Transitioning from Health Aid: A Scoping Review of Transition Readiness Assessment Tools

Many countries are now transitioning away from donor aid for health as they move from low- to middle-income status and see improved health outcomes. To promote better planning and preparedness for transition, many transition readiness assessment tools (TRAs) have been developed in recent years. The goal of this study was to identify and review existing TRAs to better understand the current landscape of how such tools are being used and the potential gaps among the currently available tools. There are several key limitations among existing tools. There are also many areas of overlap between tools, as well as clear gaps among the current tools available. For example, limited consideration has been given to emerging challenges for transitioning countries, such as demographic and disease transitions (e.g., aging populations and a shift in the burden of disease from infections to non-communicable diseases). Many critical health interventions, including vaccines and maternal and child health services, are ignored by current TRAs. Donors are the financial and technical “drivers” of all the TRAs, and so these tools are not being shaped by transitioning countries themselves. Therefore, it is difficult to determine whether or not the TRAs as designed will address the most critical needs of transitioning countries. Additionally, the role that in-country stakeholders are expected to play in the assessment process is not clearly defined and the methodologies of TRAs are not publicly available, thereby potentially limiting their usefulness to users.