During the next few years, over a dozen middle-income countries are likely to transition away from multilateral concessional assistance—that is, grants and loans that offer flexible or lenient terms for repayment—including support from International Development Association (IDA) and Gavi, the Vaccine Alliance. There are good reasons to worry these countries, including Nigeria and Pakistan, will find the transition tough. Despite being middle-income economies, many of them still have high rates of child and maternal mortality, weak health systems, and large shares of the population living in poverty.
Are these countries are more vulnerable and less ready to transition than countries that previously graduated? And, if they are, should multilateral agencies adjust their transition policies?