Sustainability Framework

© 2008 Josh Nesbit, Courtesy of PhotoshareICF Macro developed a sustainability framework that can serve as a guide to planning for sustainability of an mHealth program designed for integration into the public health system. The framework encompasses six key components of a sustainable health program.

  1. Health outcomes. Population health outcomes can be used to measure the effect of the mHealth intervention.
  2. Access to, and quality of, health service provision. How well are mHealth services being delivered to the target beneficiaries? (To some extent, this will depend on how well equipped health facilities and health workers are to provide services.)
  3. Local MOH district capacity and viability. What is the capacity of the MOH to provide institutional support for mHealth service delivery?
  4. Local NGO partner capacity and viability. What is the capacity of local partners to support demand creation activities in the community and household behaviors related to the desired health outcomes of the program?  For components 3 and 4, both organizational capacity (leadership and governance, financial management, human resources, and organizational performance) and organizational viability (financial stability, managerial strength, and access to technical knowledge and ongoing training).
  5. Community capacity. The community must not only demand mHealth services, but they must also supply resulting desired health behaviors such as adherence to treatment instructions, use of family planning, breastfeeding, or whatever the mHealth-related activity might be. For the mHealth intervention to be effective, the target beneficiaries must be able to make decisions about their own health, have some knowledge about health behaviors and openness to new information, and have access to any resources needed to participate in the mHealth intervention or change health behaviors as a result.
  6. Enabling environment. Many environmental variables can enhance or hinder the impact of the mHealth intervention. The mHealth program must take into account the local context, which includes cultural, political, environmental, social, financial, educational, gender, and other factors.