Maternal and Child Health Journal

, Volume 22, Issue 6, pp 903–912 | Cite as

Sustainability of a Community-Based CHOICE Program to Improve the Health and Nutrition Status of Mothers and Infants in Indonesia

  • Clara Eder
  • Lila Kumar KhatiwadaEmail author
  • Janine Schooley


Objectives Few studies have been undertaken to determine whether and how project results are sustained. University of Notre Dame (ND) and Project Concern International conducted a Post-Project Sustainability Study (PSS) of a USAID-funded program (CHOICE), implemented in Indonesia, Banten province, between 2003 and 2007, in order to determine lasting effects and improve PSS methodologies. Methods Sustainability was measured through a comparison of data collected on mother–infant pairs in 2014 with final evaluation data from 2007; and through a comparison of 2014 data collected from the CHOICE villages and comparison villages. Results The analysis showed positive differences in multiple indicators in CHOICE villages between 2007 and 2014, including births attended by skilled personnel (Mean Difference 48.56, 95% CI 38.68 to 58.43) and treatment of diarrhea (MD 16.42, 95% CI − 0.94 to 33.37). However, only one statistically significant difference between intervention and comparison groups in 2014 was observed, infants with diarrhea whose mothers sought advice or treatment (MD − 5.48, 95% CI − 9.55 to 1.39), showing more mothers in intervention group sought advice or treatment. Because contextual factors were not studied in detail and baseline data was not available for the comparison villages, it is difficult to determine the reasons for the results. Given that longitudinal data was not collected, it is also difficult to determine whether results fluctuated between 2007 and 2014. Conclusions for practice This PSS contributes to the limited body of knowledge in sustainability research. Lessons learned from this study will increase potential for sustainable impact of projects, as more rigorous measurement will lead to greater overall understanding of how sustainability actually “happens”.


Maternal and child health Malnutrition Public health intervention Sustainability Indonesia 



The Child Health Opportunities Integrated with Community Empowerment (CHOICE) program was made possible by the generous support of the American people through the United States Agency for International Development (USAID) Child Survival and Health Grants Program (CSHGP), Cooperative Agreement Number: CHS-A-00-03-00017-00, October 2003–September 2007. The CHOICE Post-Project Sustainability Study (PSS) was made possible by Project Concern International’s (PCI) commitment to sustainability and investment of private resources in developing standards, tools, guidelines, and PSS methodologies. This study is one example of PCI’s leadership and its pledge to expand the body of knowledge on sustainability in order to help implementing organizations, project teams, local partners, donors, and other stakeholders to better understand how project results are sustained and adapted and evolve after a project comes to an end.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. Asian Development Bank. (2010). Special evaluation study on post-completion sustainability of ADB projects. SES: OTH 2010-46. Manila: Independent Evaluation Department, ADB.Google Scholar
  2. Bamberger, M., & Cheema, G. S. (1990). Case studies of project sustainability: Implications for policy and operations from Asian experience. Washington, DC: World Bank.CrossRefGoogle Scholar
  3. Mize, L. S., Raintung, A. E., Schooley, J., & Sunarto. (2007). Final evaluation: Child health opportunities integrated with community empowerment. Project Concern International.Google Scholar
  4. Sarriot, E. G., Jahan, S., Kouletio, M., Sardar, M., Ali, K. L., Saha, S., & Rasul, I. (2008). The end of magical thinking: sustainability evaluation three years after the end of the Saidpur and Parbatipur Urban Health Project. Accessed 25 August 2017.
  5. Sarriot, E. G., Ricca, J. G., Yourkavitch, J. M., & Ryan, L. J. (2008). Taking the long view: A practical guide to sustainability planning and measurement in community-oriented health programming. Calverton, MD: Macro International Inc.Google Scholar
  6. Statistics Indonesia, (Badan Pusat Statistik—BPS), National Population and Family Planning Board (BKKBN), Kementerian Kesehatan (Kemenkes—MOH), & ICF International. (2013). Indonesia Demographic and Health Survey 2012. Jakarta: BPS, BKKBN, Kemenkes, and ICF International.Google Scholar
  7. Statistics Indonesia. (2010). Statistics Indonesia web. Population census 2010. Accessed 25 August 2017.
  8. Talaris Institute. (N.D). Parenting Counts Timeline. Web update 2013.
  9. Tang, A., Dong, K., Deitchler, M., et al. (2013). Use of cutoffs for mid-upper-arm circumference (MUAC) as an indicator or predictor of nutritional and health-related outcomes in adolescents and adults: A systematic review. Washington, DC: FHI 360/FANTA.Google Scholar
  10. USAID. (2009). Tools: KPC modules for 2009 grantees. Maternal and Child Heath Integrated Program. Accessed 25 February 2015.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Clara Eder
    • 1
  • Lila Kumar Khatiwada
    • 2
    Email author
  • Janine Schooley
    • 3
  1. 1.Strategic Information for ImpactProject Concern International (PCI)San DiegoUSA
  2. 2.Notre Dame Initiative for Global Development (NDIGD)University of Notre DameNotre DameUSA
  3. 3.Programs, Project Concern InternationalSan DiegoUSA

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