Table 1 Framework for assessment of sustainability of health services in the west Nile districts

Organisational capacity

1.1 Organisational capacity: the capacity that is needed within local organisations to maintain local services and activities

Organisational capacity in this study includes the district health service management and performance while trying to meet the health needs of the population

1.2 Organisational viability: the capacity of an organisation for continuing effectiveness, in particular organisational dependency/interdependency and interconnectedness

Organisational viability refers to inter-linkages, support and connections which a district health service holds with the MoH, aid agencies and other districts to ensure it provides health services. It reflects the district health service organizational dependency, or interdependency, in a given region and district

Funding

2.1 Concerned with having sufficient funding to continue programme objectives. It follows the trajectory of funding pre-programme to programme funding and to post programme funding outcomes

The framework incorporated funding into the organisational dimension, specifically organisational viability. However, we consider that it warrants separate consideration, considering the centrality of financing to programme sustainability

Health and social services

3.1 Health and social services approach: availability, cost, accessibility and appropriateness of services

Health services are defined in this study in the broadest terms, as composed of all aspects of the district health services. The includes quality and coverage of services. Coverage is not reported in this study as it is not integrated into routine planning and M&E. The assessment of quality of health service was deemed beyond the scope of the study

Community, social and ecological

4.1 Community competence: overlapping elements that affect the community such as social cohesion and collective efficacy – ‘community competence

‘Community competence’ is defined as ‘the functions of district health services (leadership, management, communication, responsiveness to the community) and connectedness with community they serve which contribute to the overall health outcomes of the community

4.2 Ecological, human, economic, political and policy environment: national and regional economic and political policies, and ecological conditions

In this study policy and local, regional and international political climates strongly influence the ability of the district health services and community capacity