Country ownership involves shared responsibility and mutual accountability with donors and other partners, particularly when outside financial and technical resources are needed to fully respond to the health sector needs of host countries. The U.S. Government fosters country ownership by investing in high-impact and evidence-based, country-led priorities, plans, and systems.
Defining Country Ownership for U.S. Government-Supported Global Health Programs
Country ownership is defined by the continuum of actions taken by political and institutional stakeholders in partner countries to plan, oversee, manage, deliver, and finance their health sector and achieve health goals. These actions advance sustainable, quality health programs that are locally owned and responsive to the needs of host country nationals.
Transition toward country ownership is a purposeful shift from a U.S.-led and -funded program to an integrated and country-led program. The transition process is intended to facilitate a smooth transfer of the program’s management, implementation, and “ownership” to the intended host country recipient. The ultimate intention of a transition is a changed relationship, one of a mutually beneficial technical partnership between the United States and the partner country.
Accelerating, Monitoring, and Evaluating Progress of Country Ownership
As more information becomes available and our collective knowledge expands, it will become increasingly important for the U.S. Government to develop and sustain a knowledge management function that ensures broad dissemination of new learning, as well as opportunities for practitioners and researchers to gather occasionally to discuss the practical implications of this learning for policies and programs in the field.
Promoting and Engaging In-Country Partners
The process of advancing country ownership requires strengthening the capabilities and changing the dynamics between the U.S. Government and in-country partners, with increasing host country and institutional leadership for the health response. In-country partners include government entities at the national and subnational levels, academia, civil society, the private sector, and other key stakeholders with country presence. Government plays a central role in country ownership. It is the architect of – and provides oversight and coordination for – the entire health sector.
Dimensions of Country Ownership
|Political Ownership and Stewardship||Institutional and Community Ownership|
|Capabilities||Mutual Accountability, including Finance|
Applying the U.S. Government Country Ownership Approach in Botswana
For Botswana, over the next 5 years, U.S. health assistance will focus on promoting country ownership by transitioning emergency response activities to local partners and building the U.S. postemergency response program, with a renewed focus on HIV prevention. In 2011, Botswana stakeholders jointly engaged in a systematic reflection of prevention, treatment, and care programs supported by the national government and civil society, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), and other collaborating partners. Using external facilitators, over a series of weeks of dialogue, challenges in coordination and collaboration, gaps in local technical and managerial capabilities, weak disease surveillance and program data (including financial data) at both the central and district levels, and gaps in local capacity to maintain performance of quality programs were all identified as areas of need. To solve the challenges and sustain the programs, a roadmap was developed that identifies stakeholder roles in needed areas for improvement, cross-sectoral work groups, clear deliverables, and monitoring tools. This roadmap includes capacitating the Government of Botswana to completely finance and manage the country’s antiretroviral therapy, prevention of mother-to-child transmission of HIV, and blood safety programs.