This study examines the role of external technical assistance in transitioning donor-supported health programs to domestic systems in China and Georgia. It highlights how both countries shifted from external aid to national ownership in financing and policymaking, offering key lessons for effective donor transitions.
The transition from donor-supported health programs to sustainable national health systems presents both opportunities and challenges for governments worldwide. This study examines the experiences of China and Georgia, two countries that successfully integrated donor-supported health initiatives into their domestic systems, ensuring long-term sustainability and national ownership. The role of external technical assistance (TA) in this transition has been instrumental, providing strategic guidance, capacity building, and policy advocacy to facilitate the process.
A key success factor in both countries was talent cultivation and capacity building, where external technical assistance played a significant role in strengthening human resources in healthcare management. In China, donor-funded training programs helped develop a skilled workforce of health managers and policymakers, many of whom later assumed leadership positions in national health institutions. Similarly, in Georgia, technical assistance supported comprehensive training programs, knowledge-sharing forums, and study exchanges, ensuring the development of national expertise that could sustain critical health initiatives beyond donor engagement.
Another major contributor to the success of the transition was the establishment of long-term partnerships between external and domestic experts. Unlike short-term interventions, China and Georgia fostered sustained collaborations, ensuring that knowledge transfer became embedded in national governance structures. In China, external technical expertise was seamlessly integrated into subnational and national policymaking processes, while in Georgia, donor support enabled the establishment of joint research initiatives, strengthening evidence-based decision-making in health policy.
The role of evidence-based policy advocacy was also a critical factor in ensuring effective donor transition. External technical assistance helped generate data-driven insights, which were instrumental in shaping key health policy reforms. In China, international donors such as the World Bank and the UK’s Department for International Development (DFID) played a crucial role in designing rural health financing reforms. In Georgia, external support facilitated empirical studies on drug policy and harm reduction, leading to the institutionalization of opioid substitution therapy within the national healthcare framework.
- Insufficient Domestic Funding for Capacity Building
- After the donor exit, budget constraints hindered sustained investment in health workforce training and program administration.
- Rural and underfunded regions faced greater financial barriers in continuing donor-supported programs.
- Dependency on External Implementation Partners
- In some cases, domestic institutions were slow to take full ownership, leading to gaps in project management and service delivery
- Variability in Governance Structures
- The integration of donor-funded programs into national health policies varied, leading to inconsistencies in implementation across different regions.
To ensure successful donor transitions, several key enablers were identified. The institutional integration of technical assistance within public health governance structures allowed for smoother knowledge transfer and long-term policy alignment. Strong and sustained engagement between donors and recipient governments ensured that policy changes were not only implemented but also maintained and expanded. Additionally, strengthening local research capacity and promoting evidence-driven policymaking proved essential in maintaining an adaptive and resilient health system.
The experiences of China and Georgia offer valuable lessons for countries navigating similar transitions. Their success underscores the importance of investing in local capacity building, fostering long-term partnerships, and ensuring that policy reforms are anchored in data-driven decision-making. Moving forward, ensuring adequate domestic financing, strengthening governance structures, and promoting equitable resource allocation will be crucial in securing the sustainability and effectiveness of national health programs post-donor transition.