Between 2004 and 2013, the global AIDSRelief program supported rapid scale-up of HIV care and treatment services for poor and underserved people in ten countries across Africa, the Caribbean, and Latin America. AIDSRelief served more than 700,000 clients, including more than 390,000 who enrolled in antiretroviral therapy (ART) through 276 facilities.

AIDSRelief established basic packages of HIV care and treatment that exceeded what many thought possible in resource-constrained environments. The program helped broad cadres of health workers to identify and manage treatment failure or other adverse drug events; to diagnose, treat, and prevent opportunistic infections; and to provide patients with adherence counseling and support, empowering them to effectively manage their own treatment. The program also cultivated sustainable patient access to quality services provided and managed directly by local partners.

To capture and share knowledge gained through AIDSRelief’s transitions to local partners, the Health and Social Services unit at Catholic Relief Services (CRS) has developed this learning document. Interviews with project staff, local partners, and facility personnel involved with transition provide the foundation for an exploration of challenges, successes, and potential best practices identified in five AIDSRelief countries.

The experiences of transitioning grant management, clinical oversight, and strategic information management from a consortium made of international organizations to wide-ranging local partners varied tremendously. In the four countries profiled in this document, common themes appeared: cultivating a shared vision, bringing partners “to the table” in a meaningful way, encouraging staff continuity, and balancing flexibility with prescription. Shared common understanding vision and commitment to transition process, as well as improving local partner’s systems and building trust, confidence among stakeholders, facilitated the transition process toward local ownership.

This analysis also made clear that sustainability is a process and there are degrees of organizational maturity. For a successful transition, the receiver or local partner needs to have adequate organizational and technical capacity. Many local partners already have substantial capacity and most have the potential to strengthen their capacity. They are best positioned to address local problems because of their situational knowledge and existing networks and relationships. However, even the most robust organizations benefit from targeted outside expertise, which is often best provided by international partners (IPs):

• Large, well-resourced international institutions continue to have greater access to highly specialized skills and knowledge than local partners. IPs are well positioned to provide technical assistance in these areas (e.g., U.S. government grant and financial management, state-of-the-art technology or clinical practices).
• Competencies such as financial management and human resources typically take priority in organizational development interventions. They are essential, yet a fully realized organization must perform other functions (e.g., communications, documentation, advocacy, and qualitative research). IPs can provide resources and technical assistance in areas such as these. 
• Successful transition to a truly local partner has emerged as a skill in itself and direct experience is relatively rare. Transition requires dedicated resources; it must be scheduled, budgeted, staffed, and monitored, and it requires targeted capacity strengthening. Donors and implementers must be willing to set up local partners for success by investing in deliberate, context-specific transition planning and implementation. Experienced IPs and organizationally mature local organizations have important roles to play in future development efforts.