Transitioning from External Aid and Ensuring Sustainability of UHC


UHC2030 (formerly the International Health Partnership, IHP+), co-hosted by the World Health Organization (WHO) and the World Bank, has established a working group (WG) on sustainability, transition from aid and health systems strengthening. The objective of the WG is to explore roles, responsibilities and opportunities for collaboration among countries, development partners, and expert networks to enhance efforts to sustain increased effective coverage of priority health interventions with financial protection in countries transitioning from aid. ThinkWell supports the UHC2030 WG in the development of (i) a glossary of key terms related to transition to support consensus building and collective understanding; (ii) a country consultation paper, which will be based on feedback from countries and will classify common health system pressure points related to transition as seen by countries; and (iii) a mapping exercise on the global landscape on country transition. The three analytical products were presented at a meeting of the WG in November 2017 in conjunction with the WHO Health Financing Symposium in Montreux, Switzerland.


Countries transitioning 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.


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). Discussions focused on health system challenges and opportunities due to transition, policy responses, process coordination, and lessons learned.


The themes that emerged from the country consultations will guide the WG’s future work to support countries in transition. The priorities to address include: maintaining coverage for vulnerable population groups following transition; ensuring that public health programs are protected and sustained; effectively mobilizing domestic resources for the health sector; engaging private sector actors to advance UHC progress through aligned incentives; capacity building to help countries through transition; and fostering mutual accountability for both countries’ and donors’ responsibilities for joint transition planning.


key informant interviews conducted in 7 countries

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