Summary

ThinkWell supported the UHC2030 Technical Working Group on Sustainability, Transition from Aid and Health Systems, co-hosted by the World Health Organization (WHO) and the World Bank. The working group’s objective was to explore roles, responsibilities, and opportunities for collaboration among countries, development partners, and expert networks to enhance efforts to sustain and increase effective coverage of priority health interventions with financial protection in countries transitioning from aid. ThinkWell developed for the working group (i) a glossary of key terms related to transition to support consensus building and collective understanding; (ii) a country consultation paper, which was based on feedback from countries and classified common health system pressure points related to transition as seen by countries; and (iii) a mapping exercise on the global landscape on country transition. Throughout the process, ThinkWell’s health financing researchers conducted key informant interviews with stakeholders in seven different countries (Kyrgyzstan, Myanmar, Nepal, Panama, Papua New Guinea, Sri Lanka, and Zambia). The interviews focused on health system challenges and opportunities due to transition, policy responses, process coordination, and lessons learned. The three analytical products were presented at a working group meeting in conjunction with the WHO Health Financing Symposium in Montreux, Switzerland.

Challenges

Countries that transition from external aid face numerous challenges. The most predominant of these challenges is the lack of domestic funds to cover donor-funded programs. In most cases, this implies that vulnerable populations stand to lose coverage. Furthermore, vertically financed programs are under risk as donors phase out, which can reduce coverage of priority interventions.

Approach

ThinkWell used a team of health financing researchers to conduct key informant interviews with different stakeholders at the country level in seven different countries (Kyrgyzstan, Myanmar, Nepal, Panama, Papua New Guinea, Sri Lanka, and Zambia). Our discussions focused on health system challenges and opportunities due to transition, policy responses, process coordination, and lessons learned.

Results

The themes that emerged from the country consultations guided the working group’s work to support countries in transition. We specifically contributed to efforts to:

• Maintain coverage for vulnerable population groups following transition
• Ensure that public health programs are protected and sustained
• Effectively mobilize domestic resources for the health sector
• Engage private sector actors to advance UHC progress through aligned incentives
• Capacity building to help countries through transition
• Foster mutual accountability for both countries’ and donors’ responsibilities for joint transition planning