Severe acute malnutrition (SAM) threatens the lives of millions of children globally. In developing countries, 15% of the population is undernourished; and half of the mortality for children younger than 5 years old is associated to undernutrition (UNICEF, 2008), the most vulnerable population to malnutrition. Overall, Haiti reports 19.2% of children are undernourished, 11.4% are underweight, and 10.3% are wasted (Lutter et al., 2011; DHS, 2005, CWW-proposal, 2007). The treatment for the management of SAM has evolved over the decades (Lancet, 2006). The Community Management of Acute Malnutrition (CMAM) is an evidence-based intervention with proven effectiveness for treating children with SAM (Collins, 2007). The CMAM intervention reduces infant mortality related to SAM (Lancet, 2006, Collins, 2007; WHO, 2001; UNICEF, 2009). The CMAM intervention was validated in 2007 through the United Nations agencies for the management of SAM. Nevertheless, it has had limited reach and poor public health impact in some of the developing countries (e.g.; Haiti) where it was implemented. Concern Worldwide is a non-profit humanitarian organization, which pioneered in the creation of the CMAM intervention. Concern introduced the CMAM interventions in Haiti in October 2007 as a pilot program. The program was implemented in close to 20 health institutions in the metropolitan Port-au-Prince. As is the case with any other public health program, there were many challenges to the CMAM intervention implementation in Haiti. Concern’s CMAM intervention was not sustainable after it retracted the technical support in 2012 (UNICEF-Haiti country report, 2014). The purpose of this paper is to first review the Concern Worldwide CMAM program implementation in five communes of Port-au-Prince. Then, a suggested plan is outlined for the revitalization of the intervention’s activities and long-term sustainability once revitalized.

Agriculture is crucial to the economic and social wellbeing of the Republic of Cameroon. A national need for increased productivity, farm incomes, food security and rural development requires more effective agricultural extension and advisory systems. The need is persistent. This study analyzed strengths, weaknesses, opportunities, and threats that existed within the current national extension program and examined how form, function, and policy influenced two regions in Cameroon. Analysis focused on 15-year time changes using a comparative case study design. Four regional focus groups and 28 individual interviews bounded 59 cases from four stakeholder groups of farmer leaders, non-governmental organizations, extension representatives, and governmental counterparts. Eighteen primary themes emerged with overlap of opportunities and threats among stakeholders. Incentives to program performance included staff competence and innovative technology transfer. Barriers included infrastructure, postharvest technology, market incentives, financial sustainability, and feedback. A lack of vision for sustainability, inadequate government funding, poor collaboration and linkages, uncoordinated parallel programs, and ineffective management systems reduced program potential. Four themes framed recommendations for improved programs: government investment, trainings, market incentives, and management. Options to improve program sustainability included subsidies that benefit all farmers, more council and private sector engagement with extension, rural infrastructure development, price standardization, and fees for service. Medium and large-scale farmers were willing to pay for extension services when and if available whereas small-scale farmers relied heavily on subsidized services. Accessibility to markets, farm size, and cash crop production are associated with farmers’ acceptance of fees for service. These findings highlighted areas where changes in the nation’s agricultural extension service could improve its relevance in meeting performance targets. Stakeholders’ recommendations for more effective agricultural extension and advisory systems included: 1) providing an autonomous extension service that focuses on specific needs and market opportunities and coordinates all support/parallel programs while collaborating among research and private advisory services; 2) implementing holistic government policies that integrate technology transfer, innovation, health, value-chains, and markets to benefit all farmers; 3) redesigning subsidies that equitability incentivize production and sound environmental practices that benefit all farmers; 4) increasing in-service trainings related to innovations; and 5) updating innovations and harmonizing program activities.

