Child Survival Sustainability Assessment (CSSA)

Excerpts from the Executive Summary follow (footnote numbers omitted):

...The CSSA is an outcome of the CORE-CSTS+ Sustainability Initiative, a qualitative research effort led by the Child Survival Technical Support (CSTS+) project and the Child Survival Collaborations and Resources Group (CORE) with the private voluntary organization (PVO) CS community.

The CSSA is presented as a tool helping CS interventions, notably PVO CS interventions, better integrate their plans and monitoring and evaluation (M&E) systems under the overarching purpose of achieving sustainable child health gains. It seeks to do so through a realistic and contextually relevant systematic approach, yet expecting to increase the ability of the CS community as a whole to be accountable, to learn about and to communicate our common responsibility to the children today and tomorrow....

Offering a definition of sustainability relevant to CS projects

Based on the lessons of the Sustainability Initiative, the following definition of sustainability as it relates to the CS projects can be offered:

Sustainability in Child Survival projects is a contribution to the development of conditions enabling individuals, communities, and local organizations to express their potential, improve local functionality, develop mutual relationships of support and accountability, decrease dependency on insecure resources (financial, human, technical, informational), in order for local stakeholders to negotiate their respective roles in the pursuit of health, wellness and development, beyond a project intervention.

The individuals, communities and local organizations constitute a local system with their environment, and it is ultimately their coordinated social interactions and efforts, based on the understanding of their own health and development that will lead to lasting health impact.

The Child Survival Sustainability Assessment (CSSA): Toward a shared sustainability assessment framework for CS projects

The CSSA methodology proposes both a framework, which allows approaching systematically the shared dimensions of evaluation on which progress can be measured, and a process for a participatory sustainability assessment with communities and local partners. The process starts with the consideration of the communities, institutional stakeholders, and environment, which define a "local system" expected to own the process of improving health beyond the life of a project...

The framework's three main dimensions and their respective components [include]:

1. The first dimension consists of elements reflecting the primary health goals of the local system:
   
   • The first component is the population's health status (or proxies, such as immunization coverage).
   • The second component consists of elements in the health and social services approach and quality, which will influence the durability of any health improvement, such as access, effectiveness, equity, appropriateness and fit of the activities.
2. The second dimension consists of elements reflecting local organizational capacity and viability:
   
   • The first component of this second dimension represents the organizational capacity, which needs to exist in the local partner(s) to maintain performance.
   • The second component represents the organizational viability or the profile of dependency of this key local partner. Dependency relates not only to financial viability, but also to the other essential types of support on which an organization may depend to continue existing and fulfilling its mission.
3. The last dimension addresses the conditions in the community and the social ecological systems in which the project evolves:
   
   • Its first component refers to community capacity and the overlapping elements of cultural acceptance and social cohesion. All these elements can be viewed under the umbrella concept of community competence.
   • The second component includes a number of elements within the environment of the project in the largest sense: national policies, the economic and political environment, and the environmental and human development situation. These elements are frequently, but not always, outside of a project's scope of intervention. They may, however, be relevant to a sustainability assessment within a CS project, as they indicate important transitional stages of development, which PVOs cannot ignore.
4. Completing this framework is an added dimension of threat identification. Some issues are far beyond the control of a PVO and its partners and can place threats on even the best plans for sustainability. These risks need to be understood for what they are and may warrant contingency plans.

Identifying measurement tools and indicators in the dimensions of the CSSA

The CSSA is strongly based on PVO-shared values and experience. It does not offer a new measurement tool, but seeks to integrate assessment tools already in use in the CS community...

For the various types of measurement tools available, the CSSA suggests building performance criteria describing stages of progress on any given indicator from "minimal," "emerging," "medium," "promising," to "strong" contribution to sustainability. Given the multidimensionality of the questions raised by sustainability, the complexity of the issues and the diversity of measurements that can be made, the development of performance criteria will help managers and evaluators:

• Synthesize the information about a given dimension, if appropriate, by combining indicators into an index score,
• Compare progress toward sustainability on elements of a different nature, assessed through different tools, thus deriving programmatic implications,
• Establish comparisons across sites and projects for the sake of cross-learning, benchmarking and improving evaluation tools, and research questions.

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Source:

Child Survival Technical support site.