Transition and Sustainability in Global Health
Across the globe, countries are navigating a critical moment: how to sustain progress in health as donor priorities shift, funding models evolve, and health needs grow more complex. Without strong transition strategies, essential global health programs risk disruption, leaving patients and families vulnerable to gaps in lifesaving services. With the right planning and strategic investments, however, transitions can reinforce country ownership, lead to stronger, more resilient health systems, and extend the impact of decades of investment in improving population health.
This moment calls for evidence, tools, and partnerships that can guide effective transitions while safeguarding population health. Our team works alongside governments, donors, and implementing partners to generate evidence and practical approaches for transition and sustainability in global health.
We focus on four interconnected areas:
Planning, Monitoring, Learning, and Evaluation of Transition
We develop frameworks and tools to help organizations plan for and manage programmatic transitions. Our work in this space has included evaluating the transition of a large-scale HIV prevention program in India, assessing the impacts of USAID’s changing HIV/AIDS investment strategy on health system functions in Kenya and Uganda, facilitating the transition of Countrywide Mortality Surveillance for Action (COMSA) in Mozambique, and most recently, supporting transition planning and institutional strengthening efforts in Uttar Pradesh, India.
Strengthening Health Systems for Sustainable Impact
Transitions succeed when programs are embedded in resilient and adaptable health systems. We help partners integrate donor-funded services into national health systems, strengthen local institutions and essential public health functions, and identify strategies to protect access to essential care. Recent work has explored the capabilities of health systems that are critical for addressing emerging health crises and strategies for strengthening the performance of essential public health functions through workforce development.
Exploring the role of power, process, and partnerships
Successful sustainability depends on inclusive and equitable collaboration. We analyze how decision-making, governance, and relationships shape transition outcomes, and we work with donors and partners to build strong, country-led approaches to sustainability. Our research has documented lessons learned from the Global Polio Eradication Initiative’s transition experience and explored pathways for improving sustainable HIV programming, including elevating regional leadership bodies and improving fair financing processes.
Training and capacity strengthening
We offer training opportunities for students and professionals to build skills in planning, evaluating, and leading sustainable health initiatives, and help organizations navigate complex transition processes. You can join our one-week course on sustainability, or contact Sara Bennett (sbennett@jhu.edu) and Abigail Neel (aneel1@jhu.edu) for more information on guided training opportunities.
Spotlight on Current Research
Together with our partners, we’ve launched a survey to understand the impact of USAID’s funding freeze on health systems and how stakeholders are responding. If you’re a professional working in a health system that has been affected, please take the survey.
Upcoming Seminars
Shaping Global Health Together: An International Dialogue Join a global panel Thursday, September 18, 2025, 8:00 – 9:00 a.m. ET to discuss ways to promote equity, shared leadership, and strong community voices in global health.
Connect with Faculty
Recent Publications
2025
- Ratevosian J, Millett G, Honermann B, Bennett S, Connor C, Bekker L, Beyrer C. (2025). PEPFAR under review: What’s at stake for PEPFAR’s future? The Lancet, 405(10479):603–605. https://doi.org/10.1016/S0140-6736(25)00258-2
- Bennett S, Merritt M. (2025). The implications of fair processes for financing UHC report for development assistance: Reflection and an application of the decision-making principles to PEPFAR. Health Economics, Policy and Law. 20(1):26-33 doi: 10.1017/S1744133124000276 https://doi.org/10.1017/S1744133124000276
