Asking the right questions: Sentinel indicators help tell the story of health programs' progress toward sustainability in Nigeria

Sustaining effective and equitable health programming requires an interconnected array of inputs and enabling factors, ranging from the difficult-to-quantify (like good governance and leadership) to the relatively objective (like consistent investment). As part of the USAID-supported Health, Population, and Nutrition (HPN) portfolio evaluation in Nigeria, Data for Impact (D4I) is assessing sustainability, and the major factors that influence it, in three states where integrated, disease-focused, and combined programming models are being respectively implemented. A mixed methods sustainability assessment completed in 2022 for the evaluation found mostly small differences between states on self-reported factors required for sustainable program implementation, system and organizational capacity, community embeddedness, and enabling environment. Program stakeholders reported that external structural constraints such as low funding levels and inadequate human resources contribute to and reflect limited progress toward sustainability across program models, and that state-level factors beyond the choice of program model are more critical to sustaining service delivery and outcomes. In response to the need for more data to contextualize and supplement these findings with evidence related to the tangible effects of sustainable programming such as adequate health financing and human resources, in 2023 D4I sought to generate state-level results estimates on a new set of sentinel sustainability indicators. Selected through a collaborative process and based on attributes including usability, accessibility, and data quality, these sentinel indicators offer a replicable model for identifying and tracking countries’ progress toward ensuring that individuals, families, and communities continue to receive the health services they need to ensure their wellbeing.