3.8 How to improve sustainability

In order to maximize the health impact of NCD research, effective policies and interventions must be well implemented and well sustained. Too often, effective policies or interventions suffer from a so called innovation–evaporation effect – where they are not sustained after the initial implementation period.⁽⁹⁹⁾

The following are all factors for failure to sustain a policy or intervention:⁽⁹⁸⁾

• not adapting intervention approaches to the local context
• resisting the introduction of new practices due to capacity constraints
• a lack of human resources
• intervention costs (and other economic factors)
• insufficient investment in implementation infrastructure (including in training, monitoring and evaluation systems)
• staff recruitment and staff turnover
• lack of political will

Important elements of successfully sustained interventions include:

Sustainability planning

• It is crucial that sustainability and long-term continuation of the intervention is planned for and considered during all aspects of implementation.
• Requires a well-defined scale-up strategy.
• Includes developing strategies for integration into existing services.

Leadership and engagement

• A key ingredient for the long term success of NCD policies and interventions is strong and sustained political leadership at the highest national and international levels.
• Government sectors besides health all have to be part of the government response – e.g. finance, agriculture, justice, education, urban design, transport, foreign affairs and trade; civil society and the private sector also have a part to play.⁽¹⁰¹⁾
• Implementers need to be able to understand and manage competing interests and stakeholders and to avoid the rise of conflicts of interest.

Communicate the ongoing impact of the change to stakeholders

This requires:

• an effective communication strategy;
• strong advocacy (there should be tools/organization links for this);
• establishment of monitoring and evaluation systems.

Formalize and standardize the change

• Embed the change within organizational structures and processes (e.g. within policies).
• Remove old ways of doing things.

Training / capacity building / linking with other organizations

• This needs infrastructure to support implementation – e.g. training, delivery systems and technical resources.

Keep the intervention simple

• In this way, key stakeholders and the target audience are more readily able to understand, engage and scale up the intervention.⁽⁹⁸⁾