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HIV

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  • This report documents the advocacy campaign for Ukraine's 2014-2018 National HIV Program (NHP). The USAID- and PEPFAR-funded Health Policy Project (HPP) worked with the State Service of Ukraine on HIV/AIDS and Other Socially Dangerous Diseases to calculate the impact of funding decisions on Ukraine’s ability to reach the goals of the NHP using the Goals model. These data formed the basis of the advocacy campaign.

  • Tracking health budget allocations is critical in assessing whether resources allocated in the health sector are aligned to key policy objectives as articulated in policy documents. In Kenya, the Constitution requires that at least 15 percent of the national revenues should be allocated to the county governments to fund the devolved functions that include health. This study assessed the trends in allocations between 2013/14 and 2014/15, and sought to establish whether the allocations were aligned to sector priorities both at the national and county level.

  • The Gender & Sexual Diversity Training was developed by the USAID- and PEPFAR-funded Health Policy Project, in coordination with a U.S. Government interagency team made up of members of the PEPFAR Key Populations Working Group and the PEPFAR Gender Technical Working Group. This version of the curriculum was developed specifically for PEPFAR staff and their country-level implementing partners to help country programs understand and address the needs of gender and sexual minority communities in the context of HIV programming, U.S. workplace policy on non-discrimination, and through a human rights lens.

  • The presence of supportive FP/RH policies is considered an integral component to successful programs. However, much remains to be known about how policies are implemented, especially in a complex political, sociocultural and economic environment. This poster outlines the various methodologies that can be used to study policy implementation, which include descriptive methodologies such as literature reviews and case studies; analytic methodologies such as stakeholder mapping and analysis, cross-sectional surveys and system dynamics; quasi-experimental and experimental studies; studies describing policy implementation within complex adaptive systems, such as, path dependence; and mixed methods as well including focus groups, document analysis and interviews. This poster was presented at the Population Association America conference on May 1, 2014.

  • Civil society organizations (CSOs) can make an important contribution to health programs and public welfare by encouraging governments to involve citizens and technical specialists in identifying and addressing important human needs. Good governance exists when decisionmakers are accountable to the public; processes are transparent; institutions and information are directly accessible; and the government is able to serve the needs of its people effectively. The Health Policy Project prepared this brief to provide leaders of CSOs working in family planning, HIV care and treatment, and maternal health with guidance on ensuring good governance, social accountability, and transparency.

    This is one of two briefs focused on advancing country ownership for improved health. The other brief can be accessed here: Networking and Coalition Building for Health Advocacy: Advancing Country Ownership.

  • Over the past decade, large scale global health initiatives have had great successes in supporting improved health outcomes in many countries. Each country is unique in building its approach to public health programming, but these partnerships are beginning to identify common principles toward working together. In fall 2012, a consultation cosponsored by amfAR, the Health Policy Project (HPP), International Planned Parenthood Federation (IPPF) Africa Region, and Planned Parenthood Global brought together multi-disciplinary stakeholders to identify priorities and models for ensuring civil society engagement in health decision making. This report presents the findings of the consultation, examines civil society’s role in sustaining public health and transitioning to the country ownership model, and offers recommendations for civil society, governments, donors, and international development partners.

  • In 2007, WHO recommended that voluntary medical male circumcision (VMMC) should be scaled up in priority countries with high HIV prevalence and low male circumcision (MC) prevalence. UNAIDS estimated that 3.2 million males had undergone VMMC by the end of 2012. Implementation experience has raised questions about the need to refocus VMMC programs on specific subpopulations for the greatest epidemiological impact and programmatic effectiveness. As Malawi prepared its National Operational Plan for VMMC, it sought to examine impacts of targeting subpopulations by age and subnational region. The Health Policy Project, with funding from PEPFAR through USAID, applied the new DMPPT 2.0 model (see this poster  for model description) to study the impact of scaling up VMMC to different target populations disaggregated by age group and geographical subregions of Malawi. This poster was presented at the 20th International AIDS Conference in Melbourne, Australia, in July 2014.

  • Based on the UTETEZI Project curriculum, Advocacy for Improved Access to Services for MSM: A Workshop Curriculum for a Multi-Stakeholder Policy Advocacy Project, this advocacy for policy change guide is designed for use by MSM (men who have sex with men) groups, community-based organizations (CBOs), civil society organizations (CSOs), and individuals working in HIV and MSM health to help them advocate regionally, nationally, and locally for improved HIV and health-related MSM policies. In particular, this guide can serve as an important tool for CSOs working on MSM issues in hostile legal environments.

  • Community-based models for HIV treatment and care have shown promise in some sub-Saharan countries, especially for improving patient outcomes and increasing the sustainability of the overall program. The Health Policy Project, in collaboration with the National AIDS and STI Control Programme, reviewed the state of evidence for implementing community-based approaches to care and treatment in Kenya. While some of the evidence suggests that such models can be applicable and beneficial, more data and Kenya-specific evaluations are required before concrete recommendations can be made. This brief serves a research agenda for Kenya in this regard.

  • This USAID and PEPFAR-funded Health Policy Project report analyzes the integration of HIV and sexual and reproductive health services in the Cote d’Ivoire. 

  • In this brief, the USAID- and PEPFAR-funded Health Policy Project (HPP) offers analysis on the GOT’s tax revenue collection prospects and explores tax reforms that the GOT may implement in the future. Growth in tax revenue has been linked with countries’ progress on universal health coverage (UHC), especially in countries with low tax bases (Reeves et al., 2015). In Tanzania, the HSSP IV and HFS both identify tax reform as an important mechanism to raise the total allocation to health, and reduce the resource gap in the health sector. As has been experienced in other countries, earmarked tax revenues, from a growing overall tax base, can help secure financing for health. This brief also investigates the process by which Tanzania’s Ministry of Labor (MOL) and the Ministry of Infrastructure and Communication (MOIC) were able establish tax “set-asides” for programs in their sectors, and whether it is feasible for something similar to be done for the MOHCDGEC that would pool tax revenue specifically for health and HIV and AIDS. For example, such a set-aside was accomplished in Zimbabwe with the AIDS Levy, introduced in 1999, which is charged on individuals, companies, and trusts at a rate of 3% of taxable income or profits. This revenue, estimated at US$157 million collected over 2009-2014 (Kutyauripo, 2015), is allocated to the National AIDS Trust Fund in Zimbabwe to be managed and disbursed for HIV programming, including 50% for antiretrovirals (ART).  

  • The Government of Kenya, through the National AIDS Control Council, is developing the Kenya AIDS Strategic Framework 2014/2015 to 2018/2019 to provide guidance on the country’s priorities in HIV programming and increase the effectiveness of the national response. The framework will build on and succeed the Kenya National AIDS Strategic Plan 2010–2013 (KNASP III). To inform work on the new framework, from April to October 2014, the council collaborated on a study with the Health Policy Project (funded by the U.S. Agency for International Development and the U.S. President’s Emergency Plan for AIDS Relief). The study team examined the social, cultural, and political barriers to and facilitators of policies intended to support the four pillars in HIV programming: HIV prevention, treatment, and care and multisectoral mainstreaming. The team also considered how these barriers and facilitators, in turn, affect clients’ experience of HIV programs under previous HIV strategic plans. This information made it possible to assess the social feasibility of Kenya’s HIV programs.

  • In 2015, in order to examine the implications for key populations of reduced donor funding in Bangladesh and to provide guidance for future transitions, the USAID- and PEPFAR-funded Health Policy Project (HPP) conducted a desk review and 20 key informant interviews with civil society, local government, and international donors. The resulting case study offers lessons learned on how donors can ensure the resiliency of HIV programming for key populations while undergoing funding transitions.

  • In Barbados and Jamaica, the PEPFAR- and USAID-funded Health Policy Project (HPP) has delivered two-day stigma-reduction trainings to health facility staff. Adapted from a longer curriculum, the trainings comprehensively address stigma and discrimination by involving all health facility staff (including receptionists, pharmacists, nurses, and administration staff). HPP is also helping facility staff develop posted “codes of conduct” which outline the expectations for stigma-free services, regardless of HIV status, sexual orientation, or gender.

    The codes of conduct posters feature health facility staff photos and contact information for clients to report instances of discrimination. The codes of conduct are being rolled out across health facilities in Jamaica, Barbados, and other countries across the Caribbean.

  • For the global health community, 2015 is a year to celebrate progress achieved and prepare for the future. The past two decades have seen unprecedented gains in global health: the mortality rate for children under age five has been cut almost in half, access to antiretroviral therapy (ART) for HIV-positive individuals has saved 6.6 million lives since 1995, and maternal mortality ratios have declined significantly. Yet, as the deadline for achieving the Millennium Development Goals (MDGs) approaches, developing countries face a host of persistent and emerging health challenges. This brief, prepared by the USAID- and PEPFAR-funded Health Policy Project presents five ways to prepare for the future of health policy, taking into account the changing global health landscape. 

  • The Blueprint for the Provision of Comprehensive Care for Trans People and Trans Communities in Asia and the Pacific (the Blueprint) is a document with far-reaching potential and applications in trans health and human rights in the region. The purpose of the Blueprint is to strengthen and enhance the policy-related, clinical, and public health responses for trans people in Asia and the Pacific. The primary audience for the Blueprint is health providers, policymakers and governments. The information within the Blueprint could also serve donors, bi- and multilateral organizations and trans and other civil society organizations.

    The Asia Pacific Transgender Network (APTN), the United Nations Development Programme (UNDP), and the USAID-funded Health Policy Project (HPP) collaboratively developed the Blueprint. This document is the third in a series of regional trans health Blueprints, and builds on what was produced in Latin America and the Caribbean by the Pan American Health Organization, the Regional Office of the World Health Organization for the Americas.

  • Condom and lubricant (C/L) programming is a critical element of an evidence-based HIV prevention package for sex workers (SW), men who have sex with men (MSM) and transgender (TG) people, populations bearing a disproportionate burden of HIV in Africa. Policy impacts lubricant availability and access.The USAID- and PEPFAR-funded Health Policy Project adapted the Policy Assessment and Inventory Decision Model methodology in Burkina Faso, Togo, and Kenya to assess policies that impact SW/MSM/ TG access to services, including C/L, against international standards and best practices. This poster presents the methods and results of the study, and was prepared for the 20th International AIDS Conference in July 2014.

  • The USAID- and PEPFAR-funded Health Policy Project (HPP) conducted a budget analysis to examine the GOT’s final FY 2015/16 health sector budget. HPP’s analysis examined the trends in budget allocations for health, patterns of distribution, and funding sources. Findings from this analysis may be used to advocate for efficient and effective budget allocations for HIV and essential medicines, and can be shared with key stakeholders, including decisionmakers from the Ministry of Health and Social Welfare (MOHSW), the National AIDS Control Program (NACP), TACAIDS, national- and district-level elected leaders, the media, and the public.

  • This summary presents the findings, observations, and recommendations of the quantification of the costs of the Strategic Development Plan for the Health Sector (PDSS) from 2015 to 2019 in Madagascar. The PDSS includes an articulation of global health priorities, approaches to the implementation, and resource commitments required by the Government of Madagascar to meet healthcare goals. The Health Policy Project team used the OneHealth model to quantify the costs. The OHT can calculate the cost not only health interventions but also those of managing these health programs and cross-cutting costs of health systems, such as human resources, infrastructure and governance. 

  • To successfully lead a strategic, effective and sustainable response to AIDS, individuals must be equipped with a diverse set of skills. However, many individuals rise to leadership positions with purely medical backgrounds and lack essential skills in management, finance, advocacy and policy, and governance. For over a decade the National Institute of Public Health (Instituto Nacional de Salud Pública – INSP), part of the National Health Institutes of the Health Ministry in Mexico, has designed and conducted training courses to augment HIV leaders’ skills in these critical areas and to strengthen the regional AIDS response, particularly in Mexico, Central America, and the Caribbean.

    The USAID-funded Health Policy Project commissioned a case study of INSP’s educational programs to better understand what elements are critical for such programs to be successful, what challenges they face, and to identify opportunities to strengthen and expand regional capacity-building efforts in the future.

    The results indicated that the students surveyed felt INSP’s multidisciplinary training approach for leaders in the region’s HIV and AIDS response fostered a more harmonized response to the epidemic. Further, the lessons and tools learned through INSP modules and courses become a principal resource for former students who go on to play strategic roles in national and state AIDS programs, as well as civil society. INSP course alumni feel better equipped to make decisions based on available evidence, to design and implement strategic prevention and care strategies, and to contribute to policy development. However, challenges remain and to sustain and expand, the INSP and other training initiatives must find ways to reduce course costs and required time commitments without sacrificing the quality and comprehensiveness that has made them so effective.

    Opportunities for continued education and virtual support through networking will also provide critical ongoing support. To maximize impact, curricula should take into account the unique economic, political, social, and cultural characteristics of individual countries; differences in infrastructure and human resources; and the diverse ways the AIDS epidemic manifests across the region. Those interviewed indicated that comprehensive training programs such as those developed by INSP play an essential role in equipping national and regional leaders to improve and expand HIV and AIDS services. The INSP programs fill a critical gap in human resource training and efforts should be made to mobilize the resources and support needed to expand and duplicate these kinds of training opportunities.

