Program transition, the process of transferring external donor-supported public health programs to local beneficiaries for implementation and funding, is a topic of increasing importance on the global health agenda. If implemented carefully, program transition can enable in-country ownership of local health problems, mobilize resources, and sustain the success of transition programs. With funding from the Gates Foundation, researchers at the Johns Hopkins Bloomberg School of Public Health are investigating what makes program transitions successful, equitable, and sustainable.
Johns Hopkins University has received a new $1.1 million grant from the Gates Foundation’s India office to partner with the Gates Foundation, India Health Action Trust, and the University of Manitoba to support the transition of a critical portfolio of reproductive, maternal, newborn, child, and adolescent health (RMNCAH) and health systems strengthening investments in the Indian states of Uttar Pradesh and Bihar. The new grant is called “Framework and Tools to Inform Institutional Strengthening for Transition and Sustainability.”
Led by Dr. Sarah Bennett, professor in the Bloomberg School’s Department of Global Health, the effort will support the portfolio transition with the aim of ensuring sustainability by providing technical support and organizational strengthening, including examining the current organizational and programmatic landscape to support RMNCAH and health system strengthening in both states, and working with partners during the development, implementation, monitoring, and evaluation phases of the transition.
Public health programs in low-income and lower-middle-income countries are typically funded by donors, including multilateral international organizations, bilateral government agencies, and private philanthropic organizations. Such funding is often complemented by technical assistance provided through international implementing partners. Thus, transitions may need to consider not only financial implications, but also building management and technical capacity and local leadership.
“For programmatic transitions to be successful, sustainability must be prioritized through capacity building of local organizations and country-led efforts,” Bennett says. “Transition strategies should be developed locally and led by in-country partners closest to communities,” she stresses.
The researchers applied lessons learned from previous studies to address program transitions, including work with the Gates Foundation HIV program to achieve a sustained response to the HIV epidemic in Southern and Eastern Africa. Work on that project identified challenges to sustaining the HIV response, including a focus on treatment over prevention, difficulties integrating HIV services into health systems, including challenges in ensuring insurance coverage for marginalized people affected by HIV, and sometimes weak political commitment. Based on the challenges they faced, the researchers developed a set of recommendations, including investing in primary prevention, providing operational support for the integration process, strengthening local organizations, and addressing issues of political will. Bennett also leverages some of these insights as a member of the Sustainability Advisory Group for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) Science Advisory Board. The group aims to provide independent, evidence-based information to help sustain gains from the HIV response beyond 2030.
In addition to Bennett, Johns Hopkins colleagues working on the project include Abigail Neal (MSPH ’18), a research associate II in the department and a DrPH candidate at the Bloomberg School; Shreya Pereira (MSPH ’13), a doctoral student in the department; Shalini Singh, an associate in the School of Global Health based at Johns Hopkins India; and Kriti Singh (PhD), senior program manager at Johns Hopkins India. As part of her doctoral dissertation, Neal is conducting ongoing research to evaluate how the growing literature on learning health systems and health system resilience contributes to understanding sustainability and to document stakeholder perspectives on issues related to donor transition and sustainability. Bennett and Neal also co-teach a short course on the topic offered each summer by the School of Global Health’s Health Systems Program’s Global Health Systems Summer Institute.
