main hospital plan and budget.

2)Medium standard shelters

These are associated with some mission hospitals and also some District Hospitals especially those affiliated to corporate companies such as the Zambia Electricity Supply Corporation (ZESCO) which supports Kafue gorge Hospital in Chikankata District of Zambia. Under this model, beds and linens are provided but users provided their own food. Water and lighting is also available. The shelter is not only a preserve for waiting mothers but even patients with general cases maybe sheltered. Cleaning is done by both mothers and general workers employed by the facility. Maintenance and repairs are done by the facility with minimal community contribution.

3) Low standard shelters

These are mostly associated with rural health centres and some urban District Hospitals such as Kalomo and Choma District Hospitals in Southern Province of Zambia. Ownership of these shelters is not properly defined. They have no beds and linens. Safe drinking water is not guaranteed and waiting mothers have to fend for themselves. Safety and security is highly compromised. The shelters themselves are very dilapidated with no planned periodic repairs and renovations. Utilization is also not restricted to waiting mothers only but even those with general cases are allowed to use the shelter.

1.6 Ministry of Health policy on Mother’s Shelters

The Government of the Republic of Zambia (GRZ) remains committed to meeting SDG 3 and 5. To accelerate the achievement of these global goals, the government has initiated a large cooperative effort through the Ministry of Health (MOH), Ministry of Community Development, Mother and Child Health (MCDMCH), and several local and international organizations. Chief among these efforts is Saving Mothers, Giving Life (SMGL), a project that aims to prove that concerted and coordinated efforts could reduce maternal mortality in a short time span. This is in line with the 2017-2021 National Health Policy in which the government seeks to reduce maternal mortality ratio (MMR) from 398/100,000 live births in 2014 to 162/100,000 live births by 2021 through among other strategies the strengthening of the referral system, including scaling up of maternity waiting shelters (MoH, 2017).

The SMGL initiative was birthed after realisation that achieving complete sexual and reproductive health, especially for women and young people, was a key pillar of socio-economic development. Through close collaboration with several international public and private partners, SMGL strengthens the provision of vital life-saving services during labour and delivery and improves access to health facility services for Zambian women. Midterm results in 2015 revealed a remarkable 53 percent decrease in institutional maternal mortality in target facilities and a 43 percent increase in the number of births that took place in health facilities. (MoH, 2017) Although it was noted that Zambia had made strides towards achieving health-related Sustainable Development Goals (SDGs) such as covering all major health priorities ranging from tackling non-communicable diseases (NCDs), mental health, injuries and environmental issues, there still remained gaps and challenges to fully attain equitable and sustainable progress.

1.7 The Mothers’ shelter project and sustainability design

In 2015, The Government of the Republic of Zambia (GRZ) partnered with the Zambian Center for Applied Health Research and Development (ZCAHRD) to construct mothers’ shelters across ten sites within the Southern and Eastern Provinces of Zambia under the auspice of the Maternity Home Access in Zambia (MAHMAZ) Project. The MAHMAZ project aimed to improve maternal health by decreasing the distance that pregnant women must travel to deliver at health facilities with skilled personnel and obtain postpartum care. The project specifically targeted women that live further than 9.5 kilometers away from the closest health facility and sought to improve access to care through the construction of mothers’ shelters (MAHMAZ Project proposal).

1.7.1 Mothers’ Shelter components and design

The model prioritizes quality and availability of resources and services across four overarching categories: 1) infrastructure, equipment and supplies; 2) policies, management & finances; 3) linkages with health facilities; and 4) services offered.

1) Infrastructure, equipment and supplies;

A total of 10 mothers’ shelter were constructed. The design included a common open room with a bed capacity of 10, an office for staff members, a separate room for postnatal services with a bed capacity of four (4); a multipurpose open space for health education services and day time resting for mothers and adjacent toilets. The shelters are finished with lockable doors, windows, cooking utensils, beds, bedding and bed nets.

2) Policies, management & finances;

Unlike conventional mothers’ shelters, the MAMHAZ shelters have formalized management and governance structures with government and facility representation with clear standard operating procedures (SOPs) for clear roles and responsibilities as well as a well defined utilization data capture system that guide client intake, registration, and monitoring procedures.

3) Services and linkages with health facilities;

These mothers’mothers’ shelters are built strategically adjacent to clinic with basic emergency obstetric care (BEmONC) services and are within two (2) hours reach to comprehensive emergency obstetric care (CEmONC) facilities for the purpose of referrals in cases of emergencies. Health education during antenatal care (ANC) and postnatal care (PNC) visits are conducted at the health facility. Health education topics include family planning, breastfeeding, education on newborn danger signs and well-baby care, education on the antenatal and postpartum periods. Besides, mothers are exposed to life skills trainings in tailoring and sewing of baby clothes and other products during their stay at the shelter.