  • This presentation, "Communicating Research Findings to Policymakers," was part of a satellite session on policy implementation hosted by the USAID-funded Health Policy Project at the Second Symposium on Health Systems Research in Beijing, China, on October 31, 2012.  

  • The USAID- and PEPFAR-funded Health Policy Project (HPP) has led a global effort to compile and refine a coordinated package of “best practice” tools for health facilities. HPP brought together a group of international experts to review, prioritize, adapt, and synthesize existing measures and programmatic tools for stigma reduction. The resulting intervention package supports an evidence-informed response in health facilities and offers the following advantages:

    • Synthesis of existing tools into a streamlined research-to-action approach
    • A “total facility” approach that involves all levels of health facility staff
    • A questionnaire, field-tested in six countries for broad applicability across diverse settings
    • A “best of” set of training exercises culled from field experiences in nine countries in Africa, the Caribbean, and South and Southeast Asia
    • Training menus for different types of facility staff and timeframes
    • Action planning and policy development to support a sustained, multilevel response.

    The tools in this package may be used or adapted to counter stigma and discrimination based on HIV status, gender identity, sexual orientation, and behaviors such as sex work or injecting drug use.

  • There is considerable uncertainty surrounding key population size and HIV prevalence estimates in Tanzania. To address this data gap, the USAID- and PEPFAR-funded Health Policy Project (HPP), the Ministry of Health and Social Welfare, and the Tanzania Commission for AIDS held a one-day workshop in Dar es Salaam in April 2014 to discuss and reach consensus among key stakeholders on key population estimates for mainland Tanzania. A Delphi method was used to seek consensus on the estimated size of and HIV prevalence among the three key populations in Tanzania: female sex workers, men who have sex with men, and people who use/inject drugs. The workshop processes and outcomes are summarized in this report. 

  • The USAID- and PEPFAR-funded Health Policy Project partnered with the government of Côte d’Ivoire and PEPFAR on a study to estimate the cost and impact of HIV treatment scale-up by calculating the cost of antiretroviral treatment (ART) for one person per year for adults, children, and pregnant women. This annual ART cost was analyzed as a function of regimen, stage of illness at treatment initiation, retention, and response to treatment. The average cost was used to project the total investment necessary to scale up ART between 2015 and 2020 and achieve the country’s 90-90-90 goal, in which 90 percent of people living with HIV know their status, 90 percent of those diagnosed with HIV are on treatment, and 90 percent of those on treatment are virally suppressed. Using the Spectrum suite of policy models, the study estimated the number of lives saved and pediatric infections averted if this treatment scaleup is achieved. This study fills the critical information gap on cost as it relates to outcome. The government of Côte d’Ivoire and its development partners will be able to understand the resource needs for treatment scale-up and have the necessary data to inform decision making to effectively target available resources for HIV treatment.

  • Given the importance of effective HIV-related programs for key populations in Kenya, several government entities, donors, and stakeholders expressed the need for country-specific data on the costs of providing oral pre-exposure prophylaxis (PrEP) to prevent HIV infection. Such data would contribute to the development of evidence-based oral PrEP policies and help ensure that the required resources are made available for appropriate implementation and scale-up. In collaboration with the National AIDS and STI Control Program and the Sex Worker Outreach Program, the Health Policy Project conducted a study to address the following questions: How much does it cost to provide oral PrEP to one sex worker for a year? And, how much would it cost to scale up oral PrEP to all sex workers country-wide? The findings show that the average, annual unit cost of providing oral PrEP to one sex worker is US$602 and the total cost to extend the intervention to all HIV-negative male and female sex workers in Kenya ranges from US$24 million to US$48 million, depending on coverage from 50 to 100 percent. The report concludes with recommendations for the Government of Kenya on factors to consider when planning any future scale-up of oral PrEP.

  • The Health Policy Project's final costing study entitled Estimating the Unit Cost of Providing a Minimum Package of HIV Services to Female Sex Workers and Men Who Have Sex with Men, provides useful information for national program planners, donors, and other stakeholders.It does now, however, include operational details on how these different stakeholders can use the study results for their individual planning, budgeting, and resource mobilization and/or allocation purposes. This companion guide provides details on how study results may be used to inform decision making at multiple levels.

  • The USAID-funded Health Policy Project (HPP) formed a study team to estimate the unit costs associated with a minimum package of HIV services for female sex workers (FSWs) and men who have sex with men (MSM).

    To support the use of the analysis and cost data presented in the final study, the HPP study team also identified the need to develop a companion user guide to provide policymakers and program planners with a practical, stepwise approach to using data for decision making and evidence-based HIV programs, services, and policies, that address the needs of people living with HIV (PLHIV), MSM, and FSWs in Côte d’Ivoire.

    Using a stepwise approach with accompanying tables and worksheets, the guide first explains the importance of calculating average costs using data analysis presented in the larger study. Next, it explains how to determine and use program reach to estimate annual unit costs for HIV programs. Finally, the reader is shown how to project programmatic and national annual costs for FSWs and MSM. 

    The guide is available in English and French.

  • Knowledge of HIV status is essential for achieving universal access to HIV services. As such, HIV testing and counseling (HTC) are fundamental elements of all HIV prevention, care, and treatment programs. As the need for HTC expands in Kenya and resources dwindle, the efficiency and effectiveness of HIV spending is of utmost importance. One method to reduce HTC costs involves re-working the testing algorithm. The Health Policy Project (HPP) was invited by the National AIDS and STI Control Programme (NASCOP) to help conduct an analysis, whereby incremental costs, defined as the costs in addition to that of the current algorithm, were calculated for three newly proposed algorithms. Based on the results of this analysis, which highlights the cost savings of each option, a recommendation for a more cost-efficient algorithm was proposed.

  • The National AIDS Control Program (NACP) in the Ministry of Health and Social Welfare (MoHSW), with support from the USAID-funded Health Policy Project (HPP), engaged in a stakeholder-driven process to estimate the costs of the Third Health Sector HIV and AIDS Strategic Plan (HSHSP III) for the fiscal years 2013/2014-2017/2018. This report describes the HSHSP III costing process and shows the cost results by NACP program unit and HSHSP III impact area and strategic objective.

  • The Government of Tanzania (GoT) has recognized the need to stop gender-based violence and strengthen services for survivors of GBV. In 2011, the Ministry of Health and Social Welfare (MoHSW) developed management guidelines for GBV services delivered within the health care setting and began training service providers in accordance with these guidelines. In 2012, with support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through its Gender-based Violence Initiative (GBVI), the MoHSW began a phased rollout of these guidelines through training and facility support. The GBVI was aimed at strengthening coordination of GBV prevention and response efforts and their integration within existing HIV interventions. As the MoHSW moves forward with scale-up of the national guidelines, policymakers and program managers have identified the need to better understand the costs associated with GBV service delivery – for the purposes of estimating resource requirements for scale-up and also for exploring factors that drive the costs of GBV service delivery. The purpose of this study was to estimate the cost of delivering GBV services per client encounter at public health facilities in Tanzania and to understand the cost drivers of GBV service delivery in order to inform scale-up policies and planning. 

  • HPP worked with the Kenya Ministry of Health to create 47 County Health Fact Sheets that provide a county-level snapshot of selected health indicators in Kenya. They display county-specific health data and compare those data to national figures. The fact sheets bring together data from a wide array of sources and are intended to be a quick reference for a broad audience, including advocates, policymakers, health sector stakeholders, and development partners. The facts sheets were last updated July, 2015.

    You may download individual fact sheets on this page.

  • Geospatial analysis of epidemiological and health service data can generate maps of hotspots—locations where HIV prevalence is concentrated—and existing medical and social services and infrastructure. Using this method of data visualization, program planners can easily determine where HIV resources and services are lacking and where they should be deployed to have the greatest impact.

    With support from the President’s Emergency Plan for AIDS Relief (PEPFAR) and in collaboration with the Global Fund, the U.S. Agency for International Development (USAID)-funded Health Policy Project (HPP) is providing technical assistance to ten high-impact countries in Africa and Asia to strengthen their use of geospatial analysis in HIV policymaking and strategic, financial, and program planning. This brief explains how a South African district improved HIV services using maps.

  • Stigma and discrimination against people living with HIV (PLHIV) and key populations, such as sex workers and men who have sex with men, reduces access to critical services, adversely affects health outcomes, and undermines human rights. Legal services, however, are poorly resourced in low- and middle-income countries, and access is often limited to the wealthiest people.

    Drawing on lessons learned from other contexts, the Health Policy Project (HPP) collated international best practices, research on legal codes and systems in Ghana, and consultations with key stakeholders to determine approaches to monitoring discrimination. Using this information, the report the describes internet- and text message-based platforms for reporting HIV-related discrimination to the Commission on Human Rights and Administrative Justice (CHRAJ), providing a mechanism for civil society organizations to report cases to CHRAJ, track case progress, and use data on stigma and discrimination to guide future advocacy on HIV- and other related policies in Ghana.

  • Effectively capturing and reporting discrimination data can help an organization or government administration gauge the level of discrimination in a country and ensure effective responses. However, there is currently no standard design for a discrimination monitoring and reporting system. In this report, the Health Policy Project brings together known international best practices; research on relevant, existing legal codes and systems in Ukraine; and information from consultations with key stakeholders to determine priorities and approaches for monitoring discrimination. The project also documents a process for defining the scope and scale of a potential system, which both incorporates these best practices as well as considers local needs, resources, and policy environments. The report serves as the beginning of a conversation on monitoring, reporting, and resolving cases of discrimination for vulnerable populations.

  • HPP received funding to work in three countries in the Central Asia Region (CAR)—Kazakhstan, Kyrgyz Republic, and Tajikistan—to support and strengthen collaboration and coordination between nongovernmental organizations (NGOs) and governments working together to identify linkages and referral protocols for HIV-related health and social services. This desk review and analysis is intended to provide a detailed review of recently published assessment reports (2007–2012) conducted in Kazakhstan, Kyrgyz Republic, and Tajikistan to serve as a resource for USAID (CAR) and other groups interested in identifying priority HIV policy areas.

  • The Health Policy Project assembled this directory to help government agencies, development partners, and other local and international organizations identify Kenyan institutions with the skills and experience to support their health policy, finance, and governance needs. The directory is also designed to promote information sharing among the institutions it lists, as well as collaboration and partnerships, both international-local and local-local. The capabilities and accomplishments of 14 Kenyan organizations and consulting firms are highlighted, along with their mission, program and geographic areas, and contact information.

  • This brochure provides an overview of a web-based platform that civil society organizations in Ghana can use to report cases of discrimination to the country's Commission on Human Rights and Administrative Justice (CHRAJ). The system, developed with support from the USAID- and PEPFAR-funded Health Policy Project, links civil society to CHRAJ through case tracking, follow-up, and data reporting. The brochure provides information on why someone would submit a complaint, how to submit a complaint, and how to follow up on a complaint. It is meant solely for informational purposes. Step-by-step guidance on how to use the system is provided by the Discrimination Reporting System User Guide.

  • The Discrimination Reporting System User Guide outlines how civil society organizations in Ghana can use a web-based platform to report cases of discrimination to the country's Commission on Human Rights and Administrative Justice (CHRAJ). The system, developed with the support of the USAID- and PEPFAR-funded Health Policy Project, links civil society to CHRAJ through case tracking, follow-up, and data reporting. The user guide provides civil society organizations with a visual description of how to navigate the online system, submit complaints on behalf of clients, track the progress of complaints, and generate reports. It will be distributed to civil society organizations in Ghana that support people living with HIV and key populations.

  • As donor budgets for HIV have flat-lined, funding for HIV services and programming has decreased, particularly in countries with higher income status and concentrated HIV epidemics. To examine the impact of recent or ongoing PEPFAR funding transitions on key populations, the USAID- and PEPFAR-funded Health Policy Project (HPP) hosted a global consultation with key population civil society networks and developed case studies on PEPFAR’s transitions in four countries: Bangladesh, Botswana, China, and Guyana. The case studies offers lessons learned on how donors can ensure the resiliency of HIV programming for key populations while undergoing funding transitions.

    In addition, HPP developed the Readiness Assessment: Moving Toward a Country-led and –financed HIV Response for Key Populations. This guide is designed to assess the ability of a country’s stakeholders (including government, development partners, and civil society) to lead and sustain HIV epidemic control among key populations as donors transition to different levels and types of funding. The guide is a flexible tool that assesses readiness across four domains and focuses on the specific vulnerabilities of key populations.

  • The Plano Estratégico do Sector da Saúde (PESS) 2014-2019 (the Health Sector Strategic Plan), is the overall expression of the priorities, implementation approaches, and resource commitments for health of the government of the Republic of Mozambique (GRM). With support from the USAID-funded Health Policy Project (HPP), the Ministry of Health (MISAU) applied the OneHealth model to estimate the financial and health system resources need to implement the plan, and the likelihood of meeting key indicators in maternal and child health and HIV/AIDS related to the Millennium Development Goals. Detailed cost analysis was conducted for over 40 disease programs across primary and secondary health. Financial requirements for the overall human resources for health (HRH), logistics, health infrastructure, governance and leadership, and health information systems were also estimated. The report identifies potential constraints for the scale-up of services, such as inadequate human resources, and includes an HRH gap analysis. It also contains a review of the strategic planning process at MISAU, and recommendations for the institutionalization of the OneHealth approach.

