Enhancing the sustainability of donor-funded healthcare projects in pastoralist communities: a case of Samburu County

Abstract

This study explored the factors that enhance the sustainability of donor-funded healthcare projects in Samburu County, with a focus on four key dimensions: community engagement, financial budgeting, donor policies, and physical healthcare infrastructure. The specific objectives were to examine how each of these factors contributes to the long-term viability of healthcare projects in a pastoralist context. A qualitative research approach was employed, utilizing in-depth interviews and document analysis. The target population included project coordinators and ward administrators working within donor-funded health programs in Samburu County. Findings revealed that financial budgeting plays a critical role in sustainability. A diversified funding model, encompassing grants, sponsorships, community contributions, and income-generating initiatives, was found to reduce reliance on single donor streams and increase project resilience. Donor policies were also shown to significantly influence sustainability. While formal agreements help promote accountability, they often introduce rigid frameworks that limit flexibility. Projects embedded within local systems from inception, supported by structured exit strategies and active partnerships with community actors, were more likely to sustain impact. Community engagement emerged as a pivotal enabler of sustainability. Initiatives that involved local leaders, respected elders, and community health volunteers fostered stronger ownership and continuity. Physical healthcare infrastructure also had a profound influence, especially in remote pastoralist areas. However, infrastructure was only sustainable when accompanied by operational plans, maintenance support, and reliable emergency referral systems. Despite its insights, the study was limited by its reliance on qualitative methods and purposive sampling, which may restrict the generalizability of findings beyond Samburu or similar pastoralist contexts. Additionally, social desirability bias may have affected responses, particularly concerning donor relationships and program challenges.