Background: There is emerging evidence to support those factors in global development that are related to successful transition and sustainability of aid investments. At the 15 year mark, the scale and scope of the the US President''s Emergency Plan for AIDS Relief (PEPFAR) program provides ample opportunity to explore these factors and to confirm or identify those that can be incorporated early in project design to increase the sustainability of investments.
Description: The International Training and Education Center for Health (I-TECH) at the University of Washington in Seattle, USA, has been a PEPFAR partner since 2002. I-TECH has transitioned more than 300 programs, products, and tools to local ownership in that time. In 2017, I-TECH undertook to explore the degree to which a sub-set of these improvements have been sustained by local partners over time. Case examples were selected on the basis of geographic diversity, type of intervention, and sufficient time from transition to make an assessment. Key informants were interviewed, and the four domains and 15 elements of the PEPFAR Sustainability Index Dashboard (SID) were used to provide a framework and starting point for better understanding each example.
Lessons learned: Case studies were drafted on transitioned interventions in six resource limited countries to illustrate lessons learned on the long-term sustainability of health systems improvements, including both successes and failures. The cases reinforce the relevance of the SID in planning for sustainability, in particular the elements of advanced planning and coordination (1); human resources for health (7); quality management (9); domestic resource mobilization (11); and performance data (15). In addition, we found the actions of the implementing partner during transition to be a critical component.
Conclusions/Next steps: While aid investments in low and middle income countries can clearly be transitioned successfully to local ownership, they may not remain beneficial over time unless key elements of sustainability planning are intentionally addressed at the outset. Such lessons learned are instructive to a wide set of global audiences, from health and development specialists, government officials, economists, and social scientists to diplomats and security professionals worldwide. As such, lessons should be regularly disseminated.