2024
- Neel AH, Rodriguez D, Sikazwe I, Pillay Y, Barron P, Pereira SK, Bennett S. (2024). HIV programme sustainability in Southern and Eastern Africa and the changing role of external assistance for health. Health Policy and Planning, 39(Suppl_1):107–117. https://doi.org/10.1093/heapol/czad091
- Closser S, Neel AH, Gerber S, Alonge OA. (2024). From legacy to integration in the Global Polio Eradication Initiative: Looking back to look forward. BMJ Global Health, 9(8). https://doi.org/10.1136/bmjgh-2023-014758
- Shroff ZC, Sparkes SP, Paina L, Skarphedinsdottir M, Gotsadze G, Zakumumpa H, Tang K, Perera PN, Yuan M, Hanson K. (2024). Managing transitions from external assistance: Cross-national learning about sustaining effective coverage. Health Policy and Planning, 39(Suppl_1):i50–i64. https://doi.org/10.1093/heapol/czad101
2023
- Neel AH, Neill R, Cardona C, Bishai D, Gupta S, Mohan D, Jain N, Basu S, Closser S. (2023). Everyday capabilities were a path to resilience during COVID-19: A case study of five countries. Health Policy and Planning, 38(2):192–204. https://doi.org/10.1093/heapol/czac085
- Paina L, Rodriguez D, Zakumumpa H, Mackenzie C, Ssengooba F, Bennett S. (2023). Geographic prioritization in Kenya and Uganda: A power analysis of donor transition. BMJ Global Health, 8:e010499. https://doi.org/10.1136/bmjgh-2022-010499
2021
- Zakumumpa H, Paina L, Wilhelm J, Ssengooba F, Ssegujja E, Mukuru M, Bennett S. (2021). Patients’ and HIV service managers’ perceptions of the impact of loss of PEPFAR support on HIV services in transitioned health facilities in Uganda: A qualitative study. BMC International Health and Human Rights, 21:302. https://doi.org/10.1186/s12939-021-01518-2
- Zakumumpa H, Paina L, Wilhelm J, Ssengooba F, Ssegujja E, Mukuru M, Bennett S. (2021). The impact of loss of PEPFAR support on HIV services at health facilities in low-burden districts in Uganda. BMC Health Services Research, 21(1):302. https://doi.org/10.1186/s12913-021-06316-4
- Rodríguez DC, Mohan D, Mackenzie C, Wilhelm J, Eze-Ajoku E, Omondi E, Qiu M, Bennett S. (2021). Effects of transition on HIV and non-HIV services and health systems in Kenya: A mixed methods evaluation of PEPFAR’s geographic prioritization. BMC Health Services Research, 21:457. https://doi.org/10.1186/s12913-021-06456-6
- Qiu M, Paina L, Rodríguez DC, Wilhelm JA, Eze-Ajoku E, Searle A, Zakumumpa H, Ssengooba F, Mackenzie C, Bennett S. (2021). Exploring perceived effects from loss of PEPFAR support for outreach in Kenya and Uganda. Globalization and Health, 17:80. https://doi.org/10.1186/s12992-021-00750-y
- Neel AH, Closser S, Villanueva C, Majumdar P, Gupta SD, Krugman D, Akinyemi OO, Deressa W, Kalbarczyk A, Alonge O. (2021). Thirty years of polio campaigns in Ethiopia, India and Nigeria: The impacts of campaign design on vaccine hesitancy and health worker motivation. BMJ Global Health, 6(8). https://doi.org/10.1136/bmjgh-2021-006002
- Neel AH, Rodriguez DC, Mahendradhata Y, Deressa W, Owoaje E, Akinyemi O, Sarker M, Mafuta E, Gupta SD, Salehi AS, Jain A, Alonge O. (2021). The effects of polio eradication efforts on health systems: A cross-country analysis using the Develop–Distort Dilemma. Health Policy and Planning, 36(3):707–719. https://doi.org/10.1093/heapol/czab044
2019
- Wilhelm J, Paina L, Qiu M, Makuru M, Ssengooba F, Colantuoni E, Bennett S. (2019). The impact of PEPFAR transition on HIV service delivery at health facilities in Uganda. PLOS One. https://doi.org/10.1371/journal.pone.0223426
- Wilhelm J, Paina L, Qiu M, Zakumumpa H, Bennett S. (2019). The differential impacts of PEPFAR transition on private for-profit, private not-for-profit, and publicly owned health facilities in Uganda. Health Policy and Planning. https://doi.org/10.1093/heapol/czz090
- Zakumumpa H, Bennett S, Ssengooba F. (2019). Leveraging the lessons learned from financing HIV programs to advance the universal health coverage agenda in the East African Community. Global Health Research and Policy, 4:27. https://doi.org/10.1186/s41256-019-0118-y
Older
- Rodriguez D., Whiteside A., and Bennett S. (2017) Creating and Sustaining Political Commitment for Key Populations during Donor Transitions. Bull World Health Organ 2017;95:121–127. doi: 10.2471/BLT.16.179861.
