Sustainability and institutionalization of donor interventions: Methods and results from a health reform project in Armenia

Purpose: to describe and critique the methods, results, and lessons learned in institutionalizing high value interventions of a nationwide health reform project in Armenia and, as a consequence, reduce donor dependency and associated control.

Data and Methods: In collaboration with MOH officials, an “institutionalization framework” consisting of four key elements was created and built into the MOH's Five Year strategic plan as well as the project's annual work plans and reporting procedures. These included (a) systems and guidelines that describe the content and process of the activity, (b) an office in the MOH where the activity is located, and where responsibility lies, (c) skilled staff who have the knowledge and skills required to carry out the activity, and (d) financing, to ensure that the cost of the activity is built into the MOH budget, using domestic funds. Six nationwide reform initiatives supported by the project were identified as having particularly high value and thus needing institutionalization. Substantial training, coalition building and advocacy work was carried out to achieve institutionalization.

Results: Of the six interventions identified for institutionalization, three were fully institutionalized with the other three achieving partial institutionalization. The financing element was the most challenging element to institutionalize and was the primary gap in the three partially institutionalized interventions.

Policy Implications: As demonstrated by the Armenian case, generating country ownership and reducing donor dependency can be done but requires an explicit institutionalization process shared by key stakeholders. The paper concludes by summarizing seven key considerations for improving this process.