In a few instances, the donor-funded model clearly limited sustainability, with interruptions in international funding leading to some services being discontinued.
Traditional approaches to capacity building, such as offsite training workshops, are costly, interrupt service delivery, are not conducive to the sharing of newly acquired skills and knowledge between colleagues, and, therefore, have limited sustainability [ 7- 9].
The two common concerns identified about the IDI model of educational/training delivery were (a) the fact that health workers move to IDI for the training which creates a gap in service delivery within the already under-staffed health facilities and (b) the high cost of residential training programs that limits sustainability.
We recall a successful example in a resource-poor setting like South Africa, where nurse clinicians are the main providers of primary care and where in-service continuing professional development had largely been provided off site, interrupting clinical services and limiting sustainability and coverage.
But there are also concepts, which limit the sustainability of this success and can, consequently, lead to failure.
Soil health constraints beyond nutrient deficiencies and excesses currently limit agroecosystem sustainability, resilience to drought and extreme rainfall, and progress in soil and water conservation.
Likewise, although training is seen as a good motivating instrument, high staff turnover may limit the sustainability of staff training.
Crop monocultures provide poor bee diets, and shifts in agricultural and land-use practices limit the sustainability of bee populations worldwide.
Racism, poverty and other factors push issues of men's violence against women to the margins, make it harder for men to become and remain involved, limit the sustainability of programmes and unsettle strategies focused on asking disadvantaged men to critically evaluate their power and privilege.