- Zakumumpa H, Bennett S, Ssengooba F, (2017) Alternative financing mechanisms for antiretroviral treatment programs in health facilities in Uganda: A mixed-methods approach. BMC Health Services Research 17(65). doi: 10.1186/s12913-017-2009-6
- Hecht R. and Bennett S. (2016) Country Transitions from Donor Aid for Health: We Need a Common Research Agenda and Mechanisms for Joint Action Now, Health Affairs Blog.
- Zakumumpa H., Bennett S., and Ssengooba F. (2016) Accounting for variations in ART program sustainability outcomes in health facilities in Uganda: a comparative case study analysis. BMC Health Services Research 2016; 16: 584. doi: 10.1186/s12913-016-1833-4
- Ozawa S. Singh S., Singh K., Chhabra V. and Bennett S. (2016) The Avahan Transition: Effects of Transition Readiness on Program Institutionalization and Sustained Outcomes. PLOS One. doi: 10.1371/journal.pone.0158659
- Bao J., Rodriguez D., Paina L., Ozawa S., Bennett S (2015) Monitoring and evaluating the transition of large-scale programs in global health. Global Health Science and Practice 17;3(4):591-605. doi: 10.9745/GHSP-D-15-00221.
- Sara Bennett, Suneeta Singh, Daniela Rodriguez, Sachiko Ozawa, Kriti Singh, Vibha Chhabra, Neeraj Dhingra. Transitioning a Large Scale HIV/AIDS Prevention Program to Local Stakeholders: Findings from the Avahan Transition Evaluation. PLoS ONE 10(9): e0136177. doi: 10.1371/journal.pone.0136177 DOI: 10.1371/journal.pone.0136177
- Daniela C. Rodríguez, Vandana Tripathi, Meghan Bohren, Amy Paul, Kriti Singh, Vibha Chhabra, Suneeta Singh and Sara Bennett. “From me to HIV”: a case study of the community experience of donor transition of health programs. BMC Infectious Diseases 2015, 15:349 doi:10.1186/s12879-015-1068-8
- Sara Bennett, Daniela Rodriguez, Sachiko Ozawa, Kriti Singh, Meghan Bohren, Vibha Chhabra and Suneeta Singh. Management practices to support donor transition: lessons from Avahan, the India AIDS Initiative. BMC Health Services Research 2015, 15:232. doi:10.1186/s12913-015-0894-0
- Sara Bennett, Sachiko Ozawa, Daniela Rodriguez, Amy Paul, Kriti Singh, Suneeta Singh. Monitoring and evaluating transition and sustainability of donor-funded programs: Reflections on the Avahan experience. Evaluation and Program Planning, 2015, Oct; 52:148-158. doi:10.1016/j.evalprogplan.2015.05.003
- Sara Bennett, Suneeta Singh, Sachiko Ozawa, Nhan Tran, and Js Kang. Sustainability of donor programs: evaluating and informing the transition of a large HIV prevention program in India to local ownership. Glob Health Action. 2011; 4: 10.3402/gha.v4i0.7360. doi: 10.3402/gha.v4i0.7360
- Shunsuke Mabuchi, Suneeta Singh, Rituparna Bishnu andSara Bennett. Management characteristics of successful public health programs: “Avahan” HIV prevention program in India. Int J Health Plann Manage. 2013 Oct-Dec;28(4):333-45. doi: 10.1002/hpm.2153
- Nhan T Tran, Sara C Bennett, Rituparna Bishnu and Suneeta Singh. Analyzing the sources and nature of influence: how the Avahan program used evidence to influence HIV/AIDS prevention policy in India. Implementation Science 2013, 8:44. doi:10.1186/1748-5908-8-44
- Curatio International Foundation. Final Evaluation of GAVI Alliance’s Support to Bosnia and Herzegovina. Geneva: Curatio International Foundation. July 31, 2014.