Transitioning Away from Donor Funding for Health: A Cross Cutting Examination of Donor Approaches to Transition

Many donors are reconsidering their approach to providing health aid to countries that are viewed as becoming increasingly capable of self-financing their own development. To better understand this phenomenon, we analyzed the transition approaches adopted by six key global health donors, three multilateral and three bilateral, who provided nearly 75% of all disbursed official development assistance for health in 2016. We conducted a desk-based review and triangulated our findings with semi-structured key informant interviews. We found: 1) there is no consensus on the terminology used to describe the transition process; 2) donors vary in terms of the formality of their policies, the indicators used to allocate resources and/or trigger transition, and the timeline/duration of transition; 3) some donors view the unit of transition at the sector or program level rather than the country level; and 4) donors provide varying degrees of support before, during, and after transition. Our findings suggest that more explicit transition approaches and greater definitional clarity are needed. Donors should avoid a “one size fits all” approach—a lack of flexibility puts countries at risk. Evidence should be generated and shared on which transition modalities work best and under which circumstances. Donors should communicate with each other and avoid transitioning at the same time. As more low-income countries transition to middle-income status, transitions away from donor support for health will become an increasingly important phenomenon to understand.