Measuring the sustainability of health systems using absorptive capacity: Imbibing sustainable processes and outcomes
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Sambodhi Research and Communications Private Limited India
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A902
Evidence on the sustainability of outcomes has been quite minimal, limited to post-hoc evaluations. Such evidence is even scarcer in terms of sustainability of processes and the generation of evidence on what makes programs sustainable becomes crucial in resource-constraint contexts. This paper considers the case of the Technical Support Unit (TSU) in the state of Uttar Pradesh, India to showcase how absorptive capacity can be used as a mechanism to build sustainability of the processes as well as outcomes. The purpose of this Paper is to utilize the findings of TSU evaluation to posit that building ‘Absorptive Capacities’ of stakeholders is an important mechanism to build sustainability of interventions. The paper also discusses how ‘Absorptive Capacities’ were defined and implemented in the context of health system evaluation. The evaluation study employs a pre-post multi-method design with the district as the unit of analysis. Mixed method approach with semi-structured interview schedules were conducted with public health officials at the state, district and block level. Further, these are aided with the organizational assessment survey. The analyses are guided by the Absorptive Capacity(ACAP) framework to assess absorptive capacity at the individual and system level. The agenda of the evaluator in most evaluations has been on demonstrating impacts throughout funding of a program based on the theory of change. The preoccupation should not be on the initial theory of change but on an emergent theory of change that includes some reflection on post-funding dynamic supports. The findings build the case for understanding the sustainability of processes and outcomes through the ACAP framework. This thinking about the sustainability of processes and outcomes will require a focus on capacities, capabilities and absorptive capacities of “permanent” actors, like the state, and actors who have the potential of mainstreaming the intervention after the funding runs out