Managing transitions from external assistance: cross-national learning about sustaining effective coverage.

Area of Science:

• Global Health
• Health Systems Strengthening
• International Development

Background:

• Low- and middle-income countries often rely on external assistance for health financing.
• Donor transitions, where external funding ceases, pose challenges to sustained health service coverage.
• Understanding factors enabling continued service delivery post-donor support is crucial for health policy.

Purpose of the Study:

• To analyze the processes and outcomes of donor transitions in health financing.
• To identify factors associated with sustained coverage of previously donor-supported health interventions.
• To provide evidence for structuring external assistance to ensure long-term health service sustainability.

Main Methods:

• Comparative analysis of donor transitions in four countries: China, Georgia, Sri Lanka, and Uganda.
• Identification of 16 factors across policy actors, process, initiative content, and political-economic context.
• Qualitative assessment of integration strategies within national health systems.

Main Results:

• Favorable economic and political environments facilitate domestic prioritization of health interventions.
• Clear and transparent transition processes are linked to smoother transitions.
• Effective integration of donor-supported initiatives into governance, financing, and service delivery is critical for sustainability.
• Specific factors identified include long-term structural reform, co-financing policies, salary scale alignment, and community engagement.

Conclusions:

• Donor transitions necessitate strategic planning to ensure sustained health service coverage.
• Integrating donor-funded initiatives into domestic health systems is paramount for long-term success.
• Both donors and national policymakers must collaborate to optimize external assistance for enduring health system strengthening.