A Blueprint for Global Health’s Transition to Country Ownership

The United States has invested billions in epidemic control, disease programs, and stronger health systems. As the U.S. Department of State’s Global Health Security and Diplomacy Strategy makes clear, the moment has come to fully transition health programs to partner countries, leveraging domestic financing and the private sector.

Protecting and extending the gains of these lifesaving programs, including the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, depends on transitions that are politically viable, financially sustainable, and technically sound. The State Department needs a tested playbook that delivers transition — not just promises it.

Abt Global’s proven solutions support the State Department’s vision to turn transition from an exception into the norm. Our solutions span financing, efficiency, resilience, private sector engagement, and digital integration. They equip the State Department and partner governments with practical tools to execute the transition. What follows are strategies and results from our decades of work strengthening health systems—the real groundwork of every successful transition.

Financing solutions that lock in country ownership

Supporting partner governments to move donor-funded programs into domestic budgets and health insurance schemes is foundational for ensuring continuity, accountability, and ultimately, sustainability. It means U.S. dollars have catalyzed, not replaced, domestic investment.

In Zambia, the development of standard operating procedures allowed the government to better track HIV expenditures and strengthen asset and human resource management, thus increasing national capacity to manage government-to-government, or G2G, funds.

In the Democratic Republic of Congo, the Ministry of Health introduced performance-based budgeting for local health zones, tying government allocations to service delivery outcomes. Internal project reports showed that this reform increased local budget execution rates by more than 30% and created a transparent channel for tracking health expenditures, a key step toward sustaining epidemic control through domestic financing.

Digital integration as the glue

Digital is not an add-on: it’s the backbone of country-led, interoperable systems that connect financing, service delivery, and accountability.

Cambodia built an interoperability layer that linked health and social protection systems, enabling patient tracking across services and enhancing provider efficiencies and client access. The integration reduced administrative delays, ensured that vulnerable households were automatically enrolled in coverage, and allowed the government to better target subsidies — expanding access while improving efficiency and accountability.

The Dominican Republic integrated HIV indicators into its national DHIS2 platform, putting epidemic control on the same dashboards as maternal and child health. This gave health officials real-time visibility across programs, enabling faster resource allocation and earlier detection of service gaps. It also transferred full data ownership to the Ministry of Health, allowing national analysts, not donors, to lead performance reviews and make evidence-based decisions.

Looking ahead

Transitions are already happening, as these examples show. Scaling them needs proven health systems strengthening solutions: financing road maps, leaner service models, resilience packages, private sector integration, and digital backbones.

Abt Global has strengthened health systems in more than 40 countries, helping partner governments mobilize over $2 billion in domestic health financing, expand insurance coverage to tens of millions, and integrate thousands of private providers into national networks. These digital, financial, and governance systems empower countries to sustain essential services long after donor programs end.

The State Department needs these competencies to protect its investments, demonstrate accountability, and exit — leaving behind health systems that are stronger, more resilient, and wholly owned by the countries they serve.

Figures cited in this article are drawn from unpublished annual and quarterly project reports.

A version of this blog was originally published in Devex as part of Off-Ramps to Self-Reliance, a series exploring insights on the future of HIV programming and the multisectoral solutions that support countries’ off-ramps, resilient health systems, and sustained HIV progress.