    The report is available in English and Portuguese.

  • As the Government of Botswana (GOB) moves forward with a plan to expand coverage of health services, increasing the “value for money” of current health service delivery and identifying new financing sources is critical. As part of the 2010 Integrated Health Service Plan, a 10-year strategic plan for the health sector, the Ministry of Health (MOH) will introduce the Essential Health Services Package (EHSP)—health interventions to be provided as part of a package to the entire population. Although understanding the costs of delivering health interventions and the major cost drivers is critical to expanding the health sector, current knowledge of these costs is limited. This study aims to shed light on the overall costs of key interventions that address the major disease burden in Botswana.

    The study comprised two parts. In Part I, the Health Policy Project (HPP) technical team assessed the unit costs of providing specific HIV interventions at two levels of service delivery. In Part II, the team used the OneHealth tool (Avenir Health, n.d.) to project the overall resources required between 2013 and 2018 to provide EHSP services, based on normative inputs.

  • The government of Cote d'Ivoire is committed to the fight to gain control and turn the tide of the HIV epidemic. Striving to offer the best standard of HIV treatment, the country aims to adopt the new 90-90-90 target. The country also plans to roll out “test and offer” for the general population in the near future and begin piloting Option B+ for pregnant women in 2015. Such an intense scale-up of HIV treatment services will require intensified coordination to mobilize resources and effectively target those funds for treatment scale-up and sustainability.

    The aim of this cost-outcome analysis study was to estimate the cost of HIV treatment scale-up and the impact of such an expansion by estimating the cost of treatment for one person per year for adults, children, and pregnant women. Currently, limited data exist around the unit cost of HIV treatment in Cote d’Ivoire. To inform policy decisions on how best to finance scale-up of treatment with the limited resources available, understanding the outcome of HIV treatment—and the levers for improving the chances of successful treatment—is critical.

    The study found that the cost of the full year of treatment expected by following the national treatment guideline would be CFA142,431 (US$288) for adults, CFA217,603 (US$440) for children, CFA85,063 (US$172) for PMTCT Option B, and CFA 151,827 (US$207) for PMTCT Option B+. A total investment of approximately CFA147 billion (US$297 million) is required over the next five years, leading up to the year 2020, to achieve the 90-90-90 target and a 100 percent roll-out of the Option B+ approach for the prevention of mother-to-child transmission (PMTCT). This investment will save more than 35,000 lives and prevent more than 6,000 children from becoming infected via PMTCT compared to the status quo, in which treatment coverage increases at the historical pace.

  • The purpose of this guidance manual is to outline steps for estimating the cost of post-GBV services at the health-facility level. It provides the user with practical steps for conducting a costing study, including preparing for data collection, collecting and managing data, and analyzing and using the results. It provides detailed instructions on how to use the GBV Program Cost Calculator, an MS Excel-based tool developed under the Health Policy Project (HPP) that enables the use to generate unit cost estimates of providing health facility-based post-GBV interventions to a single client during one health facility visit. The cost data generated from these steps are meant to represent the cost of providing services and not on the cost to the client for seeking services. The results on the cost of post-GBV services generated from implementing these steps are to support program managers, policy makers, funding partners and government ministries to plan and scale-up GBV intervention services.

  • HPP undertook a policy analysis to determine the level of FP-HIV integration that appears in national government policy documents and explored the extent to which the policies outline and address the integration of services. For the purpose of this review, we defined policies to include policies, strategies, guidelines, action plans, implementation plans, clinical and service delivery standards, and other similar documents.

    We retrieved 30 Government of Malawi policies, strategies, and guidelines on family planning, HIV and AIDS, and general health, of which 19 addressed the provision of FP and/or HIV/AIDS services or discussed integration. There was significant mention on the need to integrate FP services into HIV services, for example through ART clinics. The policy documents are well aligned, providing supplementary guidance and information, but the fact that various elements of integration of FP-HIV services are spread out across a dozen health documents likely results in a disjointed vision for FP-HIV integration in Malawi, as well as inconsistent implementation. Furthermore, although these documents mention multisectoral collaboration, either in the development of policies or the implementation of programs, specific details on how to increase and strengthen multisectoral collaboration efforts are unclear. Since the different policies use a variety of approaches to FP-HIV integration, the MOH may want to consider developing an implementation and monitoring plan that will outline the various elements of integration noted across all the policy documents and identify how they should be measured.

  • Compelling evidence of the effectiveness of voluntary medical male circumcision (VMMC) as an HIV prevention intervention emerged during three randomized control trials that concluded in 2007. In December 2011, the World Health Organization and UNAIDS established a global strategic target of scaling up VMMC to reach 80 percent male circumcision prevalence among priority countries by 2016. As programs have rolled out VMMC, questions have arisen about how programs can be focused on populations where they will achieve the greatest impact. The Health Policy Project, with funding from PEPFAR through USAID, constructed a new model, DMPPT 2.0, to examine the impact and cost of focusing circumcision services on different age groups and subnational regions. This poster, presented at the 20th International AIDS Conference in Melbourne, Australia, provides an overview of the model.

  • The USAID and PEPFAR-funded Health Policy Project team, at the request of and in collaboration with the National Department of Health, conducted a detailed study in 2015 of the costs of providing medical male circumcision in South Africa. The objectives of this study were to:

    • Derive the unit cost of delivering medical male circumcision in South Africa at the facility level

    • Assess costs from a client perspective

    • Identify the level of spending currently incurred for demand creation

    The study’s findings, presented in this report, provide a detailed investigation, through a comprehensive bottom-up approach, of the costs to providers in offering medical male circumcision, as well as the cost to clients in receiving medical male circumcision. Results from the study will assist the South African government to assess the actual unit costs of medical male circumcision delivery and scale-up and provide information about the financial barriers medical male circumcision clients might face. This analysis will also support the National Department of Health, development partners, and implementing partners to better project resources needed for medical male circumcision service delivery and to understand cost drivers and cost variances across provinces and different modes of medical male circumcision service delivery (e.g., circumcision provided at fixed sites vs. circumcision provided as part of outreach programs). The cost data from this report will also inform the second round of South Africa’s investment case analysis.

  • In 2014, USAID requested the Health Policy Project (HPP) to undertake an assessment of the status and extent of FP-HIV integration in Malawi. Since integration at the policy level is important and the first step to a well-guided implementation of health service delivery (EngenderHealth, 2014), HPP undertook a policy analysis to determine the level of FP-HIV integration that appears in government policy documents and explored the extent to which the policies outline and address the integration of services. For the purpose of this review, we defined policies to include policies, strategies, guidelines, action plans, implementation plans, clinical and service delivery standards, and other similar documents. Other research components on the status of FP-HIV integration, including stakeholder interviews and a facility-level assessment, are documented in separate reports (forthcoming).

  • In order to better understand how FP-HIV integration is being implemented, HPP conducted a situational analysis of the policy and program environment by speaking to 48 national- and district-level stakeholders. The purpose of the interviews was to understand stakeholders’ perspectives on how integration of FP and HIV services as mentioned in the policies was being implemented and how integration of services could further be improved. The semistructured interviews covered various topics including institutional arrangements; processes for addressing integration within health systems such as human resources, commodities, infrastructure, and monitoring and reporting; financing mechanisms; integration within health facilities; the role of the private sector; and behavior change communication (BCC).

    Our findings cover stakeholder perspectives on the institutional arrangements at the national and district levels through which health services and programs are being implemented within the public sector. We further assessed opinions on the progress made in integrating FP and HIV services across the components of the health systems, such as trained healthcare workers, availability of commodities, facility structures to ensure integration, and joint monitoring and reporting. Stakeholders also described how FP and HIV services are currently being implemented in the majority of the facilities and shared some successful pilot programs of integration. This report also describes how information on FP and HIV is currently being addressed in BCC and mass media campaigns, highlights the role of the private sector in assisting to provide FP and HIV services, and also pays special attention to the progress made in reaching youth. 

  • Increasing eligibility for treatment necessitates reallocation of resources and strategic investment to prepare the healthcare system and ensure access to treatment. This policy will increase the number of patients needing treatment in the near term, which will put stress on human resources for health, facilities, and the supply chain. Recognizing these challenges, the USAID- and PEPFAR-funded Health Policy Project (HPP) provided technical assistance and programmatic support to the government of Botswana to address its ongoing efforts to restructure the health sector. Using the OneHealth Tool, HPP analyzed the costs of implementing the WHO 2013 recommendations and the test and treat model in 2016.

  • The Kenya AIDS Strategic Framework 2014/15–2018/19 (KASF) is the overarching strategic document guiding the HIV response in Kenya’s devolved governance system. The implementation of KASF goals will contribute to the achievement of Vision 2030 targets by ensuring universal access to comprehensive HIV prevention, treatment, and care. Kenya has also committed to reaching UNAIDS’ ambitious 90-90-90 targets by 2019. These targets call for 90 percent of all people living with HIV (PLHIV) to know their status, 90 percent of those diagnosed to be on antiretroviral therapy (ART), and 90 percent of people on ART to be virally suppressed. Several resource gaps for HIV programs have been estimated in the past. This brief attempts to harmonize the methodologies used in estimating HIV commodity gaps in the past. To do so, major stakeholders (Clinton Health Access Initiative, National AIDS & STI Control Programme, and National AIDS Control Council) were consulted in arriving at the assumption and targets used in the resource-gap estimation model. In this model, two scenarios are considered: financial needs for key commodities under the current guidelines, and a more ambitious “scale-up” scenario. In addition to harmonizing the way Kenya estimates HIV commodities gaps, the model will also support the mobilization of resources toward attaining the 90-90-90 targets.

  • Among the many efforts of the Government of Malawi to prevent and respond to GBV, the Department of Gender Affairs from the Ministry of Gender, Children, Disability and Social Welfare currently is working to improve GBV data systems and data use. As a part of this effort, the USAID-funded Health Policy Project has conducted a literature review to help to contribute to a better-informed national GBV response through identification and synthesis of existing studies and key government documents on gender-based violence in Malawi.

    The literature review was conducted primarily using online search methods and then followed-up with collection of documents not available online by country partners as needed. The literature was conducted to help answer how, in Malawi: GBV is defined and measured and see whether or not definitions are comparable throughout the literature; look at the prevalence rates of the various forms of GBV and how they compare across data sources; find out what information is available on GBV among specific populations or in specific settings; what factors are associated with GBV; what the impact of GBV is; what information is available on interventions and effectiveness; and what the key government documents on GBV are and how they address the issue.

  • The Sub-Saharan Africa MSM Engagement (SAME) Tool was developed based on literature reviews and expert/technical inputs from the USAID- and PEPFAR-funded Health Policy Project (HPP), the Johns Hopkins School of Public Health, amfAR, African Men for Sexual Health and Rights (AMSHeR), and USAID. In collaboration with eight leading MSM organizations—one each from Rwanda, Malawi, Togo, Mozambique, Zambia, Tanzania, Ghana, and Cameroon—HPP and AMSHeR piloted the tool from April to June 2013, in both English and French. This poster summarizes the pilot study, and was presented at the 20th International AIDS Conference in July 2014.

  • Survey results in Dominica illustrated that key drivers of Stigma and Discrimination in health facilities (fear of HIV infection, negative attitudes and facility environment, including policy) are present across all levels of health facility staff, both medical and non-medical. HPP organized participatory analysis of the evidence and dissemination among health facility staff in order to promote reflection and to propel a sense of urgency to reduce stigma in the health setting. Baseline evidence provided a tool to motivate staff and policy makers to measurable improve services. Recommendations developed by the health care workers focus on a range of training suggestions including who, when, and how to strengthen capacity through training of health and auxiliary staff; and policy development strategies. They urged a call to action based on human rights and a professional obligation to provide equitable, quality services to all. The discussion and recommendations highlight the effectiveness of a participatory approach to data analysis to inform action. 

  • St. Kitts and Nevis is implementing an intervention package to achieve “stigma-free” HIV services. This brief summarizes the results from a survey of health facility staff to inform the intervention, and review of these data in a participatory workshop with health sector stakeholders. The National AIDS Programme is leading the implementation effort with technical support from the University of the West Indies (UWI) and the USAID- and PEPFAR-funded Health Policy Project (HPP). The package includes: a comprehensive survey of all health facility staff; training for health staff and NGO leaders on stigma reduction in health facilities; development of policies and facility Codes of Conduct to reduce HIV stigma; routine monitoring of stigma and discrimination; and where possible, tracking progress on treatment adherence and uptake of testing, treatment, and prevention. The package is part of a regional initiative led by the Pan Caribbean Partnership Against HIV/AIDS (PANCAP) and facilitated by HPP and UWI to apply a jointly agreed framework for effective stigma reduction in health facilities.

