In a commentary published on the Health Affairs Blog on December 14, and based on a more detailed technical report (available at http://centerforpolicyimpact.org/donor-transitions-hiv/), Pharos staff and colleagues from Duke University point to the serious risks of declining donor aid in many middle-income countries for the sustained success of HIV programs, especially for stigmatized key populations including men who have sex with men, sex workers, transgender people, and those who inject drugs.

Over $500 billion has been spent on HIV programs in low- and middle-income countries over the past two decades, and major gains have been achieved in lowering new infections, illnesses and deaths, and mitigating other negative impacts of AIDS on society. However, when donor funding ends and countries transition to domestically-funded responses, they often struggle to maintain these programs, particularly for key populations.

Drawing on a series of country examples, we highlight lessons learned and make recommendations that can help countries to mitigate future transition risks and improve the impact of their HIV investments, thereby protecting the health of their populations and safeguarding the gains they have achieved to date in their fight against AIDS.

In this Viewpoint in the Journal of Global Health, Prof Stephen Resch of the Harvard TH Chan School of Public Health and Prof Robert Hecht of Pharos Global Health Advisors and the Yale School of Public Health provide their thoughts and suggestions on ways to improve the data, analysis, and policy advice surrounding financial transitions in global health.

Resch and Hecht stress that, worryingly, the processes and tools we have today for managing transitions are seriously incomplete and fragmented, and only weakly coordinated across donor agencies and within countries.

They highlight the main underlying trends driving transitions away from donor support for health; point to the largest risks and challenges connected with these transitions; underscore which analytical tools and policy processes need to be further strengthened at global and country levels in order to achieve more successful donor transitions in health. The Viewpoint concludes with a series of recommendations that the authors argue should be adopted by researchers, donor agency officials, and country leaders responsible for managing financial transitions.

As dozens of middle-income countries transition away from donor health aid, development institutions need to do more to assist them and better protect hard-won health gains. In this PLoS blog, Robert Hecht and Rachel Wilkinson highlight recent efforts by the Global Fund to improve country transitions, using targeted technical assistance to assess risks, design country plans, and stimulate domestic financing. This kind of technical support is key to future health aid to middle-income countries – more donors should follow the Global Fund’s lead in this area.

This Health Affairs blog on country transitions in global health, co-authored by Pharos President Robert Hecht and Professor Sara Bennett of Johns Hopkins Bloomberg School of Public Health, highlights the importance of the transition of middle-income countries away from donor assistance in the health sector and major challenges these transitioning countries face, and recommends an analytical agenda to support stronger and more sustained transitions.