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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) 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