  • The results of a survey of health facility staff in St. Kitts and Nevis, conducted by the University of the West Indies, the St. Kitts and Nevis Ministry of Health, and the USAID- and PEPFAR-funded Health Policy Project (HPP), illustrated  that key drivers of stigma and discrimination in health facilities (fear of HIV infection, negative attitudes and facility environment, including policy) are present across all levels of staff, both medical and non-medical. HPP organized a participatory analysis of the evidence and dissemination of the results  among health facility staff to promote reflection and propel a sense of urgency to reduce stigma in the health setting. Baseline evidence provided a tool to motivate staff and policymakers to measurably improve services. Recommendations developed by the healthcare workers focus on a range of training suggestions including who, when, and how to strengthen capacity through training of health and auxiliary staff; and policy development strategies. They urged a call to action based on human rights and a professional obligation to provide equitable, quality services to all. The discussion and recommendations highlight the effectiveness of a participatory approach to data analysis to inform action.       

  • A lack of comprehensive knowledge about HIV/AIDS and sexual reproductive health (SRH), financial insecurity, gender-based violence, and other risk factors can leave students of higher education institutions (HEIs), especially women, more vulnerable to HIV infection. It is therefore important to consider the specific needs of this population group when designing and implementing HIV interventions. In Ethiopia, the Health Policy Project (HPP) is supporting the Federal HIV/AIDS Prevention and Control Office and HEIs to prioritize and target HIV interventions in HEI settings. As part of this effort, HPP assisted the government's HEI Partnership sub-Forum against HIV/AIDS with developing a Planning, Monitoring, and Evaluation Framework for HIV/AIDS and SRH interventions in HEIs. Establishing a standardized system for planning, monitoring, and evaluating interventions will facilitate the generation and use of high-quality program-related data to inform decision making, thus helping to boost program effectiveness. Training and implementation of the framework has begun, and the next step will be to evaluate its effectiveness and standardization across HEIs in Ethiopia.

  • In support of the Global Fund’s New Funding Model, the President’s Emergency Plan for AIDS Relief (PEPFAR) worked in coordination with the United States Agency for International Development (USAID) through the Health Policy Project (HPP) to provide technical assistance to select high-impact countries. HPP supported the South Africa National AIDS Council (SANAC) and provincial health authorities in KwaZulu-Natal (KZN) on a proposal to map estimated HIV prevalence using routinely collected facility-level data and other related data in KZN province and the metro municipality of eThekwini (formerly known as Durban). These efforts were intended to help inform the country’s Concept Note submission, scheduled for June 2015. In addition to providing technical assistance in support of the analysis, HPP documented the methodology (Judice and Datar, 2014)—adapted from Dr. Frank Tanser’s work in Mpumalanga Province—so that SANAC might include a request to replicate this analysis in multiple municipalities throughout the country as part of the funding application to the Global Fund.This report documents the methodology, data sources, and statistical methods used to map and analyze routine data to examine HIV variation at subnational levels.

  • The Harm Reduction Expenditure Tracking Tool assesses total and unit expenditure in-country over two fiscal years for needle and syringe exchange programs (NSPs) and opioid substitution therapy (OST). The user guide provides step-by-step instructions for using this Excel-based tool. 

    The USAID- and PEPFAR-funded Health Policy Project (HPP), in collaboration with the Eurasian Harm Reduction Network (EHRN), developed the Harm Reduction Expenditure Tracking Tool. The tool was created for use by civil society groups to advocate for increased funding for harm reduction as HIV prevention in Eastern Europe and Central Asia. The tool and user guide are available in English and Russian.

  • This Harm Reduction Funding Gap Tool shows the difference in financial resource needs and commitments by year for needle and syringe exchange programs (NSP) and opioid substitution therapy (OST) programs. The user guide provides step-by-step instructions for using this Excel-based tool.

    The USAID- and PEPFAR-funded Health Policy Project (HPP), in collaboration with the Eurasian Harm Reduction Network (EHRN), developed the harm reduction funding gap tool. The tool was created for use by civil society groups to advocate for increased funding for harm reduction as HIV prevention in Eastern Europe and Central Asia. The tool and user guide are available in English and Russian.

  • This Harm Reduction Unit Costing Tool estimates the in-country unit cost per client per year for opioid substitution therapy (OST) and needle and syringe exchange (NSP) services. The user guide provides step-by-step instructions for using this Excel-based tool.

    The USAID- and PEPFAR-funded Health Policy Project (HPP), in collaboration with the Eurasian Harm Reduction Network (EHRN), developed the harm reduction unit costing tool. The tool was created for use by civil society groups to advocate for increased funding for harm reduction as HIV prevention in Eastern Europe and Central Asia. The tool and user guide are available in English and Russian.

  • Stigma and discrimination (S&D) confronting people living with HIV and key populations violate people’s rights and can adversely affect HIV prevention, care, and treatment. However, standardized approaches for quantifying and responding to health facility S&D have been unavailable. The USAID- and PEPFAR-funded Health Policy Project led a collaborative global effort to review, prioritize, adapt, and synthesize existing measures and programmatic tools. This effort involved researchers, trainers, other experts, and stakeholders. The resulting stigma-reduction package supports a comprehensive, research-to-action response in health facilities. This poster, presented at the 20th International AIDS Conference in Melbourne, Australia, in July 2014, describes the development of the stigma-reduction package and framework.

  • 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 USAID- and PEPFAR-funded Health Policy Project (HPP) in Kenya helped the Ministry of Health (MOH) secure an allocation of KSh 2.9 billion (approximately US$30 million) in the 2015/16 national budget to purchase HIV commodities and other strategic health commodities. Of this, US$21 to 23 million will go to purchase antiretroviral drugs (ARVs) and HIV testing kits. The remainder will supplement the purchase of malaria and tuberculosis commodities. HPP also helped secure the reinstatement of a line item for an annual allocation for HIV commodities in future national budgets. HPP is also working with private sector pharmacies and hospitals to stock ARVs that can be accessed by those who can afford them. As part of this initiative, the Kenya Medical Supplies Authority has already earmarked ARVs for 10,000 patients to help trigger sales. Innovative efforts, like increasing ARV sales in the commercial sector, can further enhance the sustainability of Kenya’s HIV program and increase access to ARVs and HIV services for those who cannot afford private care.

  • This two-day training was adapted from the USAID- and PEPFAR-funded Health Policy Project’s 2013 document, Understanding and Challenging HIV and Key Population Stigma and Discrimination: Caribbean Facilitator's Guide. The overall training objectives are

    1. To foster an understanding of how stigma and discrimination towards men who have sex with men and other key populations affects the HIV epidemic
    2. To increase understanding of the different identities of sexual minorities
    3. To increase understanding of how stigma and discrimination towards men who have sex with men impedes access to health services

  • Discrimination against people living with HIV and key populations is a common and challenging problem. A year ago, the Commission on Human Rights and Administrative Justice (CHRAJ) in Ghana launched a web-based system to provide a simple way for reporting HIV- and key population–related discrimination with help from the USAID and PEPFAR-supported Health Policy Project (HPP). This brief describes the outcomes of the discrimination reporting system after one year and ways forward. 

    Click here to read a blog on HPP's work on the CHRAJ stigma and discrimination reporting portal.  

  • In 2010, Kenya adopted a new constitution which both guaranteed the right to health and devolved health service delivery to Kenya’s 47 counties. A few years later, in 2014, counties became responsible for delivering health services. Although funding to support service delivery has also been devolved to the counties, it remains inadequate for county health needs, forcing the health sector to compete with other priority sectors for scarce resources.

    To help County Departments of Health secure greater allocations for the health sector, this how-to guide provides a summary of each of the main stages of the budget cycle and key milestones, suggests actions that county leaders can take during the budget process to influence county budgets, and highlights some of the potential bottlenecks at each stage. 

  • A new study released by the Health Policy Project, examines the experience of stigma and discrimination among male and female sex workers and how these experiences affect sex workers’ utilization of health services. Measuring the prevalence of four types of stigma: anticipated, witnessed/heard, experienced, and internalized; the study revealed that over 80 percent of male sex workers and over 70 percent of female sex workers avoided or delayed needed health services in the year preceding the survey. This and other findings provide critical evidence for the need to address stigma and discrimination to both improve health outcomes of and control the HIV among the key populations most affected by HIV.

  • PEPFAR’s Gender-Based Violence Initiative (GBVI) is implementing comprehensive gender-based violence (GBV) programming in three countries: Mozambique, Tanzania, and the Democratic Republic of Congo. As part of this initiative, the USAID- and PEPFAR-funded Health Policy Project (HPP)  collaborated with 12 grassroots organizations in Mozambique to integrate GBV prevention activities into existing HIV programs as a way to reduce GBV and prevent the spread of HIV—particularly among women, orphans, and vulnerable children. As HPP’s support to the NGOs ended the project systematically assessed the outcomes of the capacity development efforts at the community level. HPP documented the extent to which local program staff responded to GBV trainings, implemented gender- and GBV-integrated program design, and executed prevention and response mechanisms. The project also documented the community members’ attitudes toward and knowledge of gender equality and GBV. This report presents the findings of the assessment and documents the project’s successes, challenges, and lessons learned in its efforts to build GBV capacity in Mozambique.

  • The Health Policy Project assembled a technical team to facilitate a three-day workshop on integrating gender and gender-based violence (GBV) into HIV prevention and OVC programs for Mozambican organizations in Maputo in February 2012. The worshop applied five participatory and interactive modules to build the capacity of participants to use practical skills and tools to integrate GBV prevention and responses into existing HIV programs. The training methodologies sought to explicitly reveal the links between GBV and HIV risk and increase skills to integrate evidence-based gender and GBV practices into existing HIV programs. The workshop's results demonstrated the great interest in and need for GBV integration into current programs. They also informed the development of capacity-strengthening plans for each of the seven participating NGOs and provided a foundation for addressing gender and GBV in HIV programs for staff of the FHI-360 Capable Partners Program (CAP). 

  • In Jamaica, marginalized and key populations including men who have sex with men (MSM) and sex workers experience high levels of HIV and gender based violence (GBV). Stigma and criminalization contribute to violence experienced by key populations, and it further undermines access to HIV prevention and health services. Integrated HIV/GBV services that are client-friendly would alleviate barriers to services yet services and referral networks are inconsistent and largely unavailable in Jamaica. In 2012, Woman, Inc., with support from the USAID- and PEPFAR-funded Health Policy Project (HPP), undertook a pilot intervention in Jamaica to examine the feasibility for integrating GBV and HIV services in health clinics through development of a screening and referral process. This poster summarizing the study was presented at the 20th International AIDS Conference in Melbourne, Australia, in July 2014.

  • In Jamaica, Woman Inc., with support from the Health Policy Project (HPP), implemented a pilot project to assess the feasibility of integrating screenings and referrals for gender-based violence (GBV) with clinical services for HIV and other sexually transmitted infections. The links between GBV and HIV are widely acknowledged, but relatively few people access services for GBV, especially women and key populations with high HIV burdens such as men who have sex with men and sex workers. The pilot project involved gender training for healthcare providers and community agencies, adaptation and implementation of a GBV screening tool, and mapping and strengthening of GBV referral systems. The findings, summarized in this brief, indicate that the pilot enhanced the capacity of HIV healthcare providers to improve access to GBV support services and better meet the needs of their patients, especially women and key populations.

  • At the request of the USAID Mission in Malawi, the USAID-funded Health Policy Project (HPP) undertook a comprehensive facility-based assessment to ascertain the extent to which FP services have been integrated into HIV services in Malawi through different integration models and across various types of facilities (public and non-profit private). The study was also designed to examine how the reproductive rights of people living with HIV (PLHIV) are being respected and addressed through approaches such as PIFP and access to method choice. Finally, the study aimed to identify any systems-level barriers to integration and provide practical recommendations for the Ministry of Health (MOH) and other stakeholders to improve FP-HIV integrated services in Malawi.

  • The HIV epidemic in Ukraine is severe and concentrated: it is estimated that there were 211,800–237,000 HIV-positive individuals in the country in 2013. Once dominated by infections among people who inject drugs (PWID), the adult HIV incidence in Ukraine is increasing among other key populations and the national prevention strategy must adapt. These populations include female sex workers (FSWs), clients and casual partners of FSWs, and men who have sex with men (MSM), among others. In this context, the USAID- and PEPFAR-funded Health Policy Project partnered with the State Service of Ukraine on HIV/AIDS and the Institute for Economy and Forecasting to analyze the cost and effectiveness of HIV prevention from 2014–2018. Conducted in July 2013, the analysis aimed to inform the National AIDS Programme (NAP) 2014–2018. This poster was presented at the 20th International AIDS Conference in Melbourne, Australia.

  • Saving Mothers, Giving Life (SMGL) is five-year public-private partnership aiming to drastically reduce maternal mortality in sub-Saharan Africa. As part of the proof of concept, the USAID- and PEPFAR-funded Health Policy Project conducted an expenditure analysis to identify what additional expenditures were made to reduce maternal mortality in the eight SMGL pilot districts in Uganda and Zambia. The overall study findings showed that investments in infrastructure, transportation, training for healthcare workers, and demand creation for facility-based deliveries led to maternal mortality decreases in both countries in one year—30 percent in one, 35 percent in the other. HPP's expenditure analyses complement these evaluations, and help to inform budgeting and planning for scale-up of the district strengthening model.

