1. Service Delivery & Sustainability Plan B.R. Shamanna 2 nd COSI Symposium VEIRC, New Delhi

2. Service Delivery Community Level Primary Level Secondary Level

3. Service Delivery Primary Prevention Health Promotion Specific Protection Secondary Prevention Early Diagnosis – Screening Treatment Referral Tertiary Prevention Limitation of Disability & Rehabilitation

4. Service Delivery - Roles Eye Care organizations Development organizations Education organizations Rehabilitation organizations Other Organizations – groups, clubs etc.

5. Sustainability “Sustainability is seen as the ability of the system to produce benefits valued sufficiently by users & stakeholders leading to ensuring enough resources to continue activities with long term benefits”

6. Sustainability “A Health Service is considered sustainable when operated by an organizational system with the long term ability to mobilize and allocate sufficient resources for activities that meet individual or public health needs”

7. Sustainability – Development Parlance! “The capacity of the health system to function effectively over time with a minimum of external support”

8. Sustainability “Program continuity or sustainability refers to the capacity of a program to continue functioning, supported by its own resources (human, material and financial), even when external sources of funding have ended”

9. Components for Sustainable Development Technical Sustainability Social/Cultural Sustainability Political Sustainability Financial Sustainability Managerial Sustainability

10. Technical - staff, training, skills Managerial - organization, delivery, systems, marketing Financial - cost reduction, containment, sharing, income generation Leadership - vision, mission, values Sustainability

11. Community Primary Level Secondary Level

12. Questions? How do you plan to obtain long –term programmatic support? How do you plan to get community’s support? What will the in-country support be? (Salaries, commodities, office space, equipment, volunteers, IEC, Community Funding, User fees, Income Generation etc)

13. Questions? At what time will the above be introduced to the project? How does the organization plan to get political support for the project? (Government support, relationship with government policy, networking organizations having common goal etc) Describe plans for continued financial support. (Donor support, fund raising, how funding is solicited?)

14. Strategies for Financial Sustainability Fees for service National and International donors Income generating activities In-kind support – Volunteer, space Collaborative interventions Cross subsidies – sharing of costs

15. Strategies for Financial Sustainability Self sustaining activities internally Community networks Insurance – Group, Social etc Corporate support Fundraising campaigns

16. Strategies for Institutional/ Program Sustainability Institutional Vision, Mission and Values Staff competency – technical and Mgmt. Institutional evaluation systems Regular performance reviews “Change” – adapt and flexibility

17. Strategies for Political Sustainability Government support – organization Government support – project Community support – both above! Complementary policies Networking and collaborations Lobbying & Pressure groups – Advocacy Media management & meetings

18. Measures to Increase Sustainability User charges & community management Management reforms Designing a public health package & strengthening donor assistance Compulsory health insurance for work force Increasing effectiveness & minimizing costs

19. Sustainability Not an end state but a process Viable Organization Managerial & Technical Expertise Necessary Resources

20. Foundations of Sustainable Eye Health Program Effective Leadership Managerial Competence Clinical Competence Partnerships and Collaborations Financial Viability Process to sustain the above