A National Society is implementing a CBHFA program. What is the *primary* indicator of program sustainability?

The primary indicator of program sustainability for a National Society implementing a CBHFA (Community-Based Health Financing and Assessment) program is demonstrated local ownership and financial self-sufficiency. Let's break down what this means. Sustainability, in this context, refers to the program's ability to continue operating effectively and achieving its goals long after initial external funding (like from the CBHFA) ends.

CBHFA is a health financing model where communities pool resources – often through small contributions from households – to fund essential health services. A National Society, like the Red Cross or Red Crescent, might implement a CBHFA program to improve access to healthcare in a specific area. The assessment component (the 'A' in CBHFA) involves regularly evaluating the health needs and resources of the community to ensure the program remains relevant and effective.

While factors like strong leadership, community participation, and effective service delivery are important, they are *enablers* of sustainability, not the primary indicator itself. Local ownership signifies that the community actively participates in decision-making, program management, and monitoring. This goes beyond simply receiving services; it means community members feel a sense of responsibility for the program's success and are invested in its long-term viability. For example, a community might form a health committee to oversee the CBHFA fund and ensure it's used appropriately, demonstrating ownership.

Financial self-sufficiency is equally crucial. It means the community generates enough revenue through contributions and potentially other local sources (like small businesses or local government support) to cover the program's operational costs without relying on ongoing external funding. This doesn't necessarily mean complete independence from all external support, but it signifies a significant reduction in reliance. If a CBHFA program consistently relies on external funding to cover even basic expenses, it is unlikely to be sustainable. A successful example would be a community that, after an initial CBHFA grant, is able to cover 80% or more of its health service costs through community contributions and local fundraising efforts. The combination of these two elements – demonstrated local ownership and financial self-sufficiency – provides the strongest evidence that the CBHFA program will continue to function and benefit the community in the long term.