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The impacts of donor transitions on health systems in middle-income countries: a scoping review.

Publication ,  Journal Article
Huffstetler, HE; Bandara, S; Bharali, I; Kennedy Mcdade, K; Mao, W; Guo, F; Zhang, J; Riviere, J; Becker, L; Mohamadi, M; Rice, RL; King, Z ...
Published in: Health policy and planning
October 2022

As countries graduate from low-income to middle-income status, many face losses in development assistance for health and must 'transition' to greater domestic funding of their health response. If improperly managed, donor transitions in middle-income countries (MICs) could present significant challenges to global health progress. No prior knowledge synthesis has comprehensively surveyed how donor transitions can affect health systems in MICs. We conducted a scoping review using a structured search strategy across five academic databases and 37 global health donor and think tank websites for literature published between January 1990 and October 2018. We used the World Health Organization health system 'building blocks' framework to thematically synthesize and structure the analysis. Following independent screening, 89 publications out of 11 236 were included for data extraction and synthesis. Most of this evidence examines transitions related to human immunodeficiency virus/Acquired Immune Deficiency Syndrome (AIDS; n = 45, 50%) and immunization programmes (n = 14, 16%), with a focus on donors such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (n = 26, 29%) and Gavi, the Vaccine Alliance (n = 15, 17%). Donor transitions are influenced by the actions of both donors and country governments, with impacts on every component of the health system. Successful transition experiences show that leadership, planning, and pre-transition investments in a country's financial, technical, and logistical capacity are vital to ensuring smooth transition. In the absence of such measures, shortages in financial resources, medical product and supply stock-outs, service disruptions, and shortages in human resources were common, with resulting implications not only for programme continuation, but also for population health. Donor transitions can affect different components of the health system in varying and interconnected ways. More rigorous evaluation of how donor transitions can affect health systems in MICs will create an improved understanding of the risks and opportunities posed by donor exits.

Duke Scholars

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Published In

Health policy and planning

DOI

EISSN

1460-2237

ISSN

0268-1080

Publication Date

October 2022

Volume

37

Issue

9

Start / End Page

1188 / 1202

Related Subject Headings

  • Tuberculosis
  • International Cooperation
  • Humans
  • Health Policy & Services
  • Global Health
  • Developing Countries
  • Acquired Immunodeficiency Syndrome
  • 4407 Policy and administration
  • 4206 Public health
  • 4203 Health services and systems
 

Citation

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Huffstetler, H. E., Bandara, S., Bharali, I., Kennedy Mcdade, K., Mao, W., Guo, F., … Ogbuoji, O. (2022). The impacts of donor transitions on health systems in middle-income countries: a scoping review. Health Policy and Planning, 37(9), 1188–1202. https://doi.org/10.1093/heapol/czac063
Huffstetler, Hanna E., Shashika Bandara, Ipchita Bharali, Kaci Kennedy Mcdade, Wenhui Mao, Felicia Guo, Jiaqi Zhang, et al. “The impacts of donor transitions on health systems in middle-income countries: a scoping review.Health Policy and Planning 37, no. 9 (October 2022): 1188–1202. https://doi.org/10.1093/heapol/czac063.
Huffstetler HE, Bandara S, Bharali I, Kennedy Mcdade K, Mao W, Guo F, et al. The impacts of donor transitions on health systems in middle-income countries: a scoping review. Health policy and planning. 2022 Oct;37(9):1188–202.
Huffstetler, Hanna E., et al. “The impacts of donor transitions on health systems in middle-income countries: a scoping review.Health Policy and Planning, vol. 37, no. 9, Oct. 2022, pp. 1188–202. Epmc, doi:10.1093/heapol/czac063.
Huffstetler HE, Bandara S, Bharali I, Kennedy Mcdade K, Mao W, Guo F, Zhang J, Riviere J, Becker L, Mohamadi M, Rice RL, King Z, Farooqi ZW, Zhang X, Yamey G, Ogbuoji O. The impacts of donor transitions on health systems in middle-income countries: a scoping review. Health policy and planning. 2022 Oct;37(9):1188–1202.
Journal cover image

Published In

Health policy and planning

DOI

EISSN

1460-2237

ISSN

0268-1080

Publication Date

October 2022

Volume

37

Issue

9

Start / End Page

1188 / 1202

Related Subject Headings

  • Tuberculosis
  • International Cooperation
  • Humans
  • Health Policy & Services
  • Global Health
  • Developing Countries
  • Acquired Immunodeficiency Syndrome
  • 4407 Policy and administration
  • 4206 Public health
  • 4203 Health services and systems