Transitioning to Country Ownership of HIV Programs in Rwanda

An objective of development aid is to increase the capacity of recipient countries until they no longer require foreign assistance. Ideally, partners accompany host countries in this development journey by progressively transferring management skills and technical expertise to promote sustainability of country ownership of programs [1,2]. Reviews of donor-funded health programs have highlighted integration into existing government health systems as key to enabling sustainability [3–6]. However, there are few published analyses of how public health programs are transitioned from donor to host country management [2,7]. As defined through its national policy, Vision 2020, Rwanda has committed to reducing its dependence on external aid [8]. In response to the growing AIDS crisis, Rwanda advocated for increasing resources from bilateral, multilateral, and civil society organizations to combat HIV [9,10]. In 2003, the World Bank and the Global Fund for AIDS, Tuberculosis and Malaria (Global Fund) were among the first contributors to the AIDS response in Rwanda [8–10]. The launch of the US President’s Emergency Plan for AIDS Relief (PEPFAR) program in 2004 dramatically increased the funding available to support HIV programs in Rwanda (Fig 1). PEPFAR provided 989.7 million US dollars (USD) from 2004 to 2013, and the Global Fund provided 529.2 million USD from 2003 to 2013 [9–12]. Fig 1 Total PEPFAR approved funding to Rwanda for HIV, tuberculosis (TB)/HIV, and health systems strengthening, 2004–2013. This article describes key principles that allowed for the successful transition of HIV program ownership from the donor-led agencies to Rwanda.