Factors influencing the sustainability of community based programs : a mixed method study

Introduction: Program sustainability is a major issue for many community based organisations. When a program is not sustainable, the impact of the program is influenced, as it becomes difficult for the program to persist in the long-term. To develop sustainable programs, insight in the factors influencing sustainability is essential. Method: This study generates insight into the influencing factors of program sustainability by considering what is already known and investigating whether there are missing factors. For this purpose, a mixed method study, combining a systematic literature review and expert interviews, was conducted. Results: In the review, 14 studies were analysed of which 37 factors were abstracted. The factors were divided into 4 categories: human resources, organisational setting, social and political environment and financing. The systematic literature review was carried out prior to the interviews in order to serve as a basis for the interviews. Interviews took place with 6 experts from the field. From the interview results, it became clear that involvement of the local community was seen as the most important factor. Conclusion: This study shows that community based program sustainability is influenced by multiple factors; of which community involvement is identified as the most important. Community involvement in related to other important factors such as leadership, community capacity and financial sustainability. Keywords; sustainability, community based programs, CBO, involvement Introduction Program sustainability is a major issue for many community based organisations (CBO's), especially in lowand middle income countries (Gruen, 2008). Evidence from different studies indicates that 40 per cent of all new programs do not continue beyond the first few years following the termination of initial funding (Savaya et al., 2008). Unsustainable programs have less impact on the local community for the long term, leave community needs unmet, are wasteful of human, monetary, and technical start-up investments, and can diminish community trust and support for future programmes (Shediac-Rizkallah & Bone, 1998). In order to achieve the intended impact on a community, programs must sustain once implemented. However, planning for sustainability is challenging and thus, is rarely incorporated in the planning process of an initiative (Sridharan, Zinzow, Gray & Barrett, 2007). Program evaluation traditionally focuses on the implementation and outcomes of social programs, often neglecting to focus on sustainability (CassidLeviton, & Hunter, 2006). Frameworks and models, such as the RE-AIM model (Glasgow, Vogt & Boles, 1999), are established to create and support the process of sustainability in the implementation circle. This model conceptualizes the public health impact of an intervention as a function of five factors; reach, efficacy, adoption, implementation, and maintenance. Without focus on the final step of assessing the sustainability of a program, the intended impact will be affected (Sarriot et al., 2004, Scheirer, 2005, Savaya, Spiro & Elran-Barak, 2008). For sustainability to become a routine component of a program, there is a need for greater clarity about factors influencing sustainability.