Transitioning from donor assistance for health: in-country perspectives, experiences, and preferences in Ghana and Sri Lanka

As more countries graduate from low-income to middle-income status, they face imminent loss of international aid or concessions typically enjoyed by low-income countries. It is estimated that within the next five years, around two dozen countries are likely to face simultaneous donor transitions in which they lose funding from more than one major donor at the same time. In the health sector, loss of donor support from organizations such as Gavi, the Vaccine Alliance, the World Bank, and bilateral donors could potentially have negative impacts on population health and well-being. Yet discussions about country transitions from donor assistance for health have largely occurred at a supranational level with little input from in-country stakeholders themselves—very little is known about these stakeholders’ concerns, challenges, and opportunities.

Even less is known about the decision-making processes that underlie a country’s preparation for, or response to, donor transitions. To fill these research gaps, we are conducting a mixed-methods study in two lower-middle-income countries, Ghana and Sri Lanka. In this research we are partnering with the University of Ghana and the Institute of Health Policy, Sri Lanka.

The study aims to:

  1. Explore the perspectives and experiences of in-country stakeholders with donor transition
  2. Documents these stakeholders’ responses and adjustments to the losses arising from transition (including loss of external financing and technical assistance)
  3. Understand the “why” behind the chosen response strategies adopted.

Ipchita Bharali, Center for Policy Impact in Global Health
Hanna Huffstetler, 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
Gavin Yamey, Center for Policy Impact in Global Health

Justice Nonvignon, School of Public Health, University of Ghana
Erik Wibbles, Duke Department of Political Sciences
Sarah Blodgett Bermeo, Duke Sanford School of Public Policy
Joseph O. Dodoo, Ministry of Health, Ghana
Dr. Ravi P. Rannan-Eliya, Institute for Health Policy, Sri Lanka

Bharali I, Mao W, Huffstetler H, Hoole A, Perera P, Ogbuoji O.  Perspectives on transitions away from donor assistance for health: a discrete choices experiment in Sri Lanka. The Lancet Global Health. 2020; 8(S25). Available at:

This project is funded by the Duke Global Health Institute.

Questions? Please contact Wenhui Mao.

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