Transition Initiative

In the wake of unprecedented funding cuts to global public health, the long-term survival and sustainability of community-led health services is at stake.

Launched in May 2025, the Transition Initiative is turning this moment of crisis into an opportunity for lasting change. Working with national coalitions across five countries in Africa, it is helping build health systems that communities own, governments fund, and donor cuts cannot dismantle.

WHY THIS WORK MATTERS

Transition from ODA-funded, disease-specific approaches to nationally led and financed health systems is long overdue. However, the rapid changes in the global health financing landscape accelerated this transition in a way that many health systems could not immediately respond to.  

For Frontline AIDS and our partners, the impact has been devastating. Many partner organisations have been forced to close programmes and clinics, leaving an estimated 1.6 million people without access to life-saving HIV and sexual and reproductive health services across our partnership alone. The cuts have affected the most marginalised people, who depend on dedicated, community-led services that national systems have historically failed to reach. 

This is not a temporary disruption. It represents a structural shift in how global health is financed, and it demands a long-term, strategic response. 

WHY FRONTLINE AIDS

Frontline AIDS has spent over 30 years building something that most organisations are now trying urgently to create: genuine, sustained relationships with civil society organisations and community networks at the frontline of health systems across more than 100 countries. 

That experience was forged in one of the most complex and politically charged health responses in history. Working on the HIV response has meant navigating stigma, legal barriers and hostile governments, all while keeping the most marginalised at the centre. Communities drove the breakthroughs: securing access to treatment, pushing for legal changes and building services where none existed.  

Our model has always centred communities and now is the time to use this HIV infrastructure to support the building of new resilient and sustainable health systems. Three decades of working alongside governments, civil society and community networks have shown us what it takes to move from small pilots to lasting, systems change, that goes beyond a single disease. This cannot be done without the input and direct engagement of the people who these systems are designed to serve.  

WHAT THE TRANSITION INITIATIVE DOES

The Transition Initiative focuses on: 

• Building strong coalitions that bring together the full spectrum of civil society: feminist organisations, women’s rights groups, youth networks, people living with HIV, key population networks including sex workers and LGBTQ+ communities, faith leaders, and community health organisations, alongside other health system actors. Fragmented advocacy less effective and harder to sustain. Coalitions that represent diverse communities and constituencies carry greater legitimacy with governments, engage more effectively with decision-makers, and make better use of limited resources. Our coalitions are open to all civil society actors working to strengthen health systems, including those built through our United for Prevention programme, which has an established track record of collaboration with governments on health and financing. 

• Building long-term financing solutions, including advocacy for increased domestic health financing, budget advocacy, cross-disease integration, universal health coverage (UHC), social contracting mechanisms that enable governments to fund community-led services, and exploration of innovative financing approaches. 

• Building resilient health systems that span HIV, hepatitis, STIs, cervical cancer, TB, HPV and FGS and beyond, and that are designed to reach the most marginalised.  

• Aligning with global and regional sustainability frameworks such as the Accra Reset and the Lusaka Agenda, connecting country-level advocacy to international processes for long-term financing and policy change. 

• Delivered as part of Frontline AIDS’s broader technical support, the Transition Initiative draws on our expert staff and partners to provide hands-on, responsive, and outcomes-focused support that strengthens national civil society and community leadership, and holds governments to account. This means partners receive not just strategic guidance, but practical, expert support tailored to their specific context. 

Since May 2025, the Transition Initiative has documented 27 concrete outcomes across five countries, ranging from government commitments to formal policy changes such as reducing the age of consent; increases to national health budgets, and approval for Lenacapavir. The tools, approaches and peer learning networks developed through this work are directly transferable and available to coalitions across the region and world. 

If communities are an afterthought when redefining health architecture, governance and financing, transition becomes a risk rather than an opportunity. 

HOW AND WHERE the programme WORKs

The Transition Initiative is currently active in five countries: Kenya, Malawi, Nigeria, Tanzania and Uganda, all of which have experienced sharp reductions in aid. Frontline AIDS is also supporting government accountability advocacy with established coalitions in Angola, Mozambique and Zimbabwe. 

The programme works through broad national coalitions, not individual organisations, bringing together national community networks and civil society organisations relevant to health financing. This creates collective legitimacy and reduces individual risk in restrictive political contexts. Cross-country peer learning sits at the heart of the approach, with structured exchanges allowing partners to learn from one another on how to advocate, influence policy and technical design. 

The At a Crossroads country reports, published in 2025, document community and civil society experience of the funding withdrawal and what they say needs to happen next. 

The programme is funded by the Swedish International Development Cooperation Agency (Sida).

ACCESS TRANSITION INITIATIVE SUPPORT

If you are a civil society coalition, community network, or Global Fund grantee navigating the health transition, we want to hear from you. The Transition Initiative is open to supporting partners beyond our current implementation countries. Get in touch to find out how we can work together: technicalassistance@frontlineaids.org.