Institutionalization of Projects Into Districts in Low- and Middle-Income Countries Needs Stewardship, Autonomy, and Resources

Key Messages There are too many projects in developing countries; ill health continues because most projects fail to be institutionalized. Although a district-led integrated community case management project in Uganda had donor support, sufficient implementation led by a nongovernmental organization, and adequate human resources, it had no national or district budget for commodities and lacked supervision and monitoring. All these are characteristics of a failed design for institutionalization. Institutionalization requires optimal design with stewardship, autonomy, capacity, affordability, minimal complexity, and a system for accountability.