A donor’s questions about sustainability Billy Stewart Human Development Team Leader DFID, Yangon, Myanmar

Why are donors talking about sustainability?

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