Table 2 Results synthesis

Intervention

Organisational memory:

- Sufficient amount of resources for the project’s implementation

- Instable resources (foreign agencies)

Adaptation:

- 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)

Values/Codes:

- Few cultural artefacts shared between actors

- Problem of language between sub-groups of stakeholders

Rules/Procedures:

- Clarity of the tasks (new routines) and roles

- Regular supervisions

- Low use of the implementation tools by health workers (the supervisor takes responsibilities)

Adaptation:

- 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)

Values/Codes:

- New rituals put in place (ex.: meetings, supervisions)

- Correspondence of RBF’s goals and the organisation’s (ex.: improve performance of health centres)

Rules/Procedures:

- Reinforcement of old routines and instituting new ones (ex.: PMA)

Adaptation:

- 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)

Values/Codes:

- 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

Values/Codes:

- Correspondence of RBF’s goals and the health system’s (ex.: improve health indicators)

Adaptation:

- 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