Transitioning financial responsibility for health programs from external donors to developing countries: Key issues and recommendations for policy and research

www.jogh.org • doi: 10.7189/jogh.08.010301 1 June 2018 • Vol. 8 No. 1 • 010301 In this paper we explain why the transition of financing responsibility for health programs from external donors to domestic governments is picking up momentum; highlight the main challenges that countries and donors face in achieving smooth transitions that preserve health gains; point to the key strategies and tools that should be used in assessing, preparing, designing, and monitoring financial transitions; and finish by outlining a recommended agenda for priority research in this area. We argue that the drivers of transition include health program maturity, economic growth in aid-receiving countries, and slowing growth in levels of international donor assistance for health. We identify several factors that make successful transition especially challenging, such as establishing expectations among all key parties about levels of funding that are reasonable and fair, aligning local and international priorities, mobilizing adequate and sustained domestic funding, and improving efficiency of service delivery. We discuss several important tools available to address these challenges and improve the planning and implementation of financial transition, including robust resource tracking, policy modeling and financial forecasting, and analysis of the sustainability of increased domestic financial commitments. We conclude by highlighting key recommended areas for additional research and stakeholder engagement and avenues to pursue in these areas.