Sustain gains, invest in an exit strategy: The experience of a public health program in Papua New Guinea



All international development programs come to an end. Drawing from the principles of sustainable development, an effective program will address the future implications of closure whilst implementing services in the present. Program closure might involve phasing down, phasing out or phasing over activities, which influences the type of ‘exit strategy’ developed. An effective strategy will consider the transition of leadership, financing, programming and service delivery; and determine local capacity to sustain gains made. Poorly planned program closure risks reversing health achievements and creating additional pressure on services and institutional capacity. Abt Associates has been implementing a comprehensive public health program in Western Province, Papua New Guinea since 2009. The program is due to finish at the end of 2018. In order to sustain gains and continue activities beyond the program life, a transition plan was developed and endorsed by partners. The plan details key ‘phasing down’ and ‘phasing over’ activities under the broad pillars of the program: Partnerships and Engagement, Health System Strengthening and Service Delivery. The challenge now is to transition the program towards closure, whilst remaining accountable to current objectives and outcomes. It will be important to manage shifting priorities; community expectations; and the impact of external factors; whilst creating a supportive environment to maintain progress made. A robust monitoring and evaluation system is required to measure the success of transition, and to provide information for decision-making beyond program intervention. An opportunity presents to learn from the experience in Western Province to inform closure of future public health programs. Keywords: Community development/engagement, capacity building, partnerships; and sustainability Key Messages: 1. Complex public health programs need considerable forward planning for effective phasing down, phasing out or phasing over of activities as they near completion 2. In practice, engagement with stakeholders, communication and a robust M&E system assist in creating an enabling environment to sustain gains beyond program closure 3. The experience of a public health program in Papua New Guinea contributes to the literature on transition planning and exit strategies in international development contexts


Fiona Mactaggart

Abt Associates

Fiona Mactaggart is a Monitoring and Evaluation Manager at Abt Associates, and works on multiple health programs implemented in Papua New Guinea. Fiona oversees M&E design, data collection, analysis and reporting of program progress and also contributes to business development, operational research and program management. Fiona is near completion of a Doctorate in Public Health with the Berlin University of Technology, Germany, that explores health and well-being outcomes of regional and rural communities living in proximity to coal seam gas development. Fiona received her Master of the Control of Infectious Diseases from the London School of Hygiene and Tropical Medicine, England and worked in the UK and Australia on a range of public health programs. Fiona has a special interest in health system strengthening, rural and remote health, and infectious disease control