How are health policy makers managing donor exits: a policy analysis of Ghana’s transition from the United States President’s Emergency Plan for AIDS Relief (PEPFAR)

Abstract

Background: When Ghana undergoes economic growth, and becomes a middle-income country, it will face the loss of official development assistance (ODA), including ODA for health. PEPFAR has been supporting Ghana for many years and now is reducing its funding in Ghana. Methods: This is a qualitative study based on 21 in-depth, key informant interviews conducted between May and October 2019. Study participants were individuals who are involved in Ghana’s national HIV/AIDS response; they included government officials, technical officers from international organizations, staff from donor agencies, and staff from local civil society organizations (CSOs). Results: PEPFAR has been playing a significant role for Ghana’s national HIV/AIDS control. However, it is reducing its funding in Ghana because of Ghana’s poor performance and government commitment. PEPFAR is transiting its work focus to only the Western Region in order to achieve epidemic control in this region. This transition will bring many challenges to Ghana such as financial, governance, and system challenges. The government of Ghana and CSOs in Ghana have been aware of PEPFAR’s transition for some time, and initial plans are conducted to manage this transition. At the same time, PEPFAR is trying to initiate conversations with other donors to fill in the potential gaps.Conclusions: Transition is shared responsibility. PEPFAR as a donor could publish its specific transition plan for Ghana to navigate this transition. Ghana as a recipient country could make more commitment to perform better with donor findings. Donors will not provide permanent assistance; transition is a good chance for country to stand fully on its own feet. Mobilizing domestic resources is important to sustain Ghana as a country itself and manage the transition.