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India

  • In December 2012, the Health Policy Project (HPP) supported the ARC Coalition to bring together 20 consortium members and project partners to develop a common advocacy plan. Facilitators from HPP and the Advance Planning Project led the process by building focus, commitment, and consensus among consortium partners on a common advocacy issue. At the end of two days, the consortium members had identified key areas for policy advocacy that have the highest probability of success for ARC in the next year, identified the relevant key stakeholders, and began to develop action plans. Within the broader goal of contraceptive choices being expanded, the key areas identified included expanding the mix of spacing methods and increasing access to current methods of spacing.

  • The Health Policy Project (HPP) helped countries achieve their health goals by building capacity for policy, advocacy, governance, and finance at multiple levels. The project developed global tools and best practices for policy work, promoted South-South sharing and collaboration, and carried out regional and country-specific policy initiatives. The files included in this zip document provide brief program overviews for each country highlighting key accomplishments. Individual briefs are available from the country pages.

  • The Policy Unit of the National Institute of Health and Family Welfare (NIHFW), the USAID-funded Health Policy Project (HPP), the National Health Systems Resource Centre (NHSRC), and the Government of the State of Uttarakhand conducted a study to understand the effectiveness of National Rural Health Mission (NRHM) financing in terms of allocation, disbursement, efficiency, and utilization. The study was designed to identify barriers in the flow of NRHM funds from state to district and sub-district levels of the public health system in Uttarakhand State. It found evidence of highly centralized, top-down planning, despite NRHM’s intent for a bottom-up approach. The state often does not allocate funds according to district requests, and below the district level funds are not fully utilized. There is some evidence that expenditures were efficient in that resource use was connected with performance. This study is the follow-on report to Effectiveness of Fund Allocation and Spending for the National Rural Health Mission in Uttarakhand, India: State and District Report.

  • India's National Rural Health Mission (NRHM) is one of the world's largest government-funded primary healthcare programs. Improving the effectiveness of financing for this program is crucial for both the central and state governments in India. In partnership with the National Institute of Health and Family Welfare and the National Health System Resource Centre, the USAID-funded Health Policy Project examined the allocation and spending of funds for NRHM in Uttarakhand, one of the program's "high focus states." This report summarizes the results of the first phase of the analysis, which examined fund flows from the state to the 13 districts using financial records from fiscal years 2008–09 to 2011–12. The analysis explored three questions: 1) whether funds are allocated to districts according to their health needs, 2) whether districts are able to spend the funds allocated to them, and 3) how districts spend funds relative to health needs. Results indicate that NRHM funding in Uttarakhand could be made more efficient by aligning allocations and spending with health needs, and improving districts’ ability to spend all the funds available to them. 

  • Tackling undernutrition and achieving food security will require cross-sector collaboration, innovative approaches, and optimizing the use of all available interventions. In 2014, the USAID-funded Health Policy Project conducted two reviews of the empirical evidence on the impacts of one intervention—family planning—on food security and nutritional status, respectively. 

    This brief on nutrition shows that when women exercise their freedom and right to access voluntary family planning to meet their fertility intentions, there is a natural decline in the prevalence of high-risk and unintended pregnancies; and that by averting such pregnancies, improvements in key maternal, infant, and child nutrition outcomes can be achieved. 

    The accompanying report is available here, and a companion brief on food security is available here.

    Also see the companion desk review synthesizing the programmatic experiences of integrating family planning with food security and nutrition. It was conducted by the Food and Nutrition Technical Assistance III Project (FANTA) and is available here: http://www.fantaproject.org/focus-areas/food-security/desk-review-programs-integrating-family-planning-food-security-and-nutrition. 

  • This report covers an evaluation of the collaboration between the Ministry of Health of the Indian State of Jharkhand and the Health Policy Project to conduct a program (Nov. 2012-July 2013) to strengthen capacities at state, district, and sub-district levels to effectively implement the 2010 family planning  strategy.  It included training, mentoring, and supportive supervision. A State Resource Group of master trainers from government and civil society supported the 4-person Family Planning Cell. A pre/post-implementation quantitative and qualitative assessment highlighted that although the implementation period was short, systems were strengthened and laid a solid basis for achieving  Jharkhand’s FP goals.  The assessment highlighted improvements in timely data updates (from 27% to 91%),  increased stocks of FP commodities and IEC materials, and wider availability of doctors trained in clinical services. Budget allocations for spacing methods increased and the FP Cell invested in training health staff on counseling and  IUD skills. Staff reported an improved attitude toward information sharing and joint problem solving.  The 3-district pilot program has been scaled up in 11 additional high-need districts.  

  • As part of the USAID-led PEPFAR Sustainable Financing Initiative to increase domestic resources for HIV, the USAID- and PEPFAR-funded Health Policy Project created 31 macro-fiscal and health financing profiles for 18 countries that are transitioning to a higher income status, have high HIV burdens, and/or rely heavily on donor funding. These country profiles assess past trends and future projections in key indicators related to a country's ability to grow economically and dedicate more financial resources to health, including HIV.

    The macro-fiscal profiles provide overviews of each country's economic growth, political economy, and government revenue and expenditure. The health financing profiles analyze government, external, and out-of-pocket spending on health; health financing functions, including revenue contribution and collection, pooling, and purchasing; and HIV financing trends.