  • In Barbados and Jamaica, the PEPFAR- and USAID-funded Health Policy Project (HPP) has delivered two-day stigma-reduction trainings to health facility staff. Adapted from a longer curriculum, the trainings comprehensively address stigma and discrimination by involving all health facility staff (including receptionists, pharmacists, nurses, and administration staff). HPP is also helping facility staff develop posted “codes of conduct” which outline the expectations for stigma-free services, regardless of HIV status, sexual orientation, or gender.

    The codes of conduct posters feature health facility staff photos and contact information for clients to report instances of discrimination. The codes of conduct are being rolled out across health facilities in Jamaica, Barbados, and other countries across the Caribbean.

  • This USAID- and PEPFAR-funded Health Policy Project report synthesizes the findings of the County Health Accounts (CHAs) of 12 selected counties for financial years (FY) 2013/14 and 2014/15. The 12 counties are Bomet, Isiolo, Kakamega, Kisumu, Makueni, Migori, Mombasa, Nairobi, Nyeri, Siaya, Tharaka Nithi, and Turkana. The report compares health expenditures in the 12 counties to provide evidence of a pattern for sources and uses of health funds. It pays special attention to key financing sources for healthcare, the role of financing agents in managing healthcare funds, providers of healthcare goods and services, and the services purchased with these funds.

  • In March, the Kenya Ministry of Health convened an international consultation forum in collaboration with the World Bank Group and the United States Agency for International Development (USAID) through the Health Policy Project to deliberate on the challenges of providing universal health coverage (UHC) to all Kenyans, regardless of their ability to pay, and to explore strategic and sustainable health financing options. The Kenya Health Policy Forum reviewed options and lessons learned from other countries, and proposed recommendations on how the country can improve efficiency to achieve UHC.

    The meeting brought together local and international experts with diverse expertise spanning the health sector, including both the public and private sectors. Participants from Kenya included representatives from both levels of government, nongovernmental organizations, faith-based organizations, and the private sector. International speakers shared experiences from Brazil, Ethiopia, Ghana, India, and Mexico. Development partners who support Kenya’s health sector were also represented, including the USAID, the UK Department for International Development, the German Federal Enterprise for International Cooperation, and the World Bank.

  • Countries in West Africa (WA) have made significant progress in addressing the HIV epidemic. However, HIV prevalence among sex workers (SWs) and men who have sex with men (MSM) remains high, and data are unavailable for transgender (TG) populations. Services that meet the needs of SWs, MSM, and TG are often unavailable outside of major cities. Stigma and discrimination (S&D) against key populations impact service uptake and increase migration, making it harder to reach these populations. Policies—such as laws, national strategies, and operational procedures—impact service availability and uptake. To inform decisionmakers and improve access to HIV-related services for mobile SWs, MSM, and TG populations in West Africa, the USAID- and PEPFAR-funded Health Policy Project (HPP) conducted an analysis of key policies in countries along the Abidjan-Lagos corridor and Burkina Faso.

  • Investing for impact is an explicit goal of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The institution’s strategy for 2012 to 2016 focuses on countries and populations where interventions promise maximum rewards for public health. As part of this “New Funding Model,” the Global Fund is asking applicant countries seeking financing to more accurately  demonstrate where and how their HIV programs will yield significant, measurable improvements in limiting the spread of the virus. Accomplishing this will depend to a great extent on each country’s ability to use geospatial analysis of epidemiological data to target resources to areas with the greatest need.

    Not all countries seeking Global Fund support have extensive experience with geospatial analysis. To address this gap, the Health Policy Project (HPP)—funded by the United States Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR)—is working with 9 countries eligible for Global Fund support to strengthen their use of geospatial analysis in HIV policymaking and in strategic, financial, and program planning.

  • Health-related policy and its implementation is complex. This conceptual framework, prepared by the Health Policy Project, is designed to show the flow from health-related policy development to health-related policy and program implementation. The framework has been developed based on an extensive review of health policy and health systems literature and decades of experience in the policy areas related to family planning, reproductive health, HIV/AIDS, and maternal health. The framework includes the four stages of policy, which starts with the identification of a problem and moves to policy development, policy implementation, and policy monitoring and evaluation. The conceptual framework situates the process within the context of an enabling environment, comprising broader governance and political, sociocultural, and economic factors. It is meant to guide governments, organizations, and communities in understanding the links among health-related policies, programs, systems, outcomes and better implementation and monitoring and evaluation of health-related policies. It can also be used to frame research questions and design studies.

  • Once dominated by infections among people who inject drugs, the adult HIV incidence in Ukraine is increasing among other key populations and the national prevention strategy must adapt. In this context, the USAID-supported Health Policy Project (HPP) partnered with State Service of Ukraine on HIV/AIDS and Other Socially Dangerous Diseases, and the Institute for Economy and Forecasting of the National Academy of Sciences of Ukraine in July 2013 to analyze the cost and effectiveness of HIV prevention over 2014–2018. The analysis aimed to inform the National AIDS Programme (NAP) 2014–2018. HPP applied the Goals mathematical model to examine the effects of scaling up treatment, harm reduction, and other behavioral interventions on incidence, and developed an Excel-based model to estimate the implementation cost. Recent Ukraine-specific epidemiological, behavioral, demographic, and cost data were obtained from the Ministry of Health and other secondary sources. Results suggest that the NAP with universal access targets for prevention is the most cost-effective prevention strategy. This suggests additional investment in Ukraine would be rational and could save lives. Non-renewal of Global Fund support for key prevention interventions in Ukraine would substantially weaken the efficiency and effectiveness of its HIV response and requires an urgent resource mobilization strategy.  

  • Local Capacity Initiative Facilitated Discussion and Capacity Assessment Tool: Facilitator's Manual The purpose of this manual, prepared by Advancing Partners & Communities with support from the Health Policy Project, is to help determine technical assistance needs and to conduct an assessment of an organization’s policy, advocacy, and organizational systems capacity. The assessment consists of a facilitated self-assessment as well as optional stakeholder interviews. The tool is divided into five major sections (LCI outcome areas); four of these areas focus on critical elements for advocacy and one focuses on overall organizational capacity. Additionally, there are in-depth domains associated with each larger outcome, which can be used to further review capacity.

    Policy Advocacy Rapid Assessment Tool for CSOs This tool is used to facilitate an overarching conversation with small to medium sized CSO regarding policy advocacy capacity and priorities. The tool addresses six major topics and seven cross cutting themes related to policy advocacy. Findings identified by this conversation can be used to design capacity development strategies.

  • Through this case study, the USAID- and PEPFAR-funded Health Policy Project (HPP) seeks to share Thailand’s experience implementing the AIDS Zero Portal (AZP) and its initial impact at the national and provincial levels. The AZP offers a potential model for other countries looking to institutionalize and leverage information systems as part of their routine monitoring and evaluation, strategic planning, and resource allocation efforts.

  • For people living with and affected by HIV, stigma and discrimination within health facilities are serious barriers to healthcare access and engagement. Researchers have documented numerous instances worldwide of people living with HIV receiving substandard care or being deterred from seeking care. Although progress has been made in training and other interventions to reduce HIV-related stigma in healthcare facilities, these programs have not been institutionalized as routine practice or implemented on a large scale. Moreover, the tools for measuring stigma tend to be lengthy and time-consuming to administer, thus infeasible for use in facilities.

    To address these issues, an international team of researchers developed and piloted a brief, globally standardized questionnaire for measuring stigma and discrimination in health facilities. This tool can help facilitate routine monitoring of HIV-related stigma as well as the expansion and improvement of programming and policies at the health-facility level.

    Based on the pilot's findings, two final questionnaires are now available: a brief version for program evaluation and a comprehensive version for research purposes. Each questionnaire can be used for high-prevalence or low-prevalence settings.

  • This poster was presented at the 20th International AIDS Conference in Melbourne, Australia, in July 2014. It summarizes a study of HIV-related stigma and discrimination, which pose barriers to accessing HIV testing and treatment services and, in healthcare settings, can be especially damaging for people living with HIV (PLHIV). This cross-sectional study is part of a collaboratively funded global effort led by the USAID- and PEPFAR-funded Health Policy Project to develop a brief stigma-measurement tool for health workers. This tool allows assessment and monitoring of stigma in healthcare settings. 

  • This presentation was given during a satellite session on policy implementation hosted by the Health Policy Project at the Second Symposium on Health Systems Research, in Beijing, China, October 31, 2012.  

  • As part of a joint activity, the Health Policy Project (HPP), University of Washington, United States Agency for International Development (USAID), and Centers for Disease Control and Prevention conducted a global analysis of planned policy interventions across the 22 publicly accessible PEPFAR (President's Emergency Plan for AIDS Relief) Partnership Frameworks, with the purpose of understanding how the interventions are related to PEPFAR and country or regional priorities. In addition to the desk review, the team conducted multi-country and multi-stakeholder capacity-building workshops for monitoring the policy process within PEPFAR-supported countries. This poster, produced by HPP, provides an analysis of the data collected as well as conclusions about the need to strengthen policy monitoring. The poster was presented at the Second Global Symposium on Health Systems Research in Beijing, China, on October 31–November 3, 2012.  

  • With a high government debt burden and declines in donor assistance, Jamaica faces challenges in sustaining its national HIV and family planning programs. To heighten efficiency and sustainability, the Jamaican Ministry of Health (MOH) integrated elements of its national HIV program into its family planning (FP) program to create a new national agency for sexual health. The new sexual health agency absorbs all the functions previously carried out by the national FP and HIV/STI programs except for treatment and clinical services. In undertaking this reform, the MOH found a dearth of guidance about national HIV-FP program integration. Thus, the MOH collaborated with the USAID- and PEPFAR-funded Health Policy Project to develop this case study assessing lessons to date in Jamaica and next steps.

  • The USAID- and PEPFAR-funded Health Policy Project assisted the Ghana AIDS Commission with updating the country's National HIV/AIDS and STI Policy. The updated policy reflects the state-of-the-art and best practices in HIV and AIDS prevention and treatment, especially in the areas of human rights and key populations. The new policy provides the overarching vision for the national HIV and AIDS program in Ghana and will ensure that all new strategies and guidelines are in line with the best practices in HIV implementation incorporated into the new policy. 

  • The Government of Malawi recognizes that the health of young people is a component of public health, which is of concern in this country. However, lives of most young people continue to be threatened by a number of factors such as sexually transmitted infections including HIV and AIDS, teenage pregnancies, unsafe abortion complications, nutrition inadequacies, alcohol and drug abuse and mental health problems. This contributes significantly to the high mortality and morbidity rates in Malawi. The Ministry of Health through the Directorate of Reproductive Health and partners initiated the program evaluation of youth-friendly health services to assess the extent to which young people access the health services they need at various levels of care. The findings and recommendations from the evaluation stressed the need to have a robust adolescent and youth sexual and reproductive health strategy.

    This strategy, therefore, aims at giving direction and guidance to the implementation of SRH services for all young people countrywide, so as to achieve the highest possible level of quality integrated services.

  • Networks and coalitions can be effective in mobilizing political will, influencing policy and financing, and strengthening health programs. By sharing resources and workload, networks and coalitions can take advantage of their members' capabilities and skills to plan and implement joint advocacy campaigns, present a unified front, and make collective demands to government. The Health Policy Project prepared this brief to provide leaders of civil society organizations with guidance on working within networks and coalitions to advocate for improved family planning, HIV care and treatment, and maternal health policies and programs.

    This is one of two briefs focused on advancing country ownership for improved health. The other brief can be accessed here: Accountability and Transparency for Public Health Policy: Advancing Country Ownership.

  • The number of new HIV infections in Eastern Europe and Central Asia (EECA) continues to grow, with people who inject drugs (PWID) and their sexual partners disproportionately affected by the epidemic. To address this challenge, the Eurasian Harm Reduction Network (EHRN), with support from the USAID- and PEPFAR-funded Health Policy Project (HPP), developed a suite of easy-to-use, Excel-based tools, available in Russian and English. Civil society organizations advocating harm reduction services can use them to estimate past expenditure levels, future resource needs, and potential funding gaps using local costs of services and products. This brief introduces these tools. 

  • Until recently, the primary focus of Botswana’s health agenda (as with many of its neighbors) has been on infectious disease control—particularly HIV, since the country has one of the highest prevalence rates in the world (22% of adults ages 15–49 are HIV positive). Noncommunicable diseases (NCDs) were not a priority on the global health spectrum, but rising affluence and urbanization have contributed to increases in NCDs in the last decade. In Botswana, NCDs are estimated to account for 31 percent of all deaths. The most common NCDs include cardiovascular disease, hypertension, cancer, chronic obstructive pulmonary diseases, and diabetes. 

    In recognition of these challenges, and with the overall emphasis shifting from care and treatment to prevention of these diseases, the USAID- and PEPFAR-funded Health Policy Project (HPP) provided technical assistance and programmatic support to the government of Botswana to analyze the resource implications of this shift for CVD, type II diabetes, and kidney disease.

