SUSTAIN: A Sustainability and Transition Readiness Assessment Tool for Malaria

What is transition and sustainability?

Transition is the process by which a country moves towards fully financing, managing, and implementing its health programs independent of donor support. This often includes integrating donor-supported programs, health workforce, technical, and other resources into the public health system. A transition is successful when national malaria programs are able to maintain and improve equitable coverage and uptake of services through resilient health systems. Sustainability is the ability of country to strategically implement public health activities that ensure the long-term prevention of public health challenges, including achieving and maintaining malaria elimination. In many cases, this will include enhancing the integration of the vertical malaria response into the general health system.

What is the SUSTAIN tool and why is it useful?

Successful transitions are often hindered by a lack of awareness among government health and finance leadership about transition needs, limited coordination across donors, government programs, and implementing partners to strategically address transition priorities, and insufficient evidence about best-practice sustainability strategies. The SUSTAIN tool is designed to close these gaps by facilitating a multi-stakeholder consultative process to assess program strengths and weaknesses as they relate to sustainability, and prioritize strategies and actions for the transition period.

SUSTAIN focuses on generating dialogue and facilitating priority-setting and problem-solving discussions across key stakeholders at the national and sub-national level – essential components of sustainability and transition planning and implementation. Transition impacts not only a program’s financing, but all aspects of a program’s governance, management, and implementation. SUSTAIN therefore takes a holistic approach to assessing transition readiness, by evaluating sustainability and transition vulnerabilities in each of the core domains of the malaria response, including epidemiological surveillance and response, vector control, case management, and information systems. In each of these areas, SUSTAIN assesses sustainability in financing, leadership and management, health workforce, integration, and health product management.

Who should use this tool and how?

SUSTAIN is intended to be used by national malaria programs in collaboration with their donor, technical, implementing and research partners. National program managers will lead the development of the SUSTAIN goals and strategy, engaging the program’s technical partners, Ministry of Health leadership, collaborating departments within the Ministry of Health, Ministry of Finance, and other governmental, non-governmental and civil society, and donor agencies. A dedicated assessment team, comprising leadership of the national malaria program and an external technical partner, leads the conduct of the SUSTAIN assessment.

The SUSTAIN tool is intended to be used during the early stages of a country’s anticipated transition from donor support, ideally in advance of any reduction in donor financial or technical support to the malaria program. In this way, the tool can be used to identify potential problems prior to transition and proactively implement strategies to mitigate any anticipated challenges that may be faced during the transition period. Designing and making the programmatic and policy adjustments necessitated by transition take time, and will require new and different strategies and investments by all partners. The tool seeks to facilitate the evidence generation, consultation, and prioritization processes needed to elevate discussions of sustainability and transition and prepare the program for managing necessary changes. Implementation of the SUSTAIN tool is best followed with steps to develop and implement a sustainability and transition plan, and can be used alongside other tools in the MEI toolkit including the Malaria Budget Advocacy Framework and the LEAD Framework.