Integrated Delivery and the Global Health Program, Bill & Melinda Gates Foundation, Seattle, WA, USA.
Health Aff (Millwood). 2013 Jul;32(7):1265-73. doi: 10.1377/hlthaff.2012.0646.
Developing countries face diminishing development aid and time-limited donor commitments that challenge the long-term sustainability of donor-funded programs to improve the health of local populations. Increasing country ownership of the programs is one solution. Transitioning managerial and financial responsibility for donor-funded programs to governments and local stakeholders represents a highly advanced form of country ownership, but there are few successful examples among large-scale programs. We present a transition framework and describe how it was used to transfer the Bill & Melinda Gates Foundation's HIV/AIDS prevention program, the Avahan program, to the Government of India. Essential features recommended for the transition of donor-funded programs to governments include early planning with the government, aligning donor program components with government structures and funding models prior to transition, building government capacity through active technical and management support, budgeting for adequate support during and after the transition, and dividing the transition into phases to allow time for adjustments and corrections. The transition of programs to governments is an important sustainability strategy for efforts to scale up HIV prevention programs to reach the populations most at risk.
发展中国家面临着不断减少的发展援助和有限的捐助者承诺，这对改善当地居民健康的捐助者供资项目的长期可持续性构成了挑战。增加国家对项目的所有权是解决方案之一。将捐助者供资项目的管理和财务责任移交给政府和当地利益攸关方，代表了一种高度先进的国家所有权形式，但在大型项目中成功的例子很少。我们提出了一个过渡框架，并描述了如何将比尔及梅林达·盖茨基金会的艾滋病毒/艾滋病预防项目“安康计划”移交给印度政府。建议将捐助者供资项目移交给政府的关键特征包括：与政府进行早期规划，在过渡之前使捐助者项目组成部分与政府结构和供资模式保持一致，通过积极的技术和管理支持来建设政府能力，为过渡期间和之后的充足支持编制预算，以及分阶段进行过渡，以便有时间进行调整和纠正。将项目移交给政府是扩大艾滋病毒预防方案以覆盖风险最高人群的努力的一项重要可持续性战略。