Budgetary constraints have led many educational leaders to limit arts education programming to students across the state of Pennsylvania. The purpose of this qualitative dissertation was to investigate how educational leaders sustain access to arts education programs using alternative budgetary resources for K-12 students in Pennsylvania Title I schools. This multiple case study provided analysis within and across Pennsylvania Title I schools to help fill a gap in the educational leadership literature regarding alternative budgeting strategies to meet programming needs. The conceptual framework integrated transformational leadership, principles of creativity, and budgetary strategies. Key research questions explored sustainability frameworks and the use of creative leadership strategies to guide budget allocations while analyzing how educational leaders employ constructs of transformational leadership theory to produce measures of accountability. The study of 15 school districts across Pennsylvania employed an in-depth interview process and document review. Multiple case study analysis allowed for the exploration of leadership decisions within the current financial landscape of Pennsylvania Title I public schools during the 2017-2018 school year. The study found that alternative budgetary resources were not confined to financial support but included strategic resource management, inclusive stakeholder practices, and synoptic performance. Each of these constructs extended knowledge in leadership practice and organizational outcomes. This study's findings may have practical applications in relation to sustained leadership for arts education programs using alternative resources in Pennsylvania Title I schools.

Program sustainability is a major issue for nongovernmental organizations. Sustainability depends on the ability of an organization to maintain its capacity, which can be severely hindered by high rates of personnel turnover. This is especially true for turnover in nonprofit organizations that offer volunteer-led programs and are consequently heavily reliant upon those individuals to carry out their missions. Creating a strong institutional memory for both tacit and explicit knowledge and properly managing volunteers are two critical elements in creating the capacity needed to maintain a high-quality program. This thesis analyzes the case of a youth center in Macedonia that is dependent upon its volunteers to function and is afflicted by sustainability and discontinuity issues in its programs due to a regular rapid turnover of its volunteers. The center promotes youth development through informal education of its participants, primarily high school youth. Interviews, participant observation and document analysis provided insight into the program sustainability issues present at the youth center. I present a series of scenarios that highlight the issues of volunteer management and institutional memory loss concerning volunteer turnover that I discovered in my analysis. I conclude by calling for better preservation of institutional memory, more targeted recruitment and training that emphasizes creating routines and establishing volunteer expectations to enable improved program sustainability. / Master of Urban and Regional Planning

Maldistribution of healthcare professionals persists in remote and rural communities throughout the world. Adoption of a Community Paramedic (CP) program could improve access to quality healthcare for rural communities. The conceptual framework defined rural communities by their distinct characteristics — community efficacy, weaknesses, attitudes, assets, deficits, local culture, and the driving and restraining forces — and not defined by their small populations or distances to cities. The theoretical foundation was a synthesis of theories of Bandura, Rogers, and Lewin. This study assessed community characteristics that may influence the likelihood of success, sustainability, or program failure of the Australian CP model in a single remote Texas border community. In this qualitative formative bounded case study, 3 bounded groups were examined; data collection was by in-person interviews. Group members were purposively selected: 5 residents and 3 EMS members. The 3rd group consisted of 4 randomly self-selected resident interviews, field observations, news articles, and local social media. Data transcripts were coded using theoretical coding based on the conceptual framework and theoretical foundation. Strong individual and group efficacy, efficacy resilience, adaptability, strong communications, overlapping groups, and a strong sense of community program ownership were evident in this study. The probability of establishing an effective CP program based on the Australian model is high based on study findings. Improved access to quality healthcare in remote and rural communities could result in improved health of community members and significant social change.

Objective: This thesis aimed to advance the study of sustainability through the exploratory use of a conceptual framework for the investigation of a collaborative project. Methods: A qualitative case study design, utilizing document analysis and key informant interviews, was used to conduct a three-year follow-up of a collaborative mental health project. The study design and directed content analysis were informed by the Scheirer and Dearing (2011) conceptual framework. Results: The sustained outcomes identified by the six participating agencies included: institutionalized project components, maintained client benefits, continued collaboration and sustained attention to the issue. The sustainability of project components was associated with complex interactions between the innovation, organization, and community factors investigated. Conclusions: The study illustrated the importance of evaluating multiple aspects of sustainability to fully capture a project’s long-term effect. Complex systems theory was proposed to describe the interactions observed and as a direction for further development of the conceptual framework.

