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
Click here to see how countries are responding to COVID-19. Our Center has developed policy reports on Ghana, Kenya, Myanmar, Nigeria, and Sri Lanka (coming soon). Each country report details policy initiatives and recommendations for policymakers. How countries respond to COVID-19 will have a tremendous impact on their country’s health and economic well-being for decades to come.
Blog: Mao W, McDade KK, Hille H, Zapeda M. Do transition readiness assessment tools inform donor transitions in health care? Brookings Future Development Blog. April 30 2021. Available at: https://www.brookings.edu/blog/future-development/2021/04/30/do-transition-readiness-assessment-tools-inform-donor-transitions-in-health-care/
Blog: McDade KK, Ogbuoji O, Yamey G. What We Talk About When We Talk About Transitioning From Global Health Aid. Health Affairs Global Health Policy Blog. Weblog. 2021. Available at: https://www.healthaffairs.org/do/10.1377/hblog20210303.137565/full/
Working paper: McDade KK, Kleidermacher P, Mao W, Yamey G. Estimating Chinese bilateral aid for health: an analysis of AidData’s Global Chinese Official Finance Dataset. The Center for Policy Impact in Global Health. Duke Global Working Paper Series: number 38, March 2021. Available at: https://centerforpolicyimpact.org/estimating-chinese-bilateral-aid-for-health-an-analysis-of-aiddatas-global-chinese-official-finance-dataset/
Working paper: McDade KK, Munge K, Kokwaro G, Ogbuoji O. Development finance in transition: Donor dependency and concentration in Kenya’s health sector. The Center for Policy Impact in Global Health. Duke Global Working Paper Series: number 29, February 2021. Available at: https://centerforpolicyimpact.org/our-work/transition-donor-dependency-kenyas-health/
Working paper: Kenney C, McDade KK, Mao W, Ogbuoji O, Yamey G. Making the final decade of the Sustainable Development Goals count: an analysis of donors’ subnational approaches to reaching the poorest people. The Center for Policy Impact in Global Health. Duke Global Working Paper Series: number 28, January 2021. Available at: https://centerforpolicyimpact.org/our-work/aid-targeting-approaches-to-reach-the-poorest/
Working paper: Mao W, McDade KK, Zepeda M, Zhang X, Bharali I, Ogbuoji O, Yamey G. Transitioning from health aid: a scoping review of transition readiness assessment tools. The Center for Policy Impact in Global Health. Duke Global Working Paper Series: number 27, January 2021. Available at: https://centerforpolicyimpact.org/our-work/transitioning-from-health-aid-scoping-review-of-transition-readiness-assessment-tools/
Dialogue report: McDade KK, Ogbuoji O, Yamey G. How will COVID-19 affect the future of global health aid? The Center for Policy Impact in Global Health. Dialogue report: January 2021. Available at: https://centerforpolicyimpact.org/our-work/covid-19-and-the-future-of-global-health-aid/
Working paper: McDade KK, Schäferhoff M, Ogbuoji O, Bharali I, Dixit S, Mao W, Bandara S, Yamey G. Transitioning away from donor funding for health: a cross-cutting examination of donor approaches to transition. The Center for Policy Impact in Global Health. Duke Global Working Paper Series: number 21, April 2020. Available at: http://centerforpolicyimpact.org/transitioning-away-from-donor-funding-for-health-cross-cutting/.
Review: McDade KK, Bandara S, Schäferhoff M, Yamey G. Health aid in transition: a review of the United Kingdom’s approach to transition. The Center for Policy Impact in Global Health. Review number: 7, 2020. Available at: http://centerforpolicyimpact.org/our-work/the-4ds/donor-profiles-health-aid-in-transition/uk-approach-to-health-aid-transition/
Review: Dixit S, McDade KK, Schäferhoff M, Yamey G. Health aid in transition: a review of the World Bank International Development Association (IDA). The Center for Policy Impact in Global Health. Review number: 6, 2019. Available from: https://centerforpolicyimpact.org/wp-content/uploads/sites/18/2019/09/PEPFAR-AID-Transition-Profile.pdf.
Review: Mao W, McDade KK, Schäferhoff M, Yamey G. Health aid in transition: a review of Japan’s approach to transition. The Center for Policy Impact in Global Health. Review number: 5, 2019. Available from: https://centerforpolicyimpact.org/wp-content/uploads/sites/18/2019/11/JAPAN-Transition-Profile-Final.pdf.
Blog: McDade KK, Yamey G. Donor approaches to health aid transitions: Gavi and PEPFAR. The Center for Policy Impact in Global Health. Weblog. 2019. Available from: http://centerforpolicyimpact.org/2019/09/23/donor-approaches-to-health-aid-transitions-gavi-and-pepfar/.
Review: McDade KK, Schäferhoff M, Yamey G. Health aid in transition: a review of the United States Agency for International Development (USAID). The Center for Policy Impact in Global Health. Review number: 4, 2019. Available from: https://centerforpolicyimpact.org/wp-content/uploads/sites/18/2019/10/USAID-AID-Transition-Profile-Final.pdf.
Review: Bharali I, McDade KK, Schäferhoff M, Yamey G. Health aid in transition: a review of Gavi, the Vaccine Alliance. The Center for Policy Impact in Global Health. Review number: 3, 2019. Available from: https://centerforpolicyimpact.org/wp-content/uploads/sites/18/2019/09/Gavi-AID-Transition-Profile.pdf.
Review: McDade KK, Ogbuoji O, Schäferhoff M, Yamey G. Health aid in transition: a review of The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The Center for Policy Impact in Global Health. Review number: 2, 2019. Available from: https://centerforpolicyimpact.org/wp-content/uploads/sites/18/2019/09/PEPFAR-AID-Transition-Profile.pdf.
Review: Schäferhoff M, McDade KK, Ogbuoji O, Yamey G. Health aid in transition: a review of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. The Center for Policy Impact in Global Health. Review number: 1, 2019. Available from: https://centerforpolicyimpact.org/wp-content/uploads/sites/18/2019/06/Global-Fund-Profile.pdf.
Blog: McDade KK, Ogbuoji O, Schäferhoff M, Yamey G. How do major health donors prepare for country exits? The Center for Policy Impact in Global Health. Weblog. 2019. Available from: http://centerforpolicyimpact.org/2019/06/28/how-do-major-health-donors-prepare-for-country-exits/.
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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