  • The PANCAP Stigma Framework was developed with assistance from the USAID- and PEPFAR-supported Health Policy Project in response to regional and national requests made to PANCAP for direction on responding to stigma and discrimination in the Caribbean. Stigma and discrimination continue to be key drivers of the Caribbean HIV epidemic and are major obstacles to effective responses. Their impact on Caribbean health and development is wide ranging. HPP provided technical and financial support for PANCAP partners with experience in reducing stigma and discrimination to review existing frameworks and Caribbean tools to inform the drafting of a comprehensive approach. A small group of technical experts from HPP drafted the initial framework to meet the needs of small countries, island states, and emerging nations. This framework has initially engaged and will serve to strengthen the capacity of national HIV programs to develop, implement, and monitor effective policies and programs, and to address HIV in a sustainable manner at the national level. The PANCAP Stigma Framework is built on three components, health and development, collective empowerment, and social justice and gender equality, which are crucial in addressing the Caribbean response to HIV-related stigma and discrimination. 

  • The 2015 Country Operational Plan (COP) Guidance includes specific guidelines for engagement of PEPFAR country teams with civil society organizations (CSOs) in the planning and development of the COP.  Following the finalization of the 2015 COP process, the USAID- and PEPFAR- funded Health Policy Project was requested by the Office of the Global AIDS Coordinator and Health Diplomacy to conduct an analysis on civil society’s perception of their engagement in the PEPFAR country team Country Operational Plan (COP) planning and to solicit recommendations for future PEPFAR country team engagement with civil society. This report documents responses received from an online survey and in depth interviews with representatives from civil society organizations located in PEPFAR countries.

  • As part of its aim to deliver “the right thing at the right place at the right time,” in 2015 PEPFAR implemented a strategic pivot in the alignment of its resources in Tanzania. This pivot shifts the focus to high-volume and high-burden sites and districts, diverting resources from generalized, country-wide responses to focused geographic areas and key populations. As a result, districts and facilities with low HIV burden and low yield are experiencing a reduction in support from PEPFAR beginning at the start of the 2015/16 fiscal year. While the pivot aims to accelerate scale-up of antiretroviral therapy (ART) by prioritizing high-prevalence and high-yield populations, additional ART scale-up will be required in non-priority districts in order to reach national treatment targets that are now more ambitious.

    It is important that the Government of Tanzania (GoT), local government authorities, PEPFAR, and other partners understand the extent to which continued scale-up will be required in non-priority districts to achieve both the UNAIDS’s 90-90-90 goal in Tanzania as well as national ART targets based on adoption of “test and offer” guidelines. This brief aims to define the geographic and programmatic shifts under the PEPFAR pivot, identify activities that may face a reduction in PEPFAR support and require alternative sources of funding to support continued scale up, and clarify future scale-up targets in non-PEPFAR priority districts.

  • Males who have sex with males (MSM), transgender (TG) people, and sex workers (SWs) are at higher risk for HIV transmission than other individuals, even in generalized epidemics. Structural and policy issues have created barriers for MSM/TG/SW in seeking services and adopting individual and community harm reduction strategies. The Policy Analysis and Advocacy Decision Model for HIV-Related Services: Males Who Have Sex with Males, Transgender People, and Sex Workers, published by the Health Policy Project and AMSHeR (African Men for Sexual Health and Rights) with support from USAID and PEPFAR, is a collection of tools that helps users assess and address policy barriers that restrict access to HIV-related services for MSM/TG/SW. In 2012 and 2013, the Decision Model was applied in Burkina Faso and Togo. This brief presents the Decision Model and key policy findings.

  • Males who have sex with males (MSM), transgender (TG) people, and sex workers (SWs) are at higher risk for HIV transmission than other individuals, even in generalized epidemics. Structural and policy issues have created barriers for MSM/TG/SWs in seeking services and adopting individual and community harm reduction strategies. Published by the Health Policy Project and the African Men for Sexual Health and Rights (AMSHeR), with support from the United States Agency for International Development (USAID) and US President’s Emergency Plan for AIDS Relief (PEPFAR), the Policy Analysis and Advocacy Decision Model for HIV-Related Services: Males Who Have Sex with Males, Transgender People, and Sex Workers is a collection of tools that helps users assess and address policy barriers that restrict access to HIV-related services for MSM/TG/SWs.

    Designed to help country stakeholders build a public policy foundation that supports access to and implementation and scale-up of evidence-informed services for MSM/TG/SWs, the Decision Model helps to clearly identify and address policy barriers to services. Its policy inventory and analysis tools draw from the extensive body of international laws, agreements, standards, and best practices related to MSM/TG/SW services, allowing the assessment of a specific country policy environment in relation to these standards. This customizable, in-depth, and standardized approach will build stakeholders’ capacity to identify incremental, feasible, near-term opportunities to improve the legal environment and the resulting quality of and access to services for MSM/TG/SWs while long-term human rights strategies are implemented.

    A companion decision model geared specifically toward people who inject drugs (Policy Analysis and Advocacy Decision Model for HIV-Related Services: People Who Inject Drugs) is also available in English and Russian. 

  • The Policy Analysis and Advocacy Decision Model for Services for People Who Inject Drugs (PWID) is a collection of tools designed by the USAID-funded Health Policy Project and the Eurasian Harm Reduction Network to help stakeholders create an inventory of country policies, analyze these policies against international best practices and human rights frameworks, assess policy implementation, and create a strategic advocacy plan. The primary goal of the model is to identify the policies that most directly affect access to and sustainability of key PWID services and the needs and opportunities for policy advocacy that will improve access to services, even while larger, long-term human rights policies remain deficient.

    The Decision Model is intended for global application but includes special attention to the policy issues facing Eastern Europe and Central Asia. Stakeholders can use the tools to identify restrictive, poorly written, and absent policies that impact the access to and sustainability of key services for PWID including HIV counseling and testing, antiretroviral therapy, hepatitis and tuberculosis services, opioid substitution therapy, and needle and syringe programs. These services are analyzed within the settings of community-based programs, pre-trial detention, prison, and institutions that have custody of minors. The policy areas under consideration are extensive, with more than 1,300 policy points for analysis. Policy areas include service coordination; data use and decisionmaking; participation of PWID in decisionmaking, service delivery and evaluation; consent; personal data; stigma and discrimination; criminal sanctions; gender-based violence; human rights; procurement and supply management; eligibility; funding; and service delivery protocols.

    A companion decision model geared specifically toward males who have sex with males, transgender people, and sex workers (Policy Analysis and Advocacy Decision Model for HIV-Related Services: Males Who Have Sex with Males, Transgender People, and Sex Workers) is also available. 

  • The Policy Analysis and Advocacy Decision Model for Services for Key Populations in Kenya provides stakeholders—including policy makers, service providers, and advocates—with tools to assess and advocate policies that govern accessibility and sustainability of services for key populations (men who have sex with men, sex workers, people who inject drugs, and transgender people). By comparing existing Kenyan policies to the global normative guidelines and best practices, the model reveals gaps and challenges in implementation. This document, prepared by the USAID and PEPFAR-funded Health Policy Project for the National AIDS Control Council of the Ministry of Health, analyzes more than 120 policy and program documents related to HIV and key populations.  It also makes policy recommendations for enhanced service scale-up and uptake by key populations in Kenya. 

  • This USAID-funded assessment, conducted in Togo, is the second country application of the Health Policy Project (HPP) and African Men for Sexual Health and Rights (AMSHeR) Policy Analysis and Advocacy Decision Model for HIV-Related Services: Males Who Have Sex with Males, Transgender People, and Sex Workers (Beardsley et al., 2013). The current application of the Decision Model in Togo complements the pilot application conducted in 2012 in Burkina Faso. It was designed as an in-depth policy analysis of the legal, regulatory, and policy environment related to sex workers (SW), men who have sex with men (MSM), and prison populations in Togo to uncover gaps in policy and practical challenges to policy implementation. Beginning in June 2013, the HPP principal investigator, a legal expert from AMSHeR, and a team of local consultants conducted a document review and assessment. The team collected an inventory of 116 source policy and program documents and previous policy and program research related to HIV and/or key populations. Upon completion of the inventory, the team conducted 21 key informant interviews to examine the policy environment and assess dissemination and implementation of current policies, particularly gaps in dissemination and implementation that pose barriers to service access for key populations. The HPP policy analysis and key informant interviews confirmed that positive changes related to HIV prevention, care, and treatment are occurring in Togo. Initial steps are being taken to develop policies that recognize key populations and aim to improve access to services for them. Significant opportunities exist to further progress, including the USAID-funded Regional Project for the Prevention and Care of HIV/AIDS in West Africa (PACTE-VIH) and open support from the president of Togo and the permanent secretary for the National AIDS Council. However, critical gaps in policy, dissemination, and implementation remain and are highlighted in this report.

    Read the brief on this topic.

  • This handout provides an overview of the Positive Health, Dignity and Prevention (PHDP) Curriculum created by the Jamaican Network of Seropositives (JN+)—with support from the Jamaican Ministry of Health’s National HIV/STI Program (GIPA Unit) and the USAID- and PEPFAR-funded Health Policy Project. The curriculum aims to promote personal health and advocate for high-quality health services for people living with HIV (PLHIV). Although it was developed in Jamaica, the curriculum offers a promising, practical tool to help strengthen PLHIV leadership and advocacy to advance PHDP in the region and globally, and to enhance health systems and health outcomes across prevention, care, and treatment.

  • The Jamaican Network of Seropositives (JN+)—with support from the Jamaican Ministry of Health’s National HIV/STI Program (GIPA Unit) and the USAID- and PEPFAR-funded Health Policy Project—created a capacity-building curriculum led by people living with HIV (PLHIV). The curriculum aims to implement and advocate for Positive Health, Dignity, and Prevention (PHDP) and promote community leadership at the country level.

    PHDP—a global policy framework authored by the Global Network of People Living with HIV (GNP+) and UNAIDS in 2011—advances a holistic framework for PLHIV to manage their health, advocate for high-quality HIV services, and prevent onward HIV transmission. PHDP provides a concrete framework and road map that is especially relevant to meeting current global and national care and treatment goals for HIV—and to making “combination prevention” a reality.

  • The Health Policy Project designed this training manual for civil society organizations implementing HIV prevention and orphan and vulnerable children (OVC) care and support programs in Mozambique. The manual aims to raise awareness and sensitize participants on the concepts and interlinkages between gender inequality, HIV, and gender-based violence (GBV). By doing so, the organizations will better understand and appreciate the influence of gender and violence on HIV- and OVC–related issues and will be in a better position to develop and implement program strategies and interventions that will promote gender equality and help prevent GBV. The manual contains eight sessions covering a range of topics from a basic introduction to gender to developing a multisectoral response to gender-based violence.

  • HIV, hepatitis A, hepatitis C, and syphilis are all transfusion-transmissible infections that can arise from the use of unscreened blood. In collaboration with Kenya's National Blood Transfusion Services (NBTS), the Health Policy Project examined the current status of blood screening in Kenya and two key steps that could help reduce the risk of transmissible infections. Relevant research questions revealed that Kenya, like other sub-Saharan African countries, needs to completely screen, in both facilities and donation centers, the blood of all family replacement donors as well as voluntary donors. It also needs to increase the total supply of screened blood to meet the needs of a growing population. This brief summarizes the analysis conducted, presents the cost-benefit results of completely screening the existing blood supply (in terms of infections averted), and outlines cost-efficient steps for increasing the total screened blood supply.

  • Like many sub-Saharan African countries, Kenya is exploring the adoption of the World Health Organization Option B+ strategy as the standard of care for its program to prevent mother-to-child transmission of HIV. The Health Policy Project (HPP) was invited by the National AIDS and STI Control Programme (NASCOP) to help conduct a cost-effectiveness analysis of scaling up Option B+ versus other strategies. Results of the analysis suggest that implementing a scale-up of Option B+ will avert infant and adult infections but at a significant additional cost. Kenya should consider these results to assess whether Option B+ is affordable given the available resources.

  • In Côte d'Ivoire (CdI), the Health Policy Project (HPP) supported national institutions to estimate the unit cost of HIV programs targeting key populations such as males who have sex with males and sex workers. This final report provides estimates for the cost of delivering HIV services to key populations in CdI as well as projections of how costs could change over time in varying scenarios of program scale-up and service packages. These results can be used by stakeholders at all levels of the country to better plan and budget for HIV service delivery.

  • This document is a report on the District Orientation meetings led by the Malawi Ministry of Gender, Children, Disability and Social Welfare (MoGCDSW) with support from the USAID-supported Health Policy Project. The orientation meetings were held to kick-start the implementation of the national Institutional Framework and the MoGCDSW Strategic Plan, in order to achieve the objectives of the Joint Sector Strategic Plan.

  • This report documents the process undertaken for the review and update of guidelines and standards for gender mainstreaming in Malawi, which was undertaken jointly by HPP and the Ministry of Gender, Children, Disability and Social Welfare. The report also documents the outcomes of this process.

