Recent research has focused on the factors that enable middle-income countries to successfully transition away from international health assistance. The research identified three key factors needed for this transition: effective leadership, using domestic resources to bridge the financial gap caused by the loss of international aid, and adapting countries' health systems to new sources of domestic financing. This issue is topical in the context of the recent reduction of international health aid by major donor countries. Middle-income countries must prepare for the transition away from external aid by strengthening their own financial capacities and improving the management of health systems. Effective leadership is necessary for the successful implementation of these changes. Adapting systems to new domestic funding sources requires strategic planning and coordination at all levels of the health system.