How Grant-Making Bodies Assess Digital Health Program Sustainability

The landscape of digital health is littered with pilot projects that showed immense promise but failed to survive beyond the initial funding cycle. For academic researchers, public health institutions, and the very grant-making bodies that fund these initiatives, this is a critical problem. As digital tools become more integrated into global health, the focus is shifting from short-term impact to long-term viability. Understanding how to build and present a sustainable program is no longer an afterthought; it is a core requirement for securing funding and achieving lasting public health outcomes. Grant-making bodies are increasingly applying rigorous frameworks to assess whether a program has the foundational strength to endure, adapt, and scale over time.

"A review of mHealth projects funded by a major foundation found that only 12% were still active two years after the initial grant period ended." - (Heitmann, 2019)

Core domains of sustainability assessment

When evaluating grant making bodies digital health program sustainability, funders are moving beyond simple metrics of adoption and clinical outcomes. They are looking for a holistic picture of a program's resilience and its potential for long-term integration into the existing health ecosystem. This assessment is often structured around several key domains, drawing from established frameworks like the Program Sustainability Assessment Tool (PSAT) developed by researchers at Washington University in St. Louis. These domains provide a common language and a structured approach for both program implementers and funders to plan and evaluate for the future.

The core domains include financial stability, organizational capacity, partnerships, and community engagement. A program that can demonstrate strength across these areas is one that is seen as not just a project, but a permanent addition to the healthcare infrastructure. This involves planning for financial independence from day one, building the skills and leadership within the implementing organization, building strong alliances with government and other local partners, and ensuring the program is valued and owned by the community it serves.

Assessment Framework	Key Focus Areas	Primary Use Case
Program Sustainability Assessment Tool (PSAT)	Environmental Support, Funding Stability, Partnerships, Organizational Capacity, Program Evaluation, Program Adaptation, Communications, Strategic Planning	Public health programs seeking to self-assess and improve long-term sustainability.
ORCHA Baseline Review (OBR)	Data Privacy, Clinical Assurance, User Experience, Technical Stability, Health ROI	Digital health app developers and national health bodies assessing app quality and safety.
WHO Digital Health Atlas	Maturity of technology, interoperability, country infrastructure, policy and governance	Governments and large NGOs planning and coordinating national digital health strategies.

Key criteria for sustainability

Drilling down into the broader domains, grant-making bodies assess a number of specific, evidence-based criteria. These are not a simple checklist, but a series of interconnected indicators that together paint a picture of a program's long-term prospects.

• Financial Viability: This goes beyond a simple budget. It includes diversified funding streams, cost-effectiveness analyses, and a clear path to reduced reliance on grant funding. Is there a business model, whether through public sector budgets, insurance reimbursement, or other mechanisms, that can support the program long-term?
• Technical Robustness: The technology itself must be sustainable. This means it should be affordable to maintain, adaptable to changing needs, and interoperable with existing health information systems. A reliance on proprietary, expensive, or highly specialized technology can be a significant red flag for funders.
• Local Ownership and Capacity: For a program to last, it must be owned and run by local stakeholders. Grant proposals that demonstrate a clear plan for transferring knowledge, skills, and leadership to local partners are viewed much more favorably. This includes training community health workers, health ministry officials, and local managers.
• Political and Environmental Support: A program's success is deeply intertwined with its context. Funders look for evidence of support from key stakeholders, including government bodies, community leaders, and other influential organizations. The program must align with national health priorities and be integrated into existing strategic plans.

Industry Applications

Community health worker programs

For digital health interventions that support community health workers (CHWs), sustainability assessment places a heavy emphasis on user-centric design and workflow integration. Grant-making bodies want to see that the technology is not just a data collection tool, but a genuine asset that makes the CHW's job easier and more effective. Evidence of co-design with CHWs, strong training and support systems, and clear value for the individual health worker are critical. The long-term cost of devices, data plans, and technical support must also be factored into the sustainability plan.

Health system integration

Another key application is the integration of digital tools into national health systems. A standalone digital health project, no matter how innovative, is unlikely to be sustainable. Funders are looking for programs that strengthen, rather than bypass, existing public health infrastructure. This means aligning with Ministry of Health standards, ensuring data flows into national health information systems, and demonstrating how the program will support government health goals over the long term.

Current research and evidence

The shift towards sustainability is supported by a growing body of research. Studies by practitioners like Dr. Luke Messac and researchers at institutions such as the Johns Hopkins Bloomberg School of Public Health have highlighted the challenges of "pilotitis" and the importance of planning for scale from the outset. For example, a 2021 study in The Lancet Digital Health by a team from the University of Cape Town analyzed the factors that led to the successful scale-up of a mobile health program in South Africa, emphasizing the role of early engagement with government stakeholders (Le Roux et al., 2021). The Program Sustainability Assessment Tool (PSAT) itself is the product of extensive research, validated across hundreds of public health programs to identify the key drivers of long-term success (Luke et al., 2014).

The future of digital health sustainability

Looking ahead, the assessment of digital health program sustainability is likely to become even more sophisticated. We can expect to see a greater emphasis on health equity, ensuring that digital tools do not exacerbate existing disparities. There will also be a growing focus on the environmental sustainability of digital health, considering the entire lifecycle of devices and the energy consumption of data centers. As data becomes ever more central to healthcare, funders will also apply greater scrutiny to data governance, privacy, and security, viewing these not just as technical issues, but as fundamental components of a trustworthy and sustainable program.

Frequently asked questions

What is the most common reason digital health programs fail to be sustained? The most common reason is a lack of long-term financial planning. Many programs are designed around a short-term grant and do not have a clear strategy for securing funding once the initial grant ends.

How can a program demonstrate local ownership to a grant-making body? By providing letters of support from local partners, demonstrating co-design with community members and local staff, and presenting a clear plan for transitioning leadership and management to local teams over time.

Is it better to use open-source or proprietary technology for a sustainable program? Both can be sustainable, but the key is to justify the choice. Open-source software can offer greater flexibility and lower costs, but may require more technical capacity to maintain. Proprietary software may offer better support and usability, but can lead to vendor lock-in and higher long-term costs. The best choice depends on the specific context and the program's long-term plan.

As the field of digital health matures, the conversation is rightly shifting from short-term pilots to long-term impact. The ability to demonstrate a clear and credible path to sustainability is now the key that unlocks funding and paves the way for lasting change. Circadify is actively engaged in this space, working with partners to design and deploy digital health solutions that are built to last. To learn more about our research and collaborations in building sustainable health programs, visit our research blog at circadify.com/blog.