4) Sustainability of Mothers’ Shelters

Mothers’ shelters in Zambia have been used to bring women in remote communities closer to quality delivery and postpartum care. However, many shelters have fallen into disrepair because there has not been a targeted effort to ensure their sustainability (MAHMAZ project proposal, 2015). To ensure operational and financial sustainability of the MS, MAHMAZ project facilitated the creation and establishment of governance committees. These are community boards responsible for leadership and governance of the shelters. Aside from creating these structures, the project implemented different IGAs in the 10 BEmONC sites where MS have been built. The IGAs were selected by the MSGCs in consultation with their respective communities and are based on identified business needs. The financial sustainability of the mothers’ shelter includes the standard income sources and support services (SMAG tailoring, keyholes garden, lobby for funds or supplies from the health center or district, raise funds from community contributions towards construction, and arrange in-kind contributions to maintenance and cleaning) implemented across the ten sites, and selective income sources decided upon by each site from a menu of IGAs (MAHMAZ Project sustainability strategy, 2015)

The project has also developed a multi-tier strategy to engage Zambian government at the district, provincial, and ministerial level. The success of these initiatives it is envisioned will produce replicable and actionable results that can inform the efforts of policymakers in Zambia and elsewhere to improve maternal and newborn health through larger-scale implementation of mothers’ shelters (MAHMAZ M & E Plan, 2016)

1.8 STATEMENT OF THE PROBLEM

Sustainability is a major concern for many non-profit organizations, and especially for community based organisations (CBOs) (Gruen, R.L et al, 2008), with evidence from various studies indicating that around 40 per cent of all such programs terminates in their first few years of implementation, after the initial funding is discontinued (Savaya, R et al, 2008), leaving community needs unmet. Williams (2008) observed that failure by community and stakeholders to take up ownership of projects have plunged projects into immense financial huddles threatening their sustainability as well as their daily operations daily. Unfortunately, sustainability is seldom included in the program planning (Sridharan, S. et al, 2007) while evaluation traditionally focuses on immediate outcomes, often neglecting long-term sustainability (Cassidy, E.F, et al 2006). The Organization for Economic Co-operation and Development (OECD) shows that health projects in public hospitals collapse one year after completion of the projects (OECD, 2014). Despite all the efforts from the various development partners, most of the health projects in public hospitals experience major hurdles in their life cycle and barely overcome the implementation stage. Most of the projects have failed and others struggle to survive and sustain jobs and benefits created by the projects (World Bank, 2013). This means that continued capacity of local stakeholders and the community at large to develop and deliver sustainable project outcomes beyond external support is still a challenge for development practitioners.

Whilst research and literature is rich on aspects that are critical to project sustainability, little is known about the role of primary stakeholders in project sustainability. This is because the discourse of sustainability is mostly defined and extrapolated from the contextual lens of donors and hardly from the perspective of primary stakeholders who are the direct project beneficiaries. For instance, with donors and policy makers a project is considered to be sustainable if it continues to deliver a high level of benefits after the donor ends major financial, managerial and technical support. But what really makes a project sustainable from the local stakeholders’ perspective? What is the role of local stakeholders in project management and sustainability? Who defines this role? It is these pertinent project management questions that provided a framework upon which this study was built. Project beneficiaries are critical partners whose concerns and experiences are intrinsic to the project's success. The level of community support determines whether a project becomes established, how quickly and successfully it consolidates, and how it responds and adapts to meet changing needs (USAID, 2009). Appreciating the continued capacity of local stakeholders and the community at large to develop and deliver sustainable project outcomes beyond external support is therefore a critical piece in the sustainability equation.

In order to address the capacity and motivation of local stakeholders to sustain a project, it is imperative to examine how these key stakeholders define sustainability as well as understand their role in the sustainability framework. This study therefore, sought to establish sustainability determinants of fully furnished mother’s shelter in rural Zambia by examining how governance committee members, who are the local stakeholders, defined sustainability of these shelters as well establishing their role in the sustainability of these fully furnished mother’s shelters in rural Zambia. Project sustainability is only possible if development practitioners have a deep understanding of how project beneficiaries define sustainability as well as appreciating their role in the project sustainability framework. For donors and policy makers, a project is considered to be sustainable if it continues to deliver a high level of benefits after the donor ends major financial, managerial and technical support. But what really makes a project sustainable from the local stakeholders’ perspective? What is the role of local stakeholders in project management and sustainability? These are some of the existing knowledge gaps which this study is predicated. The findings of the study constitute the tools, knowledge, values, skills, strategies and philosophical underpinnings that critical to helping development practitioners to devise responsive and relevant sustainability strategies as part of the project management framework and development of project risk management plans.

