A ‘transition’ refers to a process by which a country that was previously receiving external donor funding through Official Development Assistance (ODA) has that money reduced, ended or transferred to another programmatic aim. The transition can take place slowly or suddenly, leading to a change in the aid relationship between the donor and recipient. Transition can occur when recipients in low- and middle-income countries have funding reduced through direct (bilateral) support or via multilateral organisations, which can often happen at the same time, with domestic resources expected to replace reduced international funding.

A sustainable transition is one that protects development gains and ensures that the societal changes that are evoked by aid processes are long-lasting and transformative.

Globally, with an increasing number of countries moving from low income to lower middle-, or middle-income status, donors are beginning to transition their relationships in these countries from a focus on providing Official Development Assistance (ODA) through programmatic investments, to closer economic or diplomatic relationships instead. The UK Government has a role to play in the delivery of sustainable transitions both through its bilateral portfolio and board membership of multilateral organisations, such as the Global Fund and Gavi.

​​When transition occurs in an unplanned or unsustainable way, it could create further harm and a reversal of the development gains that years of investments have helped bring.

Issues with transition include:

1) Income Status (GNI) is often used as the main eligibility criteria donors use to identify if a country is ready to start the transition process:

  • This is based on the assumption that increased national income will be reflected in government budgets and allocations, and thus a country’s ability to sustain improvements in health outcomes. This is often accompanied by the assumption that an increase in total health spending will cause a decline in out of pocket expenditure, thus reducing the financial burdens on individuals seeking health care.
  • While income status is a simple and quantifiable measure, it does not take into account the complexity of health systems, equity issues, and the diversity of conditions and readiness that each country brings. Rising economic growth does not automatically translate into improved health indices and can mask unequal poverty and health distribution. Becoming a middle income country is not an end in itself – middle income countries are home to 82% of the world’s ‘new’ poor, 60% of the existing poor (those living below $1.90 a day).  Case study on Nigeria in Laying the Foundations.

2) The definition of transition is perceived differently by donors and recipients:

  • The word transition can be used to describe countries moving towards democracy (political); through national income brackets (economic); experiencing changes in population patterns (demographic); and shifts in disease burden (epidemiological).
  • We can also use the word transition to describe the change in aid or funding that a country receives over time (financial), along with the term “graduation”, “increased ownership”, and “sustainability”. The lack of common definition reflects the different agendas and concerns donors and recipient governments have in regard to transition. It prevents systematic transition planning in the health sector and beyond, that takes an overall country’s perspective.

3) Information on transition is fragmented:

  • The data required for donors and governments to make sense of transition are not readily available, or accessible to all stakeholders. Costing analysis, fiscal space projections, and information about donor resources are not accessible. Without clear data, transition planning is guess work focused on specific activities.

4) Transition is addressed in isolation:

  • Donors’ transition tends to be analysed from an individual donor or programme perspective, not in relation to the health system it affects. This results in fragmented or uncoordinated management of transitions at country level.

5) Sustainable outcomes of the transition process are not clear:

  • Sustainability should look at outcomes not activities. Sustainability is often considered as the ‘handover’ of activities and inputs from donors to governments. This view delegitimises the role of governments in the process of transition, and diverts attention from the goal of sustained improvements in health outcomes.
  • A transition that is able to sustain health outcomes with new ways of financing, requires continuous commitment from both donors and government to the principles of aid effectiveness (ownership, alignment, harmonisation, results, and mutual accountability).


The UK Sustainability and Transitions (ST) Working Group

STOPAIDS’ work on sustainability and transitions is done through co-chairing The UK Sustainability and Transitions (ST) Working Group.

The UK ST Working Group is made up of UK-based NGOs, think tanks and academic institutions working on issues relating to sustainability and transitions, primarily in the global health arena. The working group is co-chaired by STOPAIDS and RESULTS UK and welcomes members from across the UK who bring knowledge, experience, evidence and insight to the sustainability and transitions debate and who have an interest in advancing the groups policy positions through collaborative working.

The group shares information, builds relationships across civil society, parliamentarians and civil servants to influence the UK Government’s policies and approaches to bilateral and multilateral sustainability and transitions.


Vision & Aim

The ST Working Group works to ensure that where countries that are receiving international financing from donors experience advancement in poverty and inequality alleviation, complemented by an increased capacity to domestically finance services, there will be a gradual and sustainable transition to domestic funding. Bilateral and multilateral donors will play an active and collaborative role throughout through responsible policies and processes to support an increase in-country capacity, including:

  • Policies that integrate national governments’ priorities and reflect the need of affected communities in the withdrawal planning, to allow for long-term service delivery planning, what populations are covered and how outcomes would be met.
  • The development gains delivered from international financings, such as accessible and quality health services, will be sustained and scaled up through national government ownership.
  • Flexibility to allow for changes in circumstances; there will be the option to reintroduce international finance from donors to support development.
  • The involvement of and communication with civil society organisations and other donors, a greater understanding of the impact of effective aid and its poorly managed withdrawal, and the importance of government ownership.

Our impact will influence the overall strategy and quality of aid from all donors and will raise awareness and solidarity on transition among the UK Government and other civil society organisations.


Core Message 

The UK Government and multilateral organisations should engage in sustainable practices in the allocation and withdrawal of international financing to countries, in order to make the transition a process that sustains development gains, ensures equitable access to health and leaves no one behind.

The UK ST Working Group meets remotely once a month, if you would be interested to join the Working Group please get in touch with Amina.