Determinants of Program Sustainability and Application to the Liberia Field Epidemiology and Training Program Open Access

Nyei, Fata (Spring 2019)

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Determinants of Program Sustainability and Application

to the Liberia Field Epidemiology and Training Program

By Fata Nyei


The past decades have seen increased attempts to implement public health programs in underserved, underdeveloped countries by funding agencies. Many fizzle out after spending their initial funds. The term “sustainability” can refer to the concept of maintaining the environment, continuation of a program, or economic viability of an income-generating program in a developing country. With so many resources targeted to health-related interventions, stakeholders are increasingly focused on longevity, sustainability, and local ownership. Health systems throughout the underserved world suffer from insufficient financial and human resources, limited institutional capacity, weak health information systems, and a need for management capacity building. Using various frameworks, we assessed factors that influence sustainability and applied them to the newly organized Liberia’s Field Epidemiology Training Program.


A literature review was performed using a broad approach to explore program sustainability. Eight in-depth interviews and one focus group were conducted with key figures in the Liberia FETP. Interview participants represented host organization, the implementing partner, the funding agency and Liberia FETP participants. Interviews were transcribed and deductive codes compiled into a codebook. Coding of the transcripts were done in three stages. Initial reviews of each transcript led to additional codes. Subsequent reviews of the transcripts were performed to assign codes. The lexical search feature of MAXQDA was utilized to automatically search the documents and assign to codes. The resulting codes were organized and grouped by similarity.


Three main areas were found to influence sustainability: the financial environment; the characteristic of the program; and the political environment.



The Liberia FETP is strong in many aspects of internal program capacity. All interviewed and focus group participants highlighted the program’s strength being in its leadership and management. The quality of the program with respect to producing skilled graduates is also very high. The program does faces funding insecurity.

Table of Contents

Table of Contents

I. Introduction. 1

Problem Statement. 3

Objective. 3

Statement of Significant. 3

Key Terms. 4

II. Literature Review.. 4

Definition.. 6

Determinants of Sustainability. 9

Capacity Building. 9

Routinization. 10

Funding Stability. 10

Partnerships. 11

Political Support 12

Organizational Capacity. 12

Program Adaptation. 12

Communication. 13

Field Epidemiology Training Program... 13

III. Methods. 15

Literature Review.. 15

Data Collection.. 16

Data Analyses. 17

Ethical Considerations. 21

Results. 22

Determinants. 26

IV. Discussion. 29

Limitations. 31

Recommendation.. 32

Future Research.. 32

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