TABLE 3 Guiding Questions for Monitoring and Evaluating Global Health Program Transitions and Illustrative Indicators by Transition Domain

Domain	Guiding Questions	Sample Indicators (obtained through quantitative and qualitative inquiry)
CONTEXTUAL FACTORS	To what extent is the political environment ready for a health program transition?	Score on World Bank Governance Index % government budget spent on health % government budget spent on health program of interest
	To what extent is the economic situation ready for a health program transition?	GNI per capita USD per capita spent on health
	To what extent is there community support for the health program to transition?	Civil society engagement in health program
	To what extent is the severity and scope of the health problem addressed by the program to transition?	% geographic coverage of program # deaths or cases averted due to health program % service delivery coverage target addressed by health program # vulnerable populations reached by health program
PRE-TRANSITION	To what extent has a core set of transition stakeholders been identified?	Donor and program recipient have agreed on key stakeholders for transition, including communities/beneficiaries, civil society, etc. Transition team representing key stakeholders has been established
	To what extent has this core set of transition stakeholders agreed on transition objectives?	% key stakeholders who have participated in transition planning events
	To what extent have the transition objectives been planned for, including monitoring and evaluation?	Transition plan with M&E has been agreed upon and documented, including transition timelines
	To what extent have budget allocations been made for transition, including M&E of transition?	% program recipient transition budget that has been funded M&E transition budget available
TRANSITION
Leadership	To what extent is there clear commitment from the political level for program service delivery over the long term?	Program is integrated into national policy or health plans % leaders of affected communities who have been informed of transition plans
	To what extent is there transparent government leadership and management?	Guidelines allow exceptions to operating norms based on realities on the ground Clear lines of government accountability exist for the health program
	To what extent have local authorities incorporated the demands of program service delivery into their routine operations?	% program activities integrated into local operational plans
	To what extent do local stakeholders believe that the health program is a valuable and effective investment of their time and resources?	% program implementers who believe that program recipient has the same or higher level of commitment toward the program as the donor
Financing	To what extent does the program recipient have transparent systems to develop and maintain budgets and expenditures?	% implementers with an audit of their financial records
	To what extent have financial responsibilities been transferred from donor to program recipient?	% donor contribution to health program versus government funding Any recent or planned transitions from other donors working in health area
	To what extent has program recipient secured adequate funding to sustain program?	% gap between estimated annual program costs and resources available
Programming	To what extent is there technical, managerial, and financial capacity within the program recipient to effectively deliver key health program services?	% of required supervision sessions that occur % health program recipient staff qualified for financial management % supervisory or managerial position vacant at health program recipient
	To what extent have any shortages in capacity been identified?	Capacity needs assessment of program recipient has been conducted
	To what extent are training/capacity-building activities occurring or planned to address gaps in capacity?	% training activities completed where capacity shortages were identified
Service delivery	To what extent are budgetary and financial systems aligned with those of the program recipients?	Overall budget and individual line items are reviewed and adjusted for alignment
	To what extent are reporting structures aligned with those of the program recipients?	Reporting frequency of government and program recipients are aligned % reports that are complete upon submission
	To what extent are service delivery or procurement guidelines aligned with those of the program recipients?	% health facilities employing government procurement guidelines
	To what extent do the program M&E systems align with the host country’s M&E systems?	% donor indicators currently being reported to government health monitoring information system
INSTITUTIONALIZATION	To what extent are the key features of the original service maintained in the program post-transition?	% key features of the health program that continue post-transition
	Is there a regular budget line and allocation to support implementation of this program?	Budgets at national/district/facility level reflect funding necessary to support transitioned program Budgeted funds are allocated and disbursed in a timely fashion.
	To what extent is the program reflected in routine norms and guidelines?	Government standard operating procedures reflect modalities of the transitioned program
	Is the health program viewed as a success by key administrators and program implementers?	% key program administrators and implementers who view the program as a success
SUSTAINED SERVICES AND OUTCOMES	To what extent is the program recipient controlling and managing delivery of essential program services?	% health program services delivered through program recipient facilities
	How has the quality of program services changed?	% clients who are satisfied with the program’s services % program administrators and implementers describing same or improved quality of program services post-transition
	How has the coverage of program services changed after transition?	# health facilities providing service before, during, and after the transition
	How have key outcome indicators and key health outcome indicators relating to the health program changed?	Prevalence and incidence of health condition in question Coverage of vulnerable populations reached by the health program
	How was the transition experience overall?	% program administrators and implementers who suggest the overall program changed significantly as compared with pre-transition % program administrators and implementers describing the transition as smooth