Thesis (Master's)--University of Washington, 2021BACKGROUND: Despite the history of U.S.-based partners leading global health programs in low- and middle-income (LMIC) countries, sustainable models of health care rely on local country partners leading the way. Transition is the process of shifting funder-led programs towards country ownership, where local stakeholders plan, manage, deliver, and finance their health sector. However, transition also encompasses earlier steps where local organizations lead and manage programs but still rely on U.S.-based funding. This phase is scarcely described yet threatens long-term program sustainability if navigated too quickly or with poor outcome. METHODS: This qualitative study examines the transition of Zimbabwe’s voluntary medical male circumcision (VMMC) services and HIV prevention, treatment, care, and support services (C&T) programs from management by a U.S.-based organization, the International Training and Education Center for Health (I-TECH), to Zimbabwean management under a new local organization, the Zimbabwe Technical Assistance, Training and Education Centre for Health (Zim-TTECH). The primary objective is to explore challenges, successes, and lessons learned during transition to guide future non-governmental organizations (NGOs) entering similar processes. We conducted sixteen key informant interviews among transition team staff from I-TECH and Zim-TTECH who are based in the U.S. and Zimbabwe, respectively. RESULTS: Findings suggest five major themes to guide the process of transition: 1) Develop a vision and empower leadership for change; 2) Plan and strategize for transition; 3) Communicate with and inform stakeholders; 4) Engage and mobilize staff; 5) Define short-term and long-term success. Additional sub-themes capture the role of local context in mediating transition processes, transition perceptions and their role in mediating transition-related communication, and development of critical infrastructure and staff capacity. CONCLUSION: Local country context, short transition timelines, and indicators of transition success challenged the transition process whereas strong local staff capacity and a synergistic partnership between Zim-TTECH and I-TECH supported success. Change management frameworks suggest transition is not complete when success is defined, but once the organization consolidates gains from the change process and anchors changes in the culture. Funders, international partner organizations, and local organizations should consider their role in enabling a smooth transition process and empowering greater country ownership in the long term
