A donor’s questions about
sustainability
Billy Stewart
Human Development Team Leader
DFID, Yangon, Myanmar
Why are donors talking about sustainability?
DFID bilateral aid to India (£m)
200
150
100
DFID bilateral aid to
India (£m)
50
0
2014/5
2015/6
Questions
• Sustainability of what?
• What are the opportunities for transitioning financing of social
franchising?
• What are the challenges with maintaining equity of service
provision?
• What can donors do with regard to advocacy, governance
and institutions?
• Is sustainability of current approaches even the right goal?
Defining the question: Sustainability of what?
• Of donor supported social franchising following reduction or
graduation of donor financing
– Towards government financing
– Towards health insurance programmes
– Towards greater cost recovery
• Of network operations and quality assurance as well as
services.
• Of a focus on reaching the poorest.
• Of services for particular groups (e.g. young, unmarried
women)
What are the opportunities for transitioning from
donor financing?
• Growing government budgets for health.
• National programmes that have rates for certain services
(e.g. India National Rural Health Mission)
• Demand side financing. National Health Insurance
Programmes.
• Innovative or global sources of financing: development
impact bonds, global financing facilities (e.g. for
RMNCAH/World Bank)
What are the challenges with maintaining equity
and quality of service provision?
• If we transition to government funding, what are the
requirements to maintain equity?
• Do government schemes build in sufficient flexibility to
subsidise for the poorest?
• Are there transitional arrangements which are helpful (such
as demand side financing, equity funds)?
• Are there innovative ways (endowments, results based
financing) that could maintain quality assurance and network
functions?
What can donors do with regard to advocacy,
governance and institutions?
• How can donors assist to make the case for reimbursement
– not just of service delivery but of network management and quality
assurance.
• What kind of transitional arrangements will support a better
‘handover’?
• How can we support the development of public sector
institutions for contracting voluntary and private sector
networks?
Is sustainability of current approaches even the
right goal?
• Continuing to do what we always did –are there different
models?
• Private sector corporate models (pharmacy chains, linked
primary and hospital care).
• Franchisee funded networks
• Social investment