Recommendations for transitioning countries

A joint publication of APMGlobal Health and Aidspan. Produced with support from UNAIDS. This paper addresses the issue of transitioning to greater domestic investment for HIV and provides us with practical recommendations, examples, various methods and possible approaches.


Many donors and countries are in the process of transitioning away from reliance on external funding in favour of greater domestic investment for HIV. This process, in itself, carries grave risks to the funding for, and implementation of, HIV programming, especially for key populations. Recent experiences in Central and Eastern Europe provide examples of this.

But planning and implementing transitions are not straightforward. There are many questions about when countries should transition, how they should do so, and whether or not donor exits will leave critical gaps in the response, especially for key populations.

This policy paper suggests that transitions need to be based on the following sets of principles and is structured in 3 parts, based on them:

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(1) transparency and predictability,

(2) good practice and

(3) human rights.



The Key messages of the paper, according to those principles, are:

To aid in the transparency and predictability of transition processes, we need:

  • Systematic transition criteria: A clear set of criteria needs to be developed for assessment of a country’s transition preparedness.
  • Publicly available transition schedules: Transition should be discussed between donors and representatives of the country to determine start and end dates and duration of transition.
  • Coordinated donor decisions: Donors need a clearer mechanism to communicate their transition plans about a particular country with each other.

“Good practice” transitions require:

  • Time: Not only is a period of several (5-10) years required, but also a phased roadmap to achieve various specified financial and operational targets is needed.
  • High-level political commitment: Without commitment at the highest political levels, transitions can be easily derailed by changes in staffing, in political parties, in economic circumstances, etc.
  • Country ownership: Aligning donor-funded projects with national policy as well as with the national context is important if projects are to be absorbed by domestic bill-payers.
  • Built-in monitoring and evaluation: M&E is needed to assess progress against the roadmap targets, as well as to track changes to the epidemic, issues affecting the testing and treatment cascade, access by key populations to essential services, and other important considerations.

Transitions that promote and protect human rights are most likely to maintain and expand access to essential HIV services by key populations through:

  • Funding mechanisms for NGOs, which must be in place and working effectively to enable access to sufficient funds for key population service delivery programs.
  • High-level political engagement, specifically related to the costs and benefits of excluding or including specific key populations in national HIV responses.
  • Improved in-country capacity for advocacy based on data collection and analysis by NGOs or community-based networks representing each relevant key population.
  • Increased capacity of NGOs to demonstrate specifically the level and types of activities they will undertake in the HIV prevention and treatment cascade to justify the sustained allocation.
  • Ensured funding for police, security, and criminal justice reform programs because these structural elements have the strongest influence in most countries over access of key populations to needed services.

You can look through and download the full text of the paper here.