Resources for Transitioning from Relief to Development in the Health Sector

In follow up to the 2012 InterAction Annual Forum, the Integrating Health in Relief and Development (IHRD) working group began an exploration of available resources on the transition from relief to development in the health sector.  While there are a significant number of case studies, reasearch and position papers on the transition period, little practical information exists on how international NGOS can take the steps recommended by donors, researchers and practioners to engage appropriately in the transition process. 

The goal of this exploration was therefore to find tools, manuals and guides that can be used by NGOs to improve efficiency in the transition from service provision during humanitarian action to health systems strengthening in the development context. The result is the compilation of the following tools, guides and other resources that we hope will be useful to NGOs as they design and implement health programs in transition periods.

The next stage of work for the IHRD working group will be to assemble a Health Transitions Task Force to assess the gaps that remain in the collection of materials and recommend priority actions to fill these gaps so that a relevant and useful Health Transitions toolkit can be developed.

Suggestions and feedback are welcome and can be emailed to Danielle Heiberg at  



Health Management Capacity Assessment Tool for Post-Conflict States (USAID/BASICS)

Capacity Building in Management

This tool from the USAID BASICS program helps the user to identify specific capacity building needs of provincial health teams to manage (plan, implement and evaluate) a decentralized provincial health system, as well as the factors that influence their ability to transition from relief to development.

A tool for implementing partners, donors and ministries of health, it helps to:

  1. Determine the stage of transition of provincial health system
  2. Identify the enabling and constraining factors that influence the provincial health team’s ability to manage decentralized health system
  3. Determine the capacity building needs of provincial health teams
  4. Propose recommendations to strengthen the ability of health teams to manage the health system

Under the framework of the tool, management is understood to be the actions of planning, implementing and monitoring six components of the health system: oversight and coordination of health sector, human resource management, resource management (medical and non-medical), health financing, community involvement, and information. It is based on a complex adaptive systems approach in which resources, skills, knowledge, organization, politics and power, and incentives are elements that influence the ability of the provincial health team to manage the health system. Its methodology relies on the involvement of all actors in the system to reach consensus on the stage of transition, needs for capacity building and the factors that influence capacity.

There are four instruments to the assessment. The first two are: a questionnaire to determine to the stage in the transition from relief to development, and interviews of the health teams and ministry of health to understand how service delivery is coordinated. The final two instruments are a group discussion about the findings from the first two instruments and a document review of the policies and guidelines that inform planning, implementation and evaluation decisions.

Performance-Based Contracting for Health Services in Developing Countries; A Toolkit (World Bank)

Working with Government

This ebook was created by the World Bank in 2008 to provide guidance to NGOs and other actors on Performance-Based Contracting. It includes a contracting plan, draft contract, terms of reference, and a checklist for designing and implementing a performance-based contract. 

Site Capacity Assessment Tool (Catholic Relief Services)

Sustainable Programming

This is a tool to enable NGOs to assess the capacity of supported health care facilities to provide HIV/AIDS programs before transitioning to local management. It enables NGOs to routinely monitor local capacity and identify the priority actions needed to improve capacity and assesses whether a facility has met the minimum requirements to ensure sustainability.

What We Know About Exit Strategies: Practical Guidance for Developing Exit Strategies in the Field (CORE Group)

Sustainable Programming

This document includes guidance and tools to enable NGOs to create exit strategies. It includes a conceptual framework for understanding exit strategies and guidance on how to create them. A planning matrix with questions to guide the process is included.

How to Mobilize Communities for Health and Social Change (USAID)

Community Involvement

A guidebook for health program directors and managers of community-based programs to use community mobilization as a method to improve health at the individual, community and family level. It includes general principles and methods as well as examples and lessons learned, focusing on marginalized groups. The guide helps the user to implement, monitor and evaluate, as well as scale up community mobilization programs.

Partnership Defined Quality: A Toolbook for Community and Health Provider Collaboration for Quality Improvement (Save the Children)

Community Involvement

Designed for project managers, health service mangers, school administrators or facilitating agencies, this toolbook guides the implementation of a methodology to build partnerships between communities and service providers with the aim of creating and monitoring a plan to improve healthcare quality. 

