From External to Local: Opportunities and Lessons Learned from Transitioning COMSA-Mozambique

Abstract

Donor transitions, where externally funded programs transfer to country ownership and management, are increasingly common. The Countrywide Mortality Surveillance for Action - Mozambique (COMSA) project established a nationwide surveillance system capturing vital events at the community level with funding from the Bill and Melinda Gates Foundation. COMSA was implemented in partnership between Johns Hopkins University (a U.S.-based academic institution) and the Instituto Nacional de Saúde (National Institute for Health) and Instituto Nacional de Estatística (National Institute for Statistics), two Mozambican public institutions. Midway through the project, the Gates Foundation directed COMSA's partners to develop and implement a transition plan that ensured COMSA's activities could be institutionalized after Gates Foundation funding ended. Here we describe the process and activities that COMSA underwent for transition planning, including stakeholder engagement and advocacy, securing financial commitments, documenting operational activities, capacity building, and supporting strategic planning. Facilitators included a project model that already embedded significant implementation and management responsibility with local agencies, high-level commitment to COMSA's activities from local stakeholders, establishing dedicated personnel and budget to manage transition, and fortuitous timing for financing. Challenges included needing to engage multiple government agencies to ensure buy-in, navigating tensions around future roles and responsibilities, reviewing and adjusting existing implementation structures, and the reality that this transition involved shifting financing from one development partner to another. Transition implementation was also constrained by the COVID-19 pandemic because key stakeholders were engaged in response efforts. COMSA's experience highlights lessons and threats for future programs facing donor transition in uncertain environments.

Figure 1.

Conceptual framework for donor transitions (from Bao et al. 2015¹⁷).

Figure 2.

Shift in Countrywide Mortality Surveillance for Action – Mozambique governance during transition. CHAMPS = Children’s Health and Mortality Prevention Surveillance; CRVS = Civil Registration and Vital Statistics; DNSP = National Public Health Directorate; DPC = Directorate for Planning and Cooperation; INE = National Institute of Statistics; INS = National Institute of Health; MISAU = Ministry of Health; MoJ = Ministry of Justice and Constitutional and Religious Matters.

Figure 3.

Countrywide Mortality Surveillance for Action (COMSA) transition governance structure. BMGF = Bill & Melinda Gates Foundation; CRVS = Civil Registration and Vital Statistics; DNSP = National Public Health Directorate; DPC = Directorate for Planning and Cooperation; INE = National Institute of Statistics; INS = National Institute of Health; JHU = Johns Hopkins University; MISAU = Ministry of Health; MJCR = Ministry of Justice; USAID = U.S. Agency for International Development.