Towards resilient and agile health systems: lessons from abrupt donor withdrawal in Jordan.

Abstract

Background: Donor-funded health programmes strengthen national quality systems in low-income and middle-income countries, but abrupt withdrawal of external support can create institutional gaps and threaten service sustainability.

Aim: To analyse the impact of sudden donor funding cessation, using the experience of the Health Care Accreditation Council (HCAC) as an illustrative case, and to explore implications for quality infrastructure and health system resilience.

Methods: This structured case-based policy analysis draws on institutional documentation, administrative records and publicly available reports to examine the effects of funding withdrawal on quality programmes and organisational capacity.

Results: Funding cessation led to contraction of technical workforce capacity, scaling back of quality improvement and professional development activities, and disruption of accreditation-related support. The case exposed vulnerabilities associated with donor dependency and insufficient transition planning.

Conclusion: Abrupt donor withdrawal can weaken quality systems and patient safety gains. Strengthening resilience requires diversified financing, structured transition frameworks and institutional strategies that embed quality governance within nationally owned systems.