Earlier this summer, something happened that we in the development community often talk about, but rarely get to see: we watched international donors hand a successful project over to the national government and local community.
Representatives of the regional government of Tanzania’s Kigoma region signed a transition plan with EngenderHealth and Thamini Uhai, the project’s implementing partners, for the continuation of a maternal and reproductive health program after international funding ended.
The transition document established that the program would continue and an increased number of skilled health professionals would be placed in Kigoma. The regional government agreed that health workers trained under the program would remain in place, and that annual budget planning for health facilities would be supported by the government to ensure adequate funds for life-saving services.
The project had been funded since 2006 by Bloomberg Philanthropies and Fondation H&B Agerup to operate in Tanzania’s Kigoma region. The results were impressive: improvements in the quality and timeliness of care from trained providers, including emergency obstetric care and family planning services. The program saved the lives of nearly 2,200 mothers and ensured safe delivery of over 210,000 newborns in program-supported health facilities. This was welcome news in a country where one woman dies every hour from complications of pregnancy or childbirth, often because she lives far from adequate services.
At the 2019 Asia Pacific Humanitarian Leadership Conference, participants discussed the value of embracing localization when responding to the growing number of natural and man-made crises.
In June, we celebrated the lives saved, but now we’re celebrating the continuation of local stewardship. As the project’s sustainability partner, brought in by Bloomberg Philanthropies to facilitate a smooth transition to government ownership, the Global Health Advocacy Incubator was able to track what worked to ensure sustainability.
Here are some of the practices that proved to be most important:
1. Local leadership
Tanzanian organizations led the advocacy campaign for government ownership. They also engaged the community at large, contributing to support and demand for the program.
2. Alignment with public priorities
The project supported the government’s prioritization of maternal health service expansion and its vision of task shifting to address health worker shortages. With government support, the project facilities redistributed tasks among health workers and equipped them to save the lives of mothers and newborns. More broadly, the funders and implementers coordinated their efforts around national targets.
3. Advocacy capacity-building
We provided hands-on, continuous technical assistance as the implementing partners developed a strategic advocacy plan, put it into practice and tracked successes along the way. In turn, the implementing organizations trained members of the community, including the project’s doctors and nurses, to become effective advocates who could identify and persuade key policymakers to support long-term funding for the program.
This process reaffirmed an essential lesson about sustainability: sustainability planning should start during project design and be integrated throughout implementation. Just as importantly, advocacy doesn’t stop now that the government has agreed to budget support. As in the United States and many other countries, the authorized funds must be appropriated through the annual federal budget cycle. This means that implementers will need to advocate every year for continued funding.
Of course, sustainability begins on the ground — but funders play a crucial role in laying the groundwork. In this case, the implementing partners and their donors decided to dedicate the final phase of the program to strengthening capacity and transitioning the program. The last three years were focused on transferring both clinical and managerial knowledge and skills, communicating the fact that international funding was ending and building support for the change.
The transition event turned into a community celebration. For the organizers, it provided hope that in the not-too-distant future, sustainability planning will become the model, not the exception.