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Shroff ZC, Sparkes SP, Paina L, Skarphedinsdottir M, Gotsadze G, Zakumumpa H, Tang K, Perera PN, Yuan M, Hanson K. Managing transitions from external assistance: cross-national learning about sustaining effective coverage. Health Policy Plan 2024; 39:i50-i64. [PMID: 38253447 DOI: 10.1093/heapol/czad101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/29/2023] [Indexed: 01/24/2024] Open
Abstract
The often-prominent role of external assistance in health financing in low- and middle-income countries raises the question of how such resources can enable the sustained or even expanded coverage of key health services and initiatives even after donor funding is no longer available. In response to this question, this paper analyses the process and outcomes of donor transitions in health-where countries or regions within countries are no longer eligible to receive grants or concessional loans from external sources based on eligibility criteria or change in donor policy. The comparative analysis of multiple donor transitions in four countries-China, Georgia, Sri Lanka and Uganda-identifies 16 factors related to policy actors, policy process, the content of donor-funded initiatives and the broader political-economic context that were associated with sustained coverage of previously donor supported interventions. From a contextual standpoint, these factors relate to favourable economic and political environments for domestic systems to prioritize coverage for donor-supported interventions. Clear and transparent transition processes also enabled a smoother transition. How the donor-supported initiatives and services were organized within the context of the overall health system was found to be critically important, both before and during the transition process. This includes a targeted approach to integrate, strengthen and align key elements of the governance, financing, input management and service delivery arrangements with domestic systems. The findings of this analysis have important implications for how both donors and country policy makers can better structure external assistance that enables sustained coverage regardless of the source of funding. In particular, donors can better support sustained coverage through supporting long-term structural and institutional reform, clear co-financing policies, ensuring alignment with local salary scales and engaging with communities to ensure a continued focus on equitable access post-transition.
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Affiliation(s)
| | - Susan P Sparkes
- World Health Organization, Department of Health Financing and Economics, World Health Organization, Avenue Appia 20, Geneva 1211, Switzerland
- World Health Organization, Alliance for Health Policy and Systems Research, Avenue Appia 20, Geneva 1211, Switzerland
| | - Ligia Paina
- Department of International Health, Johns Hopkins University School of Public Health, Baltimore 21205, USA
| | | | - George Gotsadze
- Curatio International Foundation, Georgia and Ilia State University, 0179 Kavsadze str. 3, Office 5, Tbilisi, Georgia
| | - Henry Zakumumpa
- Department of Health Policy, Planning and Management, Makerere University, School of Public Health, 7062 University Rd, Kampala, Uganda
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, 30 Shuangqing Rd, Haidian District, Beijing 100190, China
| | - Prasadini N Perera
- Institute for Health Policy, 72, Park Street, Colombo 2, Sri Lanka
- University of Peradeniya, Galaha Rd 20400, Peradeniya, Sri Lanka
| | - MyMai Yuan
- World Health Organization, Department of Health Financing and Economics, World Health Organization, Avenue Appia 20, Geneva 1211, Switzerland
| | - Kara Hanson
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
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Shroff ZC, Sparkes S, Skarphedinsdottir M, Hanson K. Rethinking External Assistance for Health. Health Policy Plan 2022; 37:932-934. [PMID: 35362537 PMCID: PMC9347018 DOI: 10.1093/heapol/czac030] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Zubin Cyrus Shroff
- Alliance for Health Policy and Systems Research, World Health Organization, Avenue Appia, 20 Geneva Switzerland
| | - Susan Sparkes
- WHO Health Financing Policy Unit, World Health Organization, Avenue Appia, 20 Geneva Switzerland
| | | | - Kara Hanson
- London School of Hygiene and Tropical Medicine Keppel St, London WC1E 7HT, United Kingdom
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Skarphedinsdottir M, Smith B, Ferrario A, Zues O, Ciobanu A, Tirdeau M, Domente S, Habicht J, Jakab M. A health system approach to improve NCD outcomes and reduce inequalities in the Republic of Moldova. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku161.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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