PEPFAR Transitions to Country Ownership: Review of Past Donor Transitions and Application of Lessons Learned to the Eastern Caribbean

This research on the process of transition to country ownership of HIV prevention funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR), already underway in the Eastern Caribbean, "seeks to highlight and apply lessons learned from other donor transitions to support a successful transition of HIV programs in the Eastern Caribbean."

The researchers used a rapid review of both peer-reviewed and gray literature on donor transitions to country ownership in family planning, HIV, and other areas, and identified 48 resources that addressed key steps in the transition process and determinants of readiness for transition. The initial review was conducted in January 2013 and then updated in May 2014 and February 2015.

"Six key steps for effective transition: (1) develop a roadmap; (2) involve stakeholders; (3) communicate the plan [- messaging through high level diplomacy is recommended]; (4) support midterm evaluations; (5) strengthen financial, technical, and management capacity; and (6) support ongoing M&E. The Eastern Caribbean will need to identify HIV champions; strengthen leadership and management; improve policies to protect key populations; engage the private sector and civil society more; integrate HIV programs into primary care; improve supply chain capacity; and address health worker shortages."

PEPFAR's guidance tool for developing country/regional operational planning is the “Sustainability Index and Dashboard” (SID) [http://www.pepfar.gov/documents/organization/237669.pdf ] to assess sustainability of country programs toward control of the HIV epidemic. This research "expands on existing guidance by describing 9 key areas, based on findings from the literature, which should be evaluated when determining readiness for transition to country ownership." They include:
"1. Leadership and Management Capacity
2. Political and Economic Factors
3. Policy Environment
4. Alternative Funding Sources
5. Integration of HIV Programs
6. Institutionalized Processes
7. Procurement and Supply Chain Management
8. Staffing and Training Needs
9. Private Sector and Civil Society Engagement"

The discussion suggests that hindrances are donor-imposed timelines, "the exclusion of key stakeholders in the planning process; lack of clear communication; and failure to ensure recipient countries have the resources and capacity to successfully maintain gains made under PEPFAR support....[The] findings suggest that stakeholder engagement and clear communication are essential steps in a successful transition to country ownership."