1.9 RESEARCH OBJECTIVES

1.9.1 PURPOSE OF THE STUDY

To establish sustainability determinants of community run mothers’ shelters

1.9.2 SPECIFIC OBJECTIVES

1. To determine the roles of governance committees in the sustainability of MAHMAZ mothers’ shelters compared to initial project plans
2. To find out how governance committees perceive sustainability of mothers’ shelters compared to initial project intentions
3. To determine sustainability adaptations and changes that occurred during the life of the project

1.10 RESEARCH QUESTIONS

1. What is the role of governance committees in the sustainability of MAHMAZ mothers’ shelters compared to initial project plans?
2. How do governance committees perceive sustainability of mothers’ shelters compared to initial project intentions?
3. What sustainability adaptations and changes have occurred during the life of the project?

1.11 SCOPE OF THE STUDY

This was an explorative survey based on the review and analysis of secondary data which was collected at two-point times between 2016 and 2017 of project implementation. It was based on captured views from governance committee members from four sites, namely Masuku, Siachitema, Kanchele and Simakutu rural health centres, on the sustainability of fully-furnished mothers’ shelters in rural Zambia.

1.12 SIGNIFICANCE OF THE STUDY

This study is significant in so many ways. Firstly the study is relevant to the policy debate on the factors affecting project sustainability beyond donor phase-out in Zambia and beyond. To the Government of Zambia, the study findings and policy implications thereof are of significance in as far as enhancing development and improving community welfare.

Secondly, the study points to areas that Zambia’s development partners should improve on in line with their international commitments on effective sustainability development. According to Scheirer (2011), ‘’funders of innovative health care, disease prevention, and community health promotion programs want to know: are their investments leading to longer-term beneficial outcomes, or do they fade away after the seed money is spent?” This study addresses some of these and many questions, as well as suggests ways to promote and facilitate long-term sustainability.

Thirdly, for researchers with an interest in projects and sustainability, this study has examined factors affecting sustainability of community run systems, an issue that both the government and development partners have committed to but since a large proportion of studies on this topic were not done on the Zambian platform, it is difficult to generalize results and apply them to the Zambian context.

Fourthly, sustainability is itself an important research topic within the broader context of translational and dissemination research on the diffusion of effective programs. When we do the work of spreading and supporting effective programs across many public health settings, we need to know whether these programs and their beneficial effects are sustained.

Finally, the findings of this research will help inform the key MAHMAZ stakeholders on the sustainability readiness of the mothers’ shelter project beyond donor support. This may ultimately help the project implementers and beneficiaries to develop a phase-out plan which is backed by evidence.

1.13 ORGANIZATION OF THE THESIS

This thesis is organized into 7 chapters. The first chapter is an introduction to the concept of sustainability and the situating of the research questions, objectives and the relevance of the study. The second chapter is a literature narrative of what other scholars have said about the determinants of project sustainability. The third chapter offers a conceptual and theoretical perspective of sustainability. The fourth chapter is a section on research methodology framework. The firth chapter presents the findings of the study both in narrative and graphical form. The sixth chapter is a discourse on empirical analysis of research findings and the seventh and last chapter is a discussion and recommendations for both practice and future research.

CHAPTER TWO: LITERATURE REVIEW

2.1 INTRODUCTION

This chapter is a narrative of the views, theories and positions of development practitioners and scholars on the discourse of project sustainability. The chapter commences with reviewing the most notable works in the field under study. The final subchapter then presents the theoretical and conceptual underpinnings of project sustainability tailored to the mother’s shelter project. This phase lays the foundation of the present research.

2.2 Project sustainability at a global glance

The growing double burden of diseases in sub Saharan Africa has led to the reexamining of a long-standing debate in international development for health: sustainability of donor-funded interventions (Dearing JW et al, 2006). For many decades, funders and implementers of health interventions have asked the question “what happens among individuals, families, communities or health care systems when donor funding for implementations expires” (Scheirer, 2011; Bossert, 2013). This question is especially pertinent for Sub Saharan Africa where despite incredible gains in health achieved over the past 20years (i.e., sharp declines in death among children under five), the continent continues to face a disproportionate share of the global disease burden. In light of the decline in donor funding, funders and policymakers have also become concerned with how to most effectively allocate limited resources, recognizing that intervention implementations which require substantial resources, are meaningless without successful long-term use (Chambers, 2018; Katz L et al, 2014). As a result, sustainability has become an important global target to achieve (Jha A et al, 2016). Yet in sub Saharan Africa, despite years of substantial assistance, with the proliferation of numerous actors involved in assisting countries to achieve global disease control targets, the conceptualization of sustainability has received remarkably little critical attention (Dearing JW et all, 2006). This research intends to move beyond the perspective of project intervention implementation in Zambia to explore sustainability so as to understand the drivers of sustainability and the key elements which stakeholders feel should be sustained.

