The Global Fund - Transition Sustainability

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  • The Global Fund - Transition Sustainability

The Global Fund - Transition Sustainability

The Global Fund defines transition as the process by which a country moves towards fully funding and implementing its health programs independent of Global Fund support. It is aiming to improve the sustainability of programmes through moving progressively from external-donor financing toward domestically funded health systems that deliver results.

The 2017-2022 Global Fund Strategic Framework includes a specific sub-objective committing the Global Fund to ‘support sustainable responses for epidemic control and successful transitions’.

According to the Global Fund’s Eligibility Policy, once a country reaches Upper Middle Income status, it is no longer eligible for funding if there is less than a ‘high’ disease burden. The Eligibility Policy allows for up to one allocation of Transition Funding following their change in eligibility.

The Global Fund provides specific funding request tools tailored to transition which aim to support the move to sustainability and transition-related priorities identified through a transition readiness assessment, and the development of a transition work plan.

The Global Fund Approach

The Global Fund approach to supporting countries for sustainability of programmes and to successfully transition includes:

  • Investing in and providing support for the development of robust, inclusive (including key and vulnerable populations), quality, evidenced-based National Health Strategies, Disease Specific Strategic Plans and Health Financing Strategies.
  • Aligning requirements to ensure that Global Fund financed programmes can be implemented through country systems in order to build resilient and sustainable systems for health.
  • Supporting countries to assess their readiness to transition both programmatically and financially, and ensure robust planning; allowing transition work plans to serve as the basis for funding requests.
  • Providing transition funding for up to one allocation period upon becoming ineligible.
  • Applying graduated co-financing requirements, ensuring that the revised application focus and co-financing requirements align domestic financing incentives to ensure that as countries move closer to transition they take up key programmes, such as interventions for key and vulnerable populations.


Figure: Adapted from the Global Fund 'Sustainability, Transition and Co-Financing Policy, April 2106'

Transition Planning

Experience shows that planning a transition from Global Fund support takes time and resources. In many countries this involves addressing complex issues such as changing legislation to allow for the public sector to contract with non-public sector providers such as civil society organizations, effectively supporting domestic advocacy for health spending, and improving procurement processes and access to ensure that countries can purchase key commodities at efficient prices.

There is often also significant political advocacy needed to ensure that all interventions appropriate to a particular country’s disease epidemiology (including interventions that focus on key and vulnerable populations) are eventually transitioned to be supported in their entirety through domestic country budgets.

The Global Fund Transition Process

The Global Fund process is flexible and is adapted based on a country’s needs and context specific factors, and tries to ensure that countries have sufficient notice, time and associated resources to plan for transition. 
It aims to build on existing systems or processes in-country. 

  1. The Global Fund aims to support countries in carrying out a ‘transition readiness assessment’. The transition readiness assessment should be an inclusive (including key and vulnerable populations), multi-stakeholder, and country-owned process including communities and civil society, led by the CCM or other multi-stakeholder coordinating body. The aim of the transition readiness assessment is to serve as a tool to stimulate dialogue at country level around transition related needs and should be developed and written in line with the national health policies, as well as with the vision of the national general health plan for the country.
  2. The findings from the transition readiness assessment should feed into an inclusive country-led transition work-plan addressing key bottlenecks and leverage opportunities towards successful transition. Critical issues for successful transitions should be addressed, which often include capacity building and support for key and vulnerable populations, interventions that respond to human rights and gender related barriers and vulnerabilities to health, and procurement and supply-chain management issues that are essential for ensuring strong national unified systems.