External donors have historically contributed a significant amount of financing for health programmes in low- and middle-income countries. However, as countries grow economically, donors expect countries to transition away progressively and sustainably from external financing and towards domestically funded health programmes.

Capacity development is given top priority in all countries where UNDP acts as interim Principal Recipient of the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) grants for HIV, tuberculosis and malaria programmes or as a channel for other donor funding to reach the implementation level, onwards to both government and civil society entities. The aim of its technical assistance is to transition the management and implementation of these programmes to national entities once capacity in the national organization is strong. A well-planned and well-managed transition process helps to avoid disruptions to service delivery and ensure the long-term sustainability and efficiency of vital health programmes.

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In countries preparing for the transition from donor- to domestically funded programmes, early and extensive planning may be needed to mobilize domestic financing to cover costs previously funded by donors, such as HIV treatment and prevention services targeted towards key populations. To leverage additional domestic financing, there is a need to support domestic advocacy for increased health spending and to assess what alternative innovative financing mechanisms can be developed to reduce dependence on donors.

As more countries transition out of external financial support for health programmes, it is also important to consider the potential impact of the transition on continuity and access to services for the most vulnerable and marginalized populations. Particularly for the delivery of HIV services, the transition may have a negative impact on key populations that experience higher rates of HIV infection, such as men who have sex with men, people who inject drugs and transgender people, and those who face stigma and discrimination that may prevent them from accessing services under government-funded responses.

The pages in this section provide guidance and tools pertaining to UNDP’s approach to transition planning in the context of the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) and other health programmes, as well as broader support to build the enabling environment for sustainable and equitable health outcomes following a transition. This includes, in particular, technical assistance to help countries strengthen the availability and efficiency of domestic financing for health and support to establish mechanisms for the public funding of civil society organizations, or social contracting, most notably for community-based HIV service delivery to key populations.

Djibouti: Gradually transitioning functional areas

With the Government of Djibouti, UNDP and stakeholders initiated a gradual transition of Global Fund HIV, TB and malaria grants in 2023 to transfer the role of Principal Recipient to the Ministry of Health for the 2024-2026 grant cycle.

At the request of the government and the Global Fund, UNDP continued supporting procurement and supply chain management and key personnel, with specialists in programme management, procurement and supply chain management, monitoring and evaluation and finance providing training and joint supervision through a peer skills transfer process, until the end of 2025.

This staggered approach to transitioning functional areas for grant delivery ensured the continued provision of health products and helped mitigate financial and operational risks. Overall, the transition was supported by political commitment, national ownership and other transition enablers.

Learn about the transition process here.