  • The OneHealth Model (OneHealth) is a tool for medium term (3 to 10 years) strategic planning in the health sector at the national level, ideally suited for public sector planners. It estimates the costs by disease program, as well as estimating the costs of utilizing the health system building blocks in delivering the targets involved in the disease programs. In Kenya, at the request of the Ministries of Health, HPP provided technical assistance in applying OneHealth to cost the Kenya Health Sector Strategic Plan III, 2012-2017, reflecting the interventions under the Kenya Essential PAckage of Health, as well as national disease strategies for programs that include HIV/AIDS, tuberculosis, malaria, non-communicable diseases, maternal, reproductive and child health, etc. The results include an assessment of the overall financial gap between resources needed and the government and donor resources available for all years of the analysis. This brief is intended for a policy audience in Kenya to support sustainable health sector planning, and may be of interest to other countries in the region who wish to apply OneHealth or similar approaches to assessing costs and financial gaps.

  • To understand programmatic challenges, promising practices, and potential solutions related to pediatric HIV in Tanzania, HPP conducted interviews with the NACP and two PEPFAR implementing partners that receive the majority of Tanzania’s ACT funding. Interviews addressed issues across the pediatric treatment cascade (see Figure 1). Interviewees identified overarching challenges, including the short implementation timeline under ACT (two years), insufficient financial resources for pediatric care and treatment, limited health worker capacity, supply chain weaknesses, lack of community and other linkages, and poor monitoring and data use. Many of the challenges reported in Tanzania are also seen in Kenya, where a more detailed qualitative analysis was under

  • Kenya's Health Sector Coordinating Committee, a joint forum of government and development partner representatives, commissioned a study in late 2012 to determine the implications of a lack of Global Fund resources for Kenya related to HIV, tuberculosis, and malaria. Conducted in 2012, and later revised in 2013, the assessment was carried out by Health Policy Project in partnership with the German technical support agency, GiZ. The study analyzes changes to the Global Fund, (e.g., the New Funding Model) and considers Kenya’s policy risks related to future Global Fund resources. The risk analysis also includes projected financial gaps for the three diseases and set of policy recommendations to the Government of Kenya to mitigate the risks of a decline in Global Fund resources and the potential challenges of implementing grants under the New Funding Mechanism.

  • This suite of tools, developed by the USAID-funded Health Policy Project, the University of Washington, USAID, and the U.S. Centers for Disease Control and Prevention, was designed to strengthen the capacity of key stakeholders to engage in and monitor health policy development and advocacy interventions. The Road Map consists of eight different tools that can be used separately or together to help stakeholders systematically review the policy process and take steps toward full implementation. Each tool is meant for a different stage of the policy process and helps users fully view the different actions necessary to move the policy process forward from development to implementation and evaluation. The Road Map is also available in French and Spanish.

  • Adolescent girls and young women are a critical priority in HIV prevention programming. People born with HIV and those becoming sexually active in an era of HIV and AIDS face complicated risks and challenges that were unknown to previous generations. Today, 1.8 billion young people ages 10–24 comprise 26 percent of the world’s population and as much as 32 percent in some regions, such as sub-Saharan Africa. Many of the countries with the highest HIV prevalence are experiencing a massive "youth bulge" in population, so even with decreasing HIV prevalence, the absolute number of young people living with HIV or at risk of acquiring HIV will grow in the next five years. Young women are especially vulnerable, with HIV infection rates nearly twice as high as those for young men. At the end of 2012, approximately two-thirds of new HIV infections in adolescents ages 15–19 were among girls. Scaling up evidence-informed interventions for adolescents is essential. This brief offers priority interventions for programmers based on evidence from successful programming for women and girls; though a number of the interventions listed also benefit men and boys. The brief is divided into three parts: evidence-informed priority areas for programming; implementation and research gaps that must be addressed; and considerations for scaling up successful programming for girls and young women. For more information on these and other interventions see www.whatworksforwomen.org. 

    What Works for Women & Girls is supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and Open Society Foundations and is being carried out under the auspices of the USAID-supported Health Policy Project, the Public Health Institute, and What Works Association, Inc. For more information, please visit www.whatworksforwomen.org or email mcrocegalis@gmail.com.

  • Over the past five years, the USAID- and PEPFAR-funded Health Policy Project (HPP) has worked in collaboration with global and country-level institutions to advance understanding and approaches to measuring and addressing HIV-related stigma. At the global level, HPP led efforts to review, prioritize, adapt, test, and synthesize existing measures and programmatic tools for stigma reduction in health facilities. This resulted in the development of a comprehensive package for “stigma free” health facilities (HPP, 2015). The package was piloted in several Caribbean countries,2 and offers a complete response to S&D in health facilities—from research to action. Its total facility approach targets all health facility staff, from doctors to cleaning staff.

    In an effort to facilitate further scale-up and refinement of these successful approaches, HPP convened an expert meeting in Washington, DC on June 3, 2015 to discuss and strategize a way forward to scale up S&D reduction efforts in health facilities. These discussions yielded valuable insights and recommendations, which are presented in this brief.

  • Reducing HIV stigma and discrimination (S&D) in the healthcare setting is particularly important because it is here that people living with HIV seek care and treatment to remain healthy while others seek information, counseling, testing, and other prevention services. Despite this recognized need, programs to reduce HIV-related stigma and discrimination in healthcare facilities have yet to be routinely institutionalized and scaled up. A key factor contributing to this gap is the lack of a globally standardized set of measures for HIV-related stigma and discrimination in healthcare facilities and among healthcare workers.

    In response, the Health Policy Project (HPP) is leading an ongoing collaborative global effort to develop a brief, standardized set of HIV-related S&D measures for use in healthcare facilities. As part of this effort, the project examined and synthesized relevant literature and subsequently held an expert meeting to review existing measures and build consensus toward a recommended and consolidated set of measures. The central outcome was the creation of a framework for HIV-related S&D reduction programmatic intervention and measurement. The framework delineates key programmatic areas (drivers) for intervention and identifies the key points within the framework where measurement should occur.

    Measurement provides policymakers, governments, donors, and civil society advocates with data necessary to develop strategic policies, monitor and evaluate progress, and implement effective programs that uphold the rights of people living with HIV and other key populations affected by HIV. Data generated from valid and reliable indicators will allow programmers to monitor interventions in a timely manner and assess and evaluate programs to determine expansion strategies of successful implementation approaches.

  • This poster presents the results of a study on measuring HIV stigma among all levels of health facility staff. A tool developed by international program implementing agencies, university and non-university based researchers, the global network of people living with HIV (GNP+), and UNAIDS was field-tested to refine it and create a brief questionnaire that can be used s a standalone survey or a module in a broader HIV survey for health facility staff. The poster was presented by staff of the USAID- and PEPFAR-funded Health Policy Project at the 17th International Conference on AIDS and STIs in Africa in December 2013, in Cape Town, South Africa.

  • Maternal deaths and infant HIV infections continue despite improved regimens for maternal health and prevention of mother-to-child transmission (PMTCT) and increases in PMTCT services. Service uptake and retention drop off significantly at each step in the PMTCT cascade. Key social factors limiting the successful completion of the cascade are stigma and discrimination. The Health Policy Project conducted a comprehensive literature review to examine the current evidence on stigma and discrimination and their negative impact on PMTCT, as well as the potential benefits of integrating PMTCT into antenatal care (ANC) and maternal, neonatal, and child health (MNCH) services.

    Substantial evidence indicates that stigma and discrimination affect (1) initial use of ANC services, (2) uptake of HIV testing during ANC, (3) initial participation in programs for PMTCT and HIV care, (4) use of skilled delivery services, (5) adherence to recommended infant feeding practices, (6) participation in early infant diagnosis, and (7) retention in and adherence to these programs during and after pregnancy.

    It will be impossible to reduce HIV-related maternal mortality without lowering the barriers of stigma and discrimination. Integrating maternal health and HIV services may not be enough to overcome social barriers that keep women, partners, and infants from fully accessing health services. Alongside important modifications to make clinical services more effective, convenient, and accessible for pregnant women and families; PMTCT, maternal, neonatal, and child health services must address HIV-related stigma and discrimination.

  • The GIS Continuum and associated costing workbook and prioritization worksheet can be used to support a strategic planning and costing exercise to determine where investments are needed to strengthen GIS as part of a country's national spatial data infrastructure and health systems strengthening.

  • The USAID- and PEPFAR-funded Health Policy Project (HPP) supports health systems strengthening (HSS) by bringing together different actors and disciplines within the health system to improve policy and ultimately achieve more equitable and sustainable access to health services. The importance of HSS for HIV and AIDS, tuberculosis, and malaria programs is recognized in Tanzania’s national strategic plans.

    In May 2014, USAID/Tanzania approached HPP to assist the Ministry of Health and Social Welfare’s Directorate of Policy and Planning in conducting a rapid HSS assessment with two main objectives: to build initial consensus around priority HSS actions that will inform a new national HSS strategy, and to provide information for the ministry to advocate for additional HSS funding. The latter includes presenting HSS priorities, activities, and actions to the Global Fund’s Tanzania National Coordinating Mechanism to be considered for inclusion in the upcoming grant application process.

  • The USAID-funded Health Policy Project supports African women leaders through coaching, as part of a larger capacity development model. Too often knowledge and skills gained during training are eclipsed by the demands of returning to work—and to one's old habits. In order to nurture the seeds planted through the Empowering Women Leaders for Country-led Development program's three-week women's leadership workshop, HPP carefully matches each participant with a coach from her own country. Thus begins a year-long relationship that enables the participant to grow professionally and personally through prioritizing, networking, and learning. This brief describes workshop participants' experiences with their coaches, and includes guidance on the effective use of a coaching model for capacity development.

  • Stigma and discrimination (S&D) remain critical barriers to achieving HIV prevention, care, and treatment targets, including zero new HIV infections and zero AIDS-related deaths. In Jamaica and elsewhere in the Caribbean, S&D falls hardest on key populations, including men who have sex with men (MSM) and sex workers (SW) and undermines access to testing and treatment.

    The Key Population Challenge Fund (KPCF) project aimed to improve the quality of and access to stigma-free HIV testing and counseling (HTC) services for key populations. Through this initiative, the Health Policy Projected (HPP) implemented a stigma-reduction toolkit for facility-based healthcare providers. Project outcomes included cultivating an enabling environment for key populations and the development of facility-level codes of conduct.

  • The United States Agency for International Development (USAID) supports the implementation of the United States President’s Emergency Plan for AIDS Relief (PEPFAR), a United States government (USG) initiative to save the lives of people around the world who are suffering from HIV and AIDS, in almost 100 countries. Since 2003, PEPFAR has worked with these countries to create systems that have stabilized the HIV epidemic by preventing new infections and providing care, support, and treatment to those infected and affected by HIV. Due to the progress that has been made in Guyana, the PEPFAR program will transition from a service delivery model to one that provides targeted technical assistance over the next five years (2013–2017). This will also result in a shift in USG funding, inclusive of USAID.

    Within this context, there is an identified need to clearly define roles and responsibilities for all key stakeholders and delineate next steps in the transition to ensure long-term sustainability of HIV prevention, care, and support services and the continuum of care for people infected and affected by HIV and AIDS.  Toward this effort, the USAID- and PEPFAR-funded Health Policy Project (HPP) supported PEPFAR Guyana by conducting a high-level assessment of HIV and AIDS NGOs, relevant private sector entities, the Ministry of Health (MOH), the National AIDS Program Secretariat (NAPS), and other relevant line ministries in Guyana. The aim of this assessment was to document the country’s capacity gaps and needs to support the transition of HIV services from donors to the country, and suggest approaches for ensuring an ethical transition and sustainability of these services over time.

  • The United States Agency for International Development (USAID) supports the implementation of the United States President’s Emergency Plan for AIDS Relief (PEPFAR), a United States government (USG) initiative to save the lives of people around the world who are suffering from HIV and AIDS, in almost 100 countries. Since 2003, PEPFAR has worked with these countries to create systems that have stabilized the HIV epidemic by preventing new infections and providing care, support, and treatment to those infected and affected by HIV. Due to the progress that has been made in Guyana, the PEPFAR program will transition from a service delivery model to one that provides targeted technical assistance over the next five years (2013–2017). This will also result in a shift in USG funding, inclusive of USAID.

    Within this context, there is an identified need to clearly define roles and responsibilities for all key stakeholders and delineate next steps in the transition to ensure long-term sustainability of HIV prevention, care, and support services and the continuum of care for people infected and affected by HIV and AIDS.  Toward this effort, the USAID- and PEPFAR-funded Health Policy Project (HPP) supported PEPFAR Guyana by conducting a high-level assessment of HIV and AIDS NGOs, relevant private sector entities, the Ministry of Health (MOH), the National AIDS Program Secretariat (NAPS), and other relevant line ministries in Guyana. The aim of this assessment was to document the country’s capacity gaps and needs to support the transition of HIV services from donors to the country, and suggest approaches for ensuring an ethical transition and sustainability of these services over time.

  • Tanzania's Ministry of Health and Social Welfare chose the OneHealth Tool, a model for medium- to long-term strategic planning in the health sector, to inform development and prioritization of the Fourth Health Sector Strategic Plan 2015/16–2019/20 (HSSP IV). Specifically, the OneHealth Tool was used to estimate the resource requirements and resources available for the health sector over the next five years, the impact on maternal and child health and HIV if HSSP IV service delivery targets are met, and the human resources constraints in scaling up health services. The results of Tanzania's OneHealth application are summarized in this report and provide an evidence base for strategic planning and resource allocation.

