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As funding agencies increasingly emphasize health program sustainability, there is a need to clarify what exactly this means. Current definitions of sustainability are ambiguous and inconsistent. Additional challenges arise when programs are expected to measure or demonstrate their progress toward sustainability. Because this concept is not operationalized, it can be impossible for programs to accomplish this task. To address these questions, I conducted a systematic review of public health and evaluation literature.
Results of the literature review indicate that there are two terms most commonly used in discussions about sustainability: sustainability and institutionalization. Sustainability is most commonly used by funding agencies and is made up of the following six dimensions: continuation of benefits/effects/outcomes, continuation of activities/outputs, increased organizational capacity, maintenance of organizational infrastructure, integration into existing organizational infrastructure, and increased community capacity. Institutionalization is used in earlier literature to describe the extent to which a program becomes embedded into an organization’s existing infrastructure, and is now recognized as just one dimension of sustainability. Measurement tools for these various dimensions are underdeveloped and applied inconsistently. These results indicate that program sustainability is a complex and abstract concept and cannot be measured on its own. Program funders need to acknowledge this and reference the various dimensions when communicating with program staff and evaluators.