Objective: This thesis aimed to advance the study of sustainability through the exploratory use of a conceptual framework for the investigation of a collaborative project. Methods: A qualitative case study design, utilizing document analysis and key informant interviews, was used to conduct a three-year follow-up of a collaborative mental health project. The study design and directed content analysis were informed by the Scheirer and Dearing (2011) conceptual framework. Results: The sustained outcomes identified by the six participating agencies included: institutionalized project components, maintained client benefits, continued collaboration and sustained attention to the issue. The sustainability of project components was associated with complex interactions between the innovation, organization, and community factors investigated. Conclusions: The study illustrated the importance of evaluating multiple aspects of sustainability to fully capture a project’s long-term effect. Complex systems theory was proposed to describe the interactions observed and as a direction for further development of the conceptual framework.

Submitted by Haroudo Xavier Filho (haroudo.xavierfo@ufpe.br) on 2016-04-20T13:59:49Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissert. Navarro- digital.pdf: 3882779 bytes, checksum: 77b13189bd896f010f248c48052b1529 (MD5) / Made available in DSpace on 2016-04-20T13:59:49Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissert. Navarro- digital.pdf: 3882779 bytes, checksum: 77b13189bd896f010f248c48052b1529 (MD5) Previous issue date: 2015-07-03 / CAPES / O Programa Nacional de Alimentação Escolar tem caráter intersetorial, estimula a participação social e incentiva às economias locais, sendo considerado uma prática de promoção da saúde. No sertão pernambucano, o município de Tabira se destacou na gestão do Programa de Alimentação Escolar (PAE) em 2012. Para compreender os processos relacionados à continuidade das ações inovadoras realizadas, este estudo buscou analisar evidências de sustentabilidade das ações bem-sucedidas do PAE de Tabira. A pesquisa teve abordagem qualitativa com estratégia de estudo de caso. Foi realizado um grupo focal e entrevistas semiestruturadas com 12 informantes-chave. Os dados foram submetidos à análise de conteúdo, com a técnica de análise temática. Foi utilizado o software NVivo® 10 para Windows como primeiro tratamento dos dados. Os resultados apontam que os processos relacionados à implementação das inovações estão relacionados à sua sustentabilidade. A gestão atual continua cumprindo com o objetivo do programa de atender às necessidades nutricionais dos alunos no período em que estão na escola, porém não continuou as atividades educativas em alimentação saudável desenvolvidas na gestão anterior, ou seja, houve uma sustentabilidade parcial do programa. Fatores dos contextos organizacional e sociopolítico favoráveis à sustentabilidade foram a institucionalização do programa, o uso eficiente dos recursos financeiros, a forma centralizada de gestão, a alta participação comunitária no programa e o uso dos recursos da região a favor do programa. Como desfavoráveis foram destacados: fragilidade da articulação intersetorial e capacitação e qualificação profissional deficientes. A forte disputa política local se configura, numa perspectiva, como um fator positivo para a sustentabilidade do programa, mas negativo em alguns aspectos. O PAE de Tabira mostrou a possibilidade de operacionalizar ações de promoção da saúde, mesmo com restrição de recursos naturais e financeiros. Experiências como esta precisam ser mais visualizadas pela comunidade acadêmica e formuladores de políticas. / The Brazilian School Feeding Program is intersectoral, encourages social participation, local economies and is considered as a practice of health promotion. In the Northeast Region, the city of Tabira has done an excellent management of its school feeding program in 2012. To understand the processes related to the continuity of the innovative actions carried out, this study analyzed the evidences of sustainability of the ongoing innovations in Tabira. The research used a qualitative approach with case study strategy. A focus group and semi-structured interviews with 12 key actors were realized. The data were processed with content analysis and thematic analysis. NVivo® software for Windows 10 was used for the first analysis of the data. The results show that the processes that led to the implementation of the innovations are related to their sustainability. The management of Tabiras’s school feeding program may be considered sustainable in part, because it is still complying with the main program's goal, that is satisfying the students nutritional needs during their school time, but did not continues the educational activities on healthy eating developed in the previous administration. Positive organizational and socio-political factors were: the program institutionalization, the efficient use of financial resources, centralized management, high community participation and the use of local resources. Negative factors were: low inter-sectoral coordination and training and poor professional qualification. The strong political engagement at the local level showed both a positive and a negative impact. This study shows that it is possible to operationalize health promotion, even with restriction of financial and natural resources. Experiences like this should be more considered and discussed within the the academic community and among policy makers.