The Challenges of Transition From Donor-Funded Programs: Results From a Theory-Driven Multi-Country Comparative Case Study of Programs in Eastern Europe and Central Asia Supported by the Global Fund

Abstract

Transitioning from donor funding toward domestic financing for HIV and TB programs in Eastern Europe and Central Asia presents major challenges. It will require a substantial multipronged approach through well-planned collective and coordinated responses from global, bilateral, and national partners.

Scaling Up a Strengthened Youth-Friendly Service Delivery Model to Include Long-Acting Reversible Contraceptives in Ethiopia: A Mixed Methods Retrospective Assessment

“…Notwithstanding contributing influencers and barriers to scaling up a tested intervention model, scaling-up efforts must always be accompanied with research documenting planning and implementation processes, health-related outcomes, and impact to communicate lessons learned and opportunities for strengthening scale-up. 32,34 Study findings are largely consistent with existing literature, [5][6][7][8][9][10][11][13][14][15] indicating that mobilizing financial resources and quality of care are of paramount importance for effective scale-up and sustainability of interventions that aim to improve RH outcomes among adolescents and youth nationally. In other words, support for adolescent and youth RH was on paper, but there was limited financial allocation.…”

“…Consequently, due recognition must be given to cost efficiencies of preventive services, and the current 70/30 curative/preventive public-sector budgetary split in healthcare financing must be revisited, particularly at the lower level of the healthcare delivery system, to facilitate a smooth transition from donor-supported interventions. 15 The study is strengthened by its use of both quantitative and qualitative methods, particularly the inclusion of methodspecific contraceptive uptake before and after LARCs training. Achieving successful scale-up and sustainability depends on the independent contribution of each of the 6 elements in our analytic framework.…”

“…national scale-up. [4][5][6][7][8][9][10][11][12][13][14][15] For example, in Ethiopia, Kyrgyzstan, and Bangladesh, strong political commitment aligned with good governance, coordinated donor support, and the ability to adapt to resource limitations and competing priorities within constrained and weak health systems have contributed to improving health outcomes. 6,12 In Nigeria, there was near nation-wide scale-up of a school-based comprehensive sexuality education program supported by strong political leadership, although lack of a predictable funding source and competing priorities for available human resources were recognized as major impediments for sustainability.…”

Can complex programs be sustained? A mixed methods sustainability evaluation of a national infant and young child feeding program in Bangladesh and Vietnam

“…This study adds to a growing global literature about sustainability [17,25,26,[57][58][59][60] with a unique mixed methods study design. We incorporated a strong theoretical foundation, and leveraged a quasi-experimental design to compare measurable and observable outcomes in intervention versus comparison areas over a long post-implementation perioda rare opportunity in implementation research [25,39] particularly in lowresource settings [41].…”

How donors support civil society as government accountability advocates: a review of strategies and implications for transition of donor funding in global health

“…The area of donor transitions is a growing area of scholarship [12][13][14][15], with authors increasingly highlighting the experiences of aid reduction and its impact on civil society [2,11,[16][17][18][19]. However, relatively few pieces have a specific, practical focus on what donors should do to support civil society's role as advocates and accountability mechanisms amidst donor transitions.…”