Transitions from donor to domestic financing are on the forefront of many government and donor agendas as countries with rising income levels increasingly become ineligible for donor financing in health. To ensure the long-term sustainability of donor-funded programs—and associated gains in health outcomes—national governments and other in-country stakeholders are expected to shoulder larger financial burdens as well as greater programmatic responsibilities. This requires certain fiscal, managerial, and governing capacities, as well as close coordination between relevant actors such as government ministries and civil society organizations.
The Global Fund—the largest contributor to the international HIV/AIDS, Tuberculosis and Malaria responses—is winding down funding in a number of middle-income countries following the parameters of its objective criteria to determine ineligibility.
The Global Fund has tasked Aceso Global to develop a guidance tool to help countries through the transition process and provide technical assistance where needed. The guidance tool builds on existing tools by other international organizations, such as PEPFAR and Curatio. It also adds to ongoing efforts by including in-depth analysis on fiscal space and health financing issues as well as a social contracting module, developed by APMG Health. The guidance tool ensures a collaborative approach that emphasizes key stakeholder engagement, including government agents across relevant ministries, civil society organizations, and other international and local donors.
The guidance tool was piloted and refined in select Latin American countries undergoing transitions in one or more Global Fund-funded diseases. Aceso Global produced country-specific reports to disseminate the findings and provide governments with recommendations for moving forward with transitions in a sustainable way.