How donors are approaching transition from aid

Many middle-income countries (MICs) are transitioning away from health aid and towards full county ownership of their health programs. Both aid donors and MICs must take steps to ensure that these programs are sustained and do not face disruptions when donors exit. However, many global health donors have only recently begun to consider formalized exit strategies and plans. Even when this planning has happened, there is little publicly available information on the governance of transitions.

In an effort to improve public knowledge on transitions from health aid and to lay the groundwork for further research, we recently analyzed how major global health funders approach country transitions. Based on our analysis, we are publishing a series on how seven global health funders are approaching health aid transition: the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), Gavi, the Vaccine Alliance (Gavi), the United States government (the US President’s Emergency Plan for AIDS Relief and the US Agency for International Development), the United Kingdom government, and the Japanese government. These funders cumulatively made up 76% of all official development assistance for health in 2017, according to the Organization for Economic Cooperation and Development Creditor Reporting System Database.

Methods: To understand how these donors consider transitions from health aid, we conducted a desk-based review, including donor websites, strategy documents, grey literature reports, and academic literature. To ensure our research reflected up to date approaches and thinking, we triangulated our findings from the desk review with findings from a series of key informant interviews with senior experts at these donor agencies. This project was screened for exemption by the Duke University Institutional Review Board as part of the study ‘Driving health progress during disease, demographic, domestic finance and donor transitions (the“4Ds”): policy analysis and engagement with transitioning countries’.

Shashika Bandara, Center for Policy Impact in Global Health
Ipchita Bharali, Center for Policy Impact in Global Health
Siddharth Dixit, Center for Policy Impact in Global Health
Hanna Huffstetler, Center for Policy Impact in Global Health
Wenhui Mao, Center for Policy Impact in Global Health
Kaci Kennedy McDade, Center for Policy Impact in Global Health
Osondu Ogbuoji, Center for Policy Impact in Global Health
Marco Schäferhoff, Open Consultants
Gavin Yamey, Center for Policy Impact in Global Health

Health aid in transition: a review of the Global Fund to Fight AIDS, Tuberculosis, and Malaria
Authors: Marco Schäferhoff, Kaci Kennedy McDade, and Gavin Yamey

How do major health donors prepare for country exits?
Authors: Kaci Kennedy McDade, Osondu Ogbuoji, Marco Schäferhoff, and Gavin Yamey

This focus area is part of a larger project, Driving health progress during disease, demographic, domestic finance, and donor transitions (the “4Ds”)​, that is funded by the Bill & Melinda Gates Foundation.

Questions? Please contact Kaci Kennedy McDade.

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