    You may download individual briefs on this page.

  • The Indian state of Jharkhand has shown commitment to improve the implementation of its family planning (FP) program and undertook a capacity-building program, with technical assistance from the USAID-funded Health Policy Project (HPP), to strengthen capacities of the state Family Planning Cell, civil society organizations, and district- and block-level health functionaries to operationalize the state's FP strategy and oversee its effective implementation. This program was piloted in three focus districts—Simdega, West Singhbhum, and Giridih—and followed an intensive approach that included a capacity needs assessment and development of a program that was in line with the findings of the needs assessment.

    This toolkit was developed as an aid for HPP’s capacity-building program in the Jharkhand. It consists of the Manager's Tool to record data during mentoring and supervisory visits; the Manual for District and Block Managers and accompanying PowerPoint slides that provide training and guidance to build capacity for a stronger health system that supports family planning programs; and the Training of Trainers Manual and accompanying PowerPoint presentations to build participants' skills to become trainers of district- and block-level managers in health systems strengthening and effective management to improve FP programming.

  • Injectable contraception has been available in the private sector in India since 1986, but is not accessible to public sector clients. With support from the USAID-funded Health Policy Project, the Policy Unit of the National Institute of Health and Family Welfare conducted a stakeholder analyses to understand the barriers to introducing injectables in the package of methods available through the public sector. This descriptive brief combines primary and secondary data to provide a status update and policy analysis to stakeholders advocating for policy change to expand the basket of contraception in the public sector.

  • Expanding access to health insurance is an important part of an overall strategy to achieve universal health coverage (UHC). Since its launch in 1999, the National Health Insurance Scheme (NHIS) has been Nigeria’s major initiative to expand health insurance in the country. To support this endeavor, the Health Policy Project conducted case studies of the experience of three countries—Colombia, India, and Thailand—as they developed government policies as a strategy to achieve universal health coverage (UHC). The lessons learned should be useful for Nigerian stakeholders involved in expanding and improving the NHIS, as well as for stakeholders in any country facing similar challenges. How health insurance expansion features in a UHC strategy depends on the resources available to the government via general taxation; the growth and maturity of private voluntary health insurance markets; and, most important, the state of the health system across primary, secondary, and tertiary healthcare. Our case studies suggest that pragmatic choices made by lower-middle and middle-income governments—a group where Nigeria may be placed—have involved hybrid health financing models.

  • The Gender, Policy and Measurement program, funded by the Asia bureau of the U.S. Agency for International Development and implemented by the Health Policy Project (HPP) and MEASURE Evaluation, undertook a comprehensive, systematic review of the impact of gender-integrated programs on health outcomes. The findings are primarily intended to inform the work of government officials, donors, nongovernmental organizations, and other key stakeholders involved in health programming in India, as well as other low- and middle-income countries around the world.

    This review presents evidence showing how gender-integrated programming influences health outcomes in low- and middle-income countries: in particular, reproductive, maternal, neonatal, child, and adolescent health; HIV prevention and AIDS response; gender-based violence; tuberculosis; and universal health coverage.

    To read the full report—Transforming Gender Norms, Roles, and Power Dynamics for Better Health: Findings from a Systematic Review of Gender-integrated Health Programs in Low- and Middle-Income Countries—please visit www.healthpolicyproject.com?zp=381.

  • The Gender, Policy and Measurement program, funded by the Asia bureau of the U.S. Agency for International Development and implemented by the Health Policy Project (HPP) and MEASURE Evaluation, undertook a comprehensive, systematic review of the impact of gender-integrated programs on health outcomes. The findings are primarily intended to inform the work of government officials, donors, nongovernmental organizations, and other key stakeholders involved in health programming in India, as well as other low- and middle-income countries around the world.

    This review presents evidence showing how gender-integrated programming influences health outcomes in low- and middle-income countries: in particular, reproductive, maternal, neonatal, child, and adolescent health; HIV prevention and AIDS response; gender-based violence; tuberculosis; and universal health coverage.

    This report was authored by Arundati Muralidharan, Jessica Fehringer, Sara Pappa, Elisabeth Rottach, Madhumita Das, and Mahua Mandal.

    To read the subject briefs associated with this report, please visit: http://www.healthpolicyproject.com/index.cfm?id=publications&get=pubID&pubId=382. 

  • According to the 2011 census, India’s population is 121 crore (1.21 billion), an increase of 18.1 crore (181 million) since 2001. United Nations estimates indicate that India will be the most populous country in the world by 2030, surpassing China. The Empowered Action Group (EAG) states constitute 45.9 percent of the country’s population, so the future of India’s population will largely be governed by the socio-demographic status of these states. This brief, developed by the Policy Unit of the National Institute of Health and Family Welfare and the USAID-funded Health Policy Project, presents a situational analysis of fertility and family planning indicators of the EAG states in India, focusing on the levels of and trends in certain crucial indicators, such as the total fertility rate, contraceptive prevalence rate, current scenario of method mix, and unmet need for contraception. This analysis could be used as a ready reckoner for stakeholders at different stages of planning and implementing family welfare programs across the EAG states.