Responsibility and Authority Mapping Process (RAMP) (Management Sciences for Health)

Capacity Building in Management | Coordination

A tool for policy makers and managers to help identify health management functions for which responsibility is ambiguous and set priority actions to clarify roles and responsibilities through interviews and consensus building among actors in health system.

Health and Peacebuilding: Securing the Future (AusAid)

Conflict Sensitive Strategic Planning

The Health and Peace-building Filter is a tool for combined health and conflict assessment. It presents factors to consider in the design, M&E of health programs to ensure that programs can more efficiently contribute towards peace-building. This analysis will help to identify the strengths and weaknesses of possible interventions. The Health-Conflict Cube Matrix helps the user to continuously assess the appropriateness of interventions according to the stage of the conflict, including Pre-Conflict,  Humanitarian Relief, Transitional and development cooperation phases.

Paying for Performance Blueprint Guide (USAID)

Human Resources for Health

This guide presents a framework for program managers to design a payment for performance program in low and middle income countries. It also provides guidance on identifying stakeholders and acquiring their buy-in. Includes past P4P blueprints and case studies in the annexes.


Case Studies

Health Service Delivery in Early Recovery Fragile States: Lessons from Afghanistan, Cambodia, Mozambique, and Timor Leste (USAID/BASICS)

Basic Service Provision

Innovative Financing in Early Recovery: The Liberia Health Sector Pool Fund (Center for Global Development, 2012)

Donor Financing

Post-conflict Health Sectors: The Myth and Reality of Transitional Funding Gaps (Health and Fragile States Network, 2008)

Donor Financing

Includes case studies of transitional funding gaps in Liberia, Afghanistan, Democratic Republic of the Congo, Sierra Leone, Southern Sudan, Timor Leste

Rehabilitating Health Systems in Post-Conflict Situations (United Nations University, 2007)

Coordination | Contracting

Rehabilitating the health system after conflict in East Timor: a shift from NGO to government leadership (London School of Hygiene and Tropical Medicine, 2006)

Coordination | Contracting | Information Sharing

The AIDSRelief South Africa Partnership (Catholic Relief Services, 2010)

Coordination | Partnership Building | Exit Strategies

The AIDSRelief Rwanda Partnership: Transitioning to the Ministry of Health (Catholic Relief Services, 2010)

Coordination | Partnerhsip Building | Exit Strategies

A Comprehensive Framework for Human Resources for Health System Development in Fragile and Post-Conflict States (Ministry of Health, Labor and Welfare, Japan)

Human Resources for Health | Training Health Workers | Coordination

This peer reviewed journal article presents lessons learned from concise analysis of NGO and government efforts to improve Human Resources for Health (HRH) in Afghanistan, the Democratic Republic of Congo, and Cambodia. It also presents a house model analytical framework for HRH similar to the WHO HRH Action Framework. 


Conceptual Frameworks and Research Studies

Overview of the Relief-to-Development Health Sector Transition (USAID/BASICS) 

This is a conceptual framework to understand the transition process. The document includes diagrams that outline the strategies that are needed to move assistance from humanitarian relief to development in the health sector, and divides these strategies between the county and state level, and the community and facility level. However, the diagrams outlines very the broad overall strategies and criteria needed for a successful transition and is not specifically addressed to NGOs. 

From Humanitarian and Post-Conflict Assistance to Health System Strengthening in Fragile States: Clarifying the Role of NGOs (USAID/HealthSystems20/20)

A policy brief that provides a conceptual framework for understanding the fragile state context and transitions in the health sector and which provides a matrix of sugessted activities to include in contracts between NGOs and governments, and indicators for those activities.  


Donors, Academic Institutes and Organizations working on Transitions/Health System Stregnthening in Fragile States


International Network on Conflict and Fragility (Funding)

United Nations

Cluster Working Group on Early Recovery (Planning | Funding) 


Health Systems 20/20 (Health Programming)

BASICS (Health Programming) 

Other organizations:

Health and Fragile States Network

HealthNet TPO