  • In the past decade, PEPFAR has committed significant technical and financial resources to the fight against HIV, working with local partners in target countries to promote prevention programs, increase the number of patients receiving ART, and strengthen national coordination and monitoring of programs. As donor funding stagnates and developing economies grow, it is critical to identify long-term, sustainable sources of domestic funding for HIV to maintain and build upon the successes achieved by low- and middle-income-countries in partnership with PEPFAR.

    As part of PEPFAR’s Sustainable Financing Initiative to increase domestic resource for HIV, HPP created a baseline assessment of the current state of HIV financing in Uganda against which future achievements in domestic resource mobilization can be measured. The assessment analyzes current resource commitments against projected need, estimates future domestic resource needs, and examines efficiency and equity in the use of funds.

  • In the past decade, the President’s Emergency Plan for AIDS Relief (PEPFAR) has committed significant technical and financial resources to the fight against HIV, working with local partners in target countries to promote prevention programs, increase the number of patients receiving antiretroviral therapy (ART), and strengthen national coordination and monitoring of programs. As donor funding stagnates and developing economies grow, it is critical to identify long-term, sustainable sources of domestic funding for HIV to maintain and build upon the successes achieved by low- and middle-income-countries in partnership with PEPFAR.

    As part of PEPFAR’s Sustainable Financing Initiative to increase domestic resource for HIV, the Health Policy Project (HPP) has created a baseline assessment of the current state of HIV financing in Zambia against which future achievements in domestic resource mobilization can be measured. The assessment analyzes current resource commitments from all sources, both domestic and external, against projected resource need under UNAIDS’ 90-90-90 target, to determine future need for new domestic resources in each country, as well examines efficiency and equity in the use of funds, with the goal of maximizing the impact of financial commitments.

  • Stigma and discrimination (S&D) in health facilities undermines HIV prevention, care, and treatment and negatively impacts health. Reducing S&D requires understanding the prevalence of its drivers and manifestations to shape a tailored response. The St. Kitts and Nevis National AIDS Program (NAP), with support from the USAID- and PEPFAR-funded Health Policy Project (HPP) and the University of the West Indies (UWI), collected data as a first step in creating a comprehensive S&D-reduction program. This poster, presented at the 20th International AIDS Conference in Melbourne, Australia, in July 2014, summarizes the results of the data collection.

  • The 2013 general election in Kenya took place on March 4, 2013, giving citizens a chance to elect new leaders, including a new President, for a five-year term. To help maintain and further progress in the health area, the Health Policy Project documented the pledges, commitments, and promises made by the 2013 presidential candidates about the health sector in Kenya. This report outlines what the candidates and their parties promised to do about different health issues and how these promises align with current health sector aspirations described in the government’s existing short- and long-term policy and planning documents. The goal is to provide stakeholders in the health sector with a reference point from which to hold the incoming government accountable on its public promises and a tool for advocacy in pursuing further commitments that can improve the public health sector.

  • It is estimated that 80,000 infants born annually in Zambia are at risk of acquiring HIV from their mothers. In 2011, more than 415,000 Zambians were on antiretroviral therapy (ART), but the number of children accessing ART services lagged significantly behind that of adults. Ensuring universal access to ART requires more information about the costs of scaling up services to reach every child in need. To inform the resource investment required to increase coverage of pediatric ART, the USAID- and PEPFAR-funded Health Policy Project (HPP), along with the Ministry of Health of the Government of the Republic of Zambia (MOH), examined the average additional cost to infant and child health services at the health facility level (incremental cost) of providing clinical pediatric ART services for children living with HIV. HPP and the MOH also analyzed the cost drivers of treatment to identify opportunities for increasing efficiencies. This poster shows the results of this work and was presented at the 20th International AIDS Conference in July 2014.

  • At the end of 2013 an estimated 189,930–206,280 adults and 34,560–36,250 children were living with HIV in Ghana. There is strong evidence to suggest a disproportionately higher HIV prevalence among certain key population groups, such as men who have sex with men (MSM) and female sex workers (FSWs). Ghana’s epidemic continues to evolve. The USAID- and PEPFAR-supported Health Policy Project (HPP) partnered with the Ghana AIDS Commission (GAC) to conduct a focused analysis of the future effectiveness of HIV prevention in the country related to possible funding from external partners. This report offers information on the targets and highlights cost-effective decisions Ghana can make over the coming years. It comes at an opportune time as the country’s current National Strategic Plan (NSP) for HIV and AIDS comes to a close in 2015.

  • This study, conducted by the USAID- and PEPFAR-funded Health Policy Project (HPP), assessed the costs and benefits of different prevention of mother-to-child transmission of HIV (PMTCT) treatment options (baseline treatment as currently offered, Option B, and Option B+). It is intended to inform the scale-up of PMTCT services in Nigeria’s 13 high-burden states, which account for 70 percent of the mother-to-child transmission burden.

  • Since 2011, the International AIDS Society (IAS) has been seeking ways to improve the effectiveness and efficiency with which HIV services are planned and delivered. This investigation focused on a survey of IAS members, many of whom are frontline providers of care, and then turned to consultations with stakeholders across the spectrum of the HIV community: donors; local, regional and national governments; civil society organizations; the private sector; doctors and other caregivers; and people living with HIV. The results of these efforts are reported in this brief, produced with support from USAID and PEPFAR through the Health Policy Project.

  • At the request of the Ghana AIDS Commission and other in-country stakeholders, the Health Policy Project (HPP) updated an analysis of the effects of various funding scenarios on program impact and HIV incidence and coverage. The project used the Goals Model to develop these scenarios, which were based on new fiscal realities and provided stakeholders with information to revise a proposal to the Global Fund to Fight AIDS, Malaria and Tuberculosis. HPP’s Goals Model helps countries respond to the HIV epidemic by showing how the amount and allocation of funding is related to the achievement of national goals, such as the reduction in HIV prevalence and expansion of care and support. The information from this analysis will continue to guide ongoing decision making and planning in Ghana regarding the country's HIV treatment, care, and support programs.

  • A literature review was conducted to identify and collect existing frameworks and other analytical tools for assessing gender factors within the health policy environment and health programs. Gender tools for family planning/reproductive health (FP/RH), HIV, and maternal and child health were the primary focus. The review, however, also included a search for relevant gender analysis tools outside these health domains and relevant areas outside the health sector. The results of the literature review are intended for use by Health Policy Project (HPP) staff to assist in strengthening gender approaches across HPP core and field support programs.

  • Classified as an upper-middle-income country in 2010, Jamaica is reorganizing its HIV response to heighten efficiency and financial sustainability. A key challenge involves sustaining the program, given declining external assistance and a government in fiscal crisis. Facing this challenge, the Jamaican Ministry of Health has integrated elements of its HIV program into its family planning program to create a new national Ministry of Health (MOH) agency for sexual health. In undertaking this reform, the MOH found a dearth of guidance about national-level integration. Thus, the MOH collaborated with the USAID- and PEPFAR-funded Health Policy Project to assess lessons to date and map next steps. This poster about the study was presented at the 20th International AIDS Conference in Melbourne, Australia, in July 2014.

  • The National AIDS and STI Control Programme (NASCOP), a department of the Ministries of Health, Kenya, is considering a major change to the process in which clinical health workers in the public sector are provided training on HIV/AIDS. This involves a new, harmonized HIV curriculum and a related process involving self-learning, placement (off-site face-to-face interaction with mentors), ongoing clinical practice, and ongoing mentoring. NASCOP and the Health Policy Project collaborated to analyze the potential efficiency gains of the harmonized curriculum process over a past practice of uncoordinated off-site trainings and limited mentoring for health workers. The analysis included comparing the cost of different methods to provide ongoing mentoring. Results suggest that the harmonized curriculum process will save significant resources for Kenya, and a district-based mentoring process will be an efficient choice. The brief provides evidence to support the policy change and is also instructive for training discussions in other vertical programs.

  • In the Caribbean, transgender persons are disproportionately affected by HIV. Moreover, high levels of stigma and discrimination create significant barriers and make it difficult for them to access the health care services they need. Most clinicians in this region also do not receive any training on transgender health or broader issues of sexuality and diversity, further limiting availability of transgender-friendly services.

    In response, HPP has developed a training manual for healthcare workers in Jamaica, Barbados, and the Dominican Republic to strengthen their capacity to provide high-quality, stigma-free health services for transgender persons. This brief highlights key content from each of the chapters contained in the manual.

  • 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. 

  • Ukraine has one of the fastest growing HIV epidemics in the world, and the number of HIV cases diagnosed in the country has doubled since 2001 (UNAIDS, 2010). Ukraine’s epidemic remains concentrated among most-at-risk populations (MARPs)—with over 80 percent of reported HIV cases occurring in these groups (PEPFAR, 2010). In this context, the Health Policy Project evaluated the degree to which an enabling policy framework for HIV exists in Ukraine, with a focus on HIV prevention among MARPs. The project interviewed 72 key informants regarding the policy environment and policy dissemination and implementation at the national and subnational levels. This assessment findings indicate a strong enabling environment, but one that has gaps and barriers, such as lack of operational guidelines to support the implementation of HIV laws and regulations. Building on the joint U.S. and Ukraine Governments’ Partnership Framework, the findings reveal new possibilities for developing effective mechanisms to support the implementation and enforcement of HIV-related regulations in Ukraine.

  • Ukraine has one of the fastest growing HIV epidemics in the world, and the number of HIV cases diagnosed in the country has doubled since 2001 (UNAIDS, 2010). Ukraine’s epidemic remains concentrated among most-at-risk populations (MARPs)—with over 80 percent of reported HIV cases occurring in these groups (PEPFAR, 2010). In this context, the Health Policy Project evaluated the degree to which an enabling policy framework for HIV exists in Ukraine, with a focus on HIV prevention among MARPs. The project interviewed 72 key informants regarding the policy environment and policy dissemination and implementation at the national and subnational levels. This assessment findings indicate a strong enabling environment, but one that has gaps and barriers, such as lack of operational guidelines to support the implementation of HIV laws and regulations. Building on the joint U.S. and Ukraine Governments’ Partnership Framework, the findings reveal new possibilities for developing effective mechanisms to support the implementation and enforcement of HIV-related regulations in Ukraine.

  • Ukraine has one of the fastest growing HIV epidemics in the world, and the number of HIV cases diagnosed in the country has doubled since 2001 (UNAIDS, 2010). Ukraine’s epidemic remains concentrated among most-at-risk populations (MARPs)—with over 80 percent of reported HIV cases occurring in these groups (PEPFAR, 2010). In this context, the Health Policy Project conducted an assessment to evaluate the degree to which an enabling policy framework for HIV exists in Ukraine, with an emphasis on HIV prevention among MARPs. The project carried out 72 key informant interviews regarding the policy environment and policy dissemination and implementation at the national and subnational levels. This report summarizes the assessment findings, which indicate a strong enabling environment but one that has gaps and barriers related to policy implementation and operational guidelines. Also see the Annex Addendum for more information.

  • Ukraine has one of the fastest growing HIV epidemics in the world, and the number of HIV cases diagnosed in the country has doubled since 2001 (UNAIDS, 2010). Ukraine’s epidemic remains concentrated among most-at-risk populations (MARPs)—with over 80 percent of reported HIV cases occurring in these groups (PEPFAR, 2010). In this context, the Health Policy Project conducted an assessment to evaluate the degree to which an enabling policy framework for HIV exists in Ukraine, with an emphasis on HIV prevention among MARPs. The project carried out 72 key informant interviews regarding the policy environment and policy dissemination and implementation at the national and subnational levels. This report summarizes the assessment findings, which indicate a strong enabling environment but one that has gaps and barriers related to policy implementation and operational guidelines. Also see the Annex Addendum for more information.

  • Developed by the USAID- and PEPFAR-funded Health Policy Project, this guide is a training tool that provides a standard for stigma reduction. It is a resource for facilitators seeking to train participants to reduce HIV and key population stigma and discrimination, and for leaders of community dialogue and policy development in this area. The guide has been piloted in the Caribbean and other settings and can be readily adapted for other contexts.

  • The response to HIV and AIDS is an integral component of efforts to improve social and economic conditions in Ghana and Côte d’Ivoire. Available data suggest that HIV prevalence rates among key populations, particularly female sex workers (FSWs) and men who have sex with men (MSM), are several times higher than the national averages for both countries. These groups also face additional barriers to social acceptance and access to services, compared with the general population. Accordingly, Ghana and Côte d’Ivoire each completed a Strategic Framework to guide interventions and service delivery specifically for key populations. The frameworks propose a package of services that includes HIV prevention; HIV treatment, care, and support; and psychosocial support and legal services. This brief describes the costing analysis conducted by HPP and in-country stakeholders to provide country-specific costing data on key populations to provide an evidence base for policy-making processes.

  • As part of its overall effort to promote evidence-based policies, decision making, planning, and advocacy, the Health Policy Project has worked with the Ghana AIDS Commission (GAC) and other important  stakeholