Sustainability as Conceptualized in the Field of Global Health Público

Abstract

Programs in global health often strive to be “sustainable.” However, there is little agreement in the field about how sustainability should be understood and applied in different contexts. As a result of this uncertainty, funders and implementers of global health projects often rely on definitions of sustainability that do not account for all its dimensions or that have priorities that are misaligned with the intended recipients of the intervention. The result is programs that are unable to providing long-lasting benefits for the stakeholders involved, including donors, practitioners, and the communities in which they work. To prevent these problems, I conducted a study of 4 key actors in global health – the Sustainability Development Goals, the Bill and Melinda Gates Foundation, PEPFAR, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. This thesis describes and critically analyzes how these organizations in global health define and apply the concept of “sustainability” in intervention implementation and research. It also serves to determine whether and how this conceptualization of sustainability differs between global health actors and global health literature.

Table of Contents

List of Acronyms…………………………………………………………………………... 1

Purpose…………………………………………………………………………………….. 2

Background and Significance….………………………………………………..………... 3

Methods……………………………………………………………………………………. 6

Findings……………………………………………………………………………………. 9

Sustainable Development Goals (United Nations)………………………………………….. 9

Context of the Sustainable Development Goals…………………………………….. 9

Sustainability in the SDGs…………………………………………………………... 11

Bill and Melinda Gates Foundation………………………………………………………… 12

Context of the Bill and Melinda Gates Foundation………………………………… 12

Sustainability in the Bill and Melinda Gates Foundation…………………………… 13

United States President’s Emergency Plan for AIDS Relief (PEPFAR)…………………… 15

Context of PEPFAR………………………………………………………………… 15

Sustainability in PEPFAR………………………………………………………….. 17

Global Fund to Fight AIDS, Tuberculosis, and Malaria…………………………………… 21

Context of the Global Fund…………………………..……………………………... 21

Sustainability in the Global Fund…………………………………………………… 22

Literature Review…………………………………………………………………………… 27

Discussion………………………………………………………………………………….. 36

Implications of Sustainability in the SDGs………………………………………………… 36

Implications of Sustainability at the Bill and Melinda Gates Foundation…………...……… 37

Implications of Sustainability at PEPFAR………………………………………………….. 40

Implications of Sustainability at the Global Fund………………………………………….. 41

Key Finding 1……………………………………………………………………………….. 42

Key Finding 2……………………………………………………………………………….. 44

Potential Explanations for the Findings………………………………………………… 45

Limitations………………………………………………………………………………… 46

Conclusion………………………………………………………………………………… 47

References…………………………………………………………………………………. 49

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palabra Clave	Global Health Sustainability
Committee Chair / Thesis Advisor	James Lavery, Emory University

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