Advancing the application of systems thinking in health: sustainability evaluation as learning and sense-making in a complex urban health system in Northern Bangladesh

Starting in 1999, Concern Worldwide Inc. (Concern) worked with two Bangladeshi municipal health departments to support delivery of maternal and child health preventive services. A mid-term evaluation identified sustainability challenges. Concern chose the Sustainability Framework method to generate creative thinking from stakeholders, create a common vision, and monitor progress. Formal assessments took place up to 5 years post-project (2009). Post-project achievements included the maintenance or improvement 5 years post-project (2009) in 9 of the 11 health indicator gains realized during the project (1999–2004). Some elements of performance and capacity weakened, but reductions in the equity gap achieved during the project were largely maintained post-project.

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Sarriot E, Kouletio M, Jahan S, Rasul I, Musha A. Advancing the application of systems thinking in health: sustainability evaluation as learning and sense-making in a complex urban health system in Northern Bangladesh. Health Research Policy and Systems. 2014;12(45). doi:10.1186/1478-4505-12-45