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Table 2 Results synthesis

From: Donor-funded project's sustainability assessment: a qualitative case study of a results-based financing pilot in Koulikoro region, Mali

Implementation contexts Determinants Processes
Intervention Organisational memory:
- Sufficient amount of resources for the project’s implementation
- Instable resources (foreign agencies)
- Design of the intervention adapted to the different contexts
- Simplicity of the design
Dev. of relationships:
- Important amount of stakeholders united for the intervention
Evaluation of the integration capacity:
- Over reliance on foreign investments/prices
- Design mapping process by KIT
Sustainability planning:
- Project understood in a determined period of time and experimental with no sustainability attached
Individuals Organisational memory:
- Increased expertise (trainings and feedbacks from supervisions)
- Improved work conditions (long and short terms investments in infrastructures and materials)
- Few cultural artefacts shared between actors
- Problem of language between sub-groups of stakeholders
- Clarity of the tasks (new routines) and roles
- Regular supervisions
- Low use of the implementation tools by health workers (the supervisor takes responsibilities)
- Correspond individuals’ needs (ex.: bonuses and better work conditions)
- Low critical perspective towards the project (absence of negative effects)
Dev. of relationships:
- High motivation of health workers (bonuses)
Execution of action towards sustainability:
- High rotation of personnel leading to few actions towards sustainability
- Cessation (or diminution) of the bonuses, supervisions, trainings, investments
Organisation Organisational memory:
- Punctual integration of new resources (financial, infrastructures, materials, staff, etc.)
- Few risks taken for the project (ex.: investments and demand of credits)
- New rituals put in place (ex.: meetings, supervisions)
- Correspondence of RBF’s goals and the organisation’s (ex.: improve performance of health centres)
- Reinforcement of old routines and instituting new ones (ex.: PMA)
- Similarity of new and old routines
- Clear system of monitoring and evaluation
- Few adaptations of the project by the organisations (ex.: new registries, awareness campaigns)
- Goals setting according to the organisation
Dev. of relationships:
- Unequal benefits to the stakeholders (ex.: bonuses for health workers and moral recognition for communes)
- Intra-organisation cooperation during the project
Evaluation of the integration capacity:
- Evaluation of performance only based over 3 months prior the project
Execution of action towards sustainability:
- Sustained routines (better reception, punctuality, use of registries)
- Few actions taken to sustain routines (ex.: talks in favour to maintain results rather than routines)
Local environment Organisational memory:
- Local investments to prepare RBF (ex.: materials, new staff, trainings)
- Absence of shared cultural artefacts
Dev. of relationships:
- Temporary reunion of stakeholders (ex.: communes, women associations, health workers)
- Competition between organisations
- Few cooperation between organisations
Evaluation of the integration capacity:
- Local particularities not taken into account during first evaluation
Sustainability planning:
- No planning to sustain the new relationships
External system Organisational memory:
- Trainings at national/regional levels
- Resources controlled by foreign agencies
- Correspondence of RBF’s goals and the health system’s (ex.: improve health indicators)
- From Rwandan RBF to “à la malienne” (decentralised version of RBF)
- Embedded in the health system apart from the budget management
Dev. of relationships:
- Lack of involvement of local authorities (ex.: communes, governmental agencies)
Evaluation of the integration capacity:
- Lack of local leadership in making a baseline study for the project (after USAID withdrew from the project because of the coup d’État)
Sustainability planning:
- Dependence on international support to maintain the gains of the project
Evaluation of sustainability and modifications:
- Sustainability is only considered through a scaling up operation