of the people living in the community working in the facilities. Also training peer workers, supporting networks of people to start groups. Building a supportive community and engaging community partners has been a process and a huge effort.” (NCV-5-USACA)
Transitioning of Programs to Local Prime Partners
The first phase of transitioning programs began with the PEPFAR original Track 1.0 partners, which were all required to complete transitioning of their programs and services to local entities in the partner countries in which they operated by February 2012 (NCV-9-USG; NCV-12-USG; NCV-30-USG; NCV-11-USG). Some of the entities are partner country governments at the national and subnational levels and their implementing partners, while others are local NGOs (NCV-5-USACA; 166-33-PCGOV; 636-9-USACA; 636-19-USNGO; 166-10-USNGO). Reportedly, entity readiness for accepting management of programs was based on formal and informal assessments of local partners including ministries of health, health facilities, district government entities, and NGOs before they received direct USG funding to serve as prime partners (NCV-4-USACA; NCV-5-USACA; NCV-6-USNGO). Some assessment tools were developed by USG partners, including USG agencies, but they vary in complexity in terms of what they measure and their ease of use. The Track 1.0 partners’ transition is offered as an example of what the USG would like to achieve across similar health programs (USG, 2012).
“The transition has to occur with trust, they shouldn’t be afraid to let go but at the same time they need to have systems in place to make sure the quality of the care provided is ensured. There is anxiety about readiness, for example with the Track 1.0 transitions. It’s time to change the relationship with the countries, changing the role of PEPFAR staff from the person who manages the program to the person who is with the person who manages the program.” (NCV-12-USG)
The Track 1.0 partner experience was also identified as an opportunity to learn lessons about what needs to be done or avoided, at what pace, and how to measure success for transferring programs to local partners:
“we haven’t actually taken the time to learn, no one has actually studied Track 1.0 to say what are, this massive transition of hundreds of millions of dollars a year and hundreds of thousands of people in chronic care, we haven’t actually sat down to look at that and say what’s worked, what hasn’t worked, what lessons are in here [. . .] if that works or doesn’t work and we learn from that, that’s what we can actually begin to do globally and you learn what