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

Municipalities are legally tasked with ensuring the delivery of primary health care services to the population but had developed almost no capacity to do so. We describe how the Sustainability Framework method was implemented following the mid-term evaluation (2002), up through the final evaluation (2004), all the way to the 5-year post-project sustainability evaluation in 2009. Development aid’s efforts at scale up and acceleration of achievements are known to create stress on country systems, regardless of good intentions. This makes the question of sustainability still enormously critical to the future of global health and global development