2.3 FACTORS AFFECTING PROJECT SUSTAINABILITY

a) Community Participation and Involvement

Community involvement is an important factor for the sustainability of projects as it is the genuine involvement of local people as active participants and equal partners whose concerns and experience are intrinsic to the project's success. Community awareness and involvement in project planning and implementation are important elements in the sustainability of a project. Many scholars suggest encouraging active community participation at all levels of project design and implementation (Bamberger & Cheema, 1990) for sustaining those programs. The quality of community participation is critical in determining the level and output of community support.

The level of community support determines whether a project becomes established, how quickly and successfully it consolidates, and how it responds and adapts to meet changing needs. It is therefore important that involving local communities’ starts at the identification phase, when decisions are being made about what type of project is required to address their priority need. Sustainability cannot be achieved without their involvement and support and thus, stakeholder analysis is paramount to be able to identify the key actors who should be involved in every stage of project management cycle (Ibid). Stakeholders, both men and women, should actively participate, hence having the opportunity to influence the direction and detail of design and implementation. Bamberger & Cheema (1990) asserts that “community participation is one of the major contributing factors for sustained community project because without the community, the project cannot stand on its own.” Since the people are the beneficiaries of development plans and projects, they have a stake in it. If they have a stake, they must be partners in that process. They must be the key participants whose views, choices, needs and feelings must be taken into account if we are to have sustainable development. According to Igboeli (1992), no matter the level of technical and financial assistance offered to self-help groups, the members should share actively in the decision to undertake certain projects. That is, rather than imposing development projects on a community, its members should be allowed to participate meaningfully in the planning and execution. Development is meaningless if it does not harness the potentials of the beneficiaries who are the primary stakeholders.

b) Sustainability strategy

From a sociological and anthropological standpoint, projects are primarily social interventions within a given social system, arousing social processes which change at least to some extent the social structures and institutions of this system and the social behavior of its members (Meyer, 2002). Therefore, development practitioners should ensure that the social systems adapt to the changing social trends in the community-based projects to enhance project sustainability. According to Ingle (2005), for a project to achieve sustainability, it needs to be implemented through a strategic approach. The strategic approach incorporates four main elements, future orientation: assuming things will change, and planning to maximize benefits which can be derived during and from that change; external emphasis: recognizing the diversity of the project environment and the many dimensions which impact on project outcomes, including technology, politics, society, and economics; environmental fit: planning for a continual fit between the project and its environment, including mission, objectives, strategies, structures, and resources; and process orientation: planning and management priorities evolve in an iterative cycle of conscious and deliberate learning from experience as the reality changes (Ibid).

c) Project duration

In a cross-case analysis of the development of health systems in several low-income countries, Lafond (1995) finds that two features of the traditional aid system exert a detrimental effect on sustainability: its inward focus and its short-term investment cycles. Donor agencies are accountable to institutions which demand swift and visible evidence of their investments; these requirements conflict with the long-term needs of the recipient communities.

Available research shows that short grant periods for establishing new programs impede institutionalization. Steckler and Goodman (1989) found that a grant period of 3 years was too short to achieve institutionalization of new health promotion programs for example. They suggest that funding agencies may want to consider supporting worthy programs up to 5 years to enhance institutionalization prospects. Similarly, Scheirer's (1990) study of the Fluoride Mouth Rinse Program in schools shows that number of years in operation was strongly related to the likelihood that the program continued: on average, continuing sites had used the program for 6.6 years compared to only 3.7 years for discontinued sites, a statistically significant difference.

[...]

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Details

Title
Perceptions from governance committees on how fully-furnished community run mother’s shelters in rural Zambia could be sustained
Author
Year
2018
Pages
68
Catalog Number
V515010
ISBN (eBook)
9783346114228
ISBN (Book)
9783346114235
Language
English
Tags
perceptions, zambia
Quote paper
Misheck Bwalya (Author), 2018, Perceptions from governance committees on how fully-furnished community run mother’s shelters in rural Zambia could be sustained, Munich, GRIN Verlag, https://www.grin.com/document/515010

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