Integration, Transition and Sustainability Planning

The Challenge

As countries strive toward universal health coverage, they must meet mounting demands on their health systems by both mobilizing additional resources and using them as efficiently as possible.

Governments navigate continual changes in the health financing landscape, driven by economic growth, shifting political priorities at home and abroad, and citizens’ mounting expectations. Growth can increase resources available to pay for services, while policies and public tax and financial management systems determine how efficiently and equitably funds are pooled and spent.

Governments must also confront declines in external funding, which stem from rising incomes, improving coverage, and shifting donor priorities. Though few health systems rely predominantly on external resources, specific populations and programs are vulnerable to receding donor funds and may need to be integrated into the mainstream health system.

Those delivering services must also navigate the changing landscape. Siloed health programs have fostered specialized providers who often depend on revenue from donors and patients. As governments seek to more holistically purchase services, providers are exploring ways to access publicly pooled funds by diversifying offerings, forming provider networks, and investing in systems to monitor and improve quality.


The Opportunity

R4D supports change agents in government and provider organizations to prepare for and thrive through health financing transitions. We build local capacity for transitions-related analysis, foster dialogue, and undertake formative research on international experiences with macro-economic and program-specific transitions. Our efforts include:

  • Partnering with governments and providers to identify opportunities and vulnerabilities in their health financing landscape;
  • Promoting dialogue within and among ministries of health, finance, and planning, national disease control programs, and development partners;
  • Facilitating collaborative learning across countries facing common transition challenges; and
  • Conducting formative research on international experiences with integration, transition, and sustainability planning.

Our Work

R4D’s projects on integration, transition, and sustainability planning include country-level analytical and process support, multi-country collaborative learning facilitation, and research to inform and influence the global discourse. Details on specific projects can be found below:

R4D also holds two framework contracts with the Global Fund to Fight AIDS, Tuberculosis, and Malaria for work on integration, transition and sustainability planning for the three diseases, including technical and analytical support on:

  • Health financing;
  • Public financial management;
  • Contracting with non-state providers; and
  • Costing, cost-effectiveness and efficiency analysis to support efficient resource allocation and service delivery.

Global & Regional Initiatives

R4D is a globally recognized leader for designing initiatives that connect implementers, experts and funders across countries to build knowledge and get that knowledge into practice.