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 to supporting countries for sustainability of programmes and to successfully transition includes:
Figure: Adapted from the Global Fund 'Sustainability, Transition and Co-Financing Policy, April 2106'
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 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.