Given the anticipated decline in development assistance for health, countries benefiting from donor investments must prepare for the eventual scale-down and transition of external funds and technical support. Although few health systems rely predominantly on external financing, donors often play a disproportionate role in funding services for specific diseases and populations. Transitioning these programs while sustaining effective coverage of the essential services they deliver will require governments to effectively plan, implement, and monitor activities as part of their routine budget and public financial management (PFM) processes.
Sustainability and transition planning helps countries to understand how donor-supported programs currently operate and what steps may be required to integrate them more seamlessly into the mainstream health system. Upstream analysis and dialogue gives countries have more time to strengthen domestic systems and processes prior to graduating from eligibility for Global Fund support. These efforts can unearth opportunities and challenges that require attention across sectors (e.g., overly rigid PFM rules), across the health sector (e.g., weak procurement systems), and within individual disease responses (e.g., underinvestment in epidemiologically important populations and geographies).
In 2016–17, R4D partnered with the governments of Kenya and Tanzania to take stock of their responses to the three diseases and identify ways to ensure the sustained effective coverage of priority interventions. Our approach centered on the need to align PFM and health financing, using an adapted process guide
In each country R4D:
- Convened a working group of focal points from key government agencies, including the ministry of health, national treasury, national disease control programs, and an inter-governmental coordination body;
- Landscaped expected medium-term funding for the three diseases and traced fund flows through public financial management processes at the national and sub-national levels; and
- Assessed opportunities to mobilize additional domestic resources for health and bolster efficiency through a qualitative fiscal space analysis, macroeconomic projection model, and key informant interviews structured around an adapted process guide for identifying PFM-health financing issues and fostering dialogue.
We are exploring ways to continue supporting the country focal points through additional analysis and process facilitation.
- Sustaining Effective Coverage for HIV, Tuberculosis, and Malaria in the Context of Transition in Kenya
- Sustaining Effective Coverage for HIV, Tuberculosis, and Malaria in the Context of Transition in Tanzania