Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, Beijing 100084, China.
Institute for International and Area Studies, Tsinghua University, No. 30 Shuangqing Road, Beijing 100084, China.
Health Policy Plan. 2024 Jan 23;39(Supplement_1):i137-i144. doi: 10.1093/heapol/czad088.
External technical assistance has played a vital role in facilitating the transitions of donor-supported health projects/programmes (or their key components) to domestic health systems in China and Georgia. Despite large differences in size and socio-political systems, these two upper-middle-income countries have both undergone similar trajectories of 'graduating' from external assistance for health and gradually established strong national ownership in programme financing and policymaking over the recent decades. Although there have been many documented challenges in achieving effective and sustainable technical assistance, the legacy of technical assistance practices in China and Georgia provides many important lessons for improving technical assistance outcomes and achieving more successful donor transitions with long-term sustainability. In this innovation and practice report, we have selected five projects/programmes in China and Georgia supported by the following external health partners: the World Bank and the UK Department for International Development, Gavi Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria. These five projects/programmes covered different health focus areas, ranging from rural health system strengthening to opioid substitution therapy. We discuss three innovative practices of technical assistance identified by the cross-country research teams: (1) talent cultivation for key decision-makers and other important stakeholders in the health system; (2) long-term partnerships between external and domestic experts; and (3) evidence-based policy advocacy nurtured by local experiences. However, the main challenge of implementation is insufficient domestic budgets for capacity building during and post-transition. We further identify two enablers for these practices to facilitate donor transition: (1) a project/programme governance structure integrated into the national health system and (2) a donor-recipient dynamic that enabled deep and far-reaching engagements with external and domestic stakeholders. Our findings shed light on the practices of technical assistance that strengthen long-term post-transition sustainability across multiple settings, particularly in middle-income countries.
外部技术援助在中国和格鲁吉亚两国发挥了至关重要的作用，促进了捐赠方支持的卫生项目/方案（或其关键组成部分）向国内卫生系统的过渡。尽管这两个中上收入国家在规模和社会政治制度方面存在很大差异，但近几十年来，它们都经历了类似的“脱离”卫生外部援助并逐步在项目供资和决策方面建立强大国家自主权的轨迹。尽管在实现有效和可持续技术援助方面存在许多有案可查的挑战，但中国和格鲁吉亚技术援助实践的遗留问题为改善技术援助成果和实现更成功的、具有长期可持续性的捐助方过渡提供了许多重要经验。在本创新和实践报告中，我们选择了中国和格鲁吉亚的五个项目/方案，这些项目/方案得到了以下外部卫生合作伙伴的支持：世界银行和英国国际发展部、全球疫苗免疫联盟和全球抗击艾滋病、结核病和疟疾基金。这五个项目/方案涵盖了不同的卫生重点领域，从农村卫生系统强化到阿片类药物替代疗法。我们讨论了由跨国研究团队确定的三项创新技术援助实践：（1）为卫生系统中的关键决策者和其他重要利益攸关方培养人才；（2）外部和国内专家之间的长期伙伴关系；以及（3）由本地经验培育的循证政策倡导。然而，实施的主要挑战是过渡期间和之后国内用于能力建设的预算不足。我们进一步确定了促进捐助方过渡的两个促成因素：（1）融入国家卫生系统的项目/方案治理结构；以及（2）使外部和国内利益攸关方能够进行深入和深远接触的捐助方-受援方动态。我们的研究结果阐明了加强多个环境中长期过渡后可持续性的技术援助实践，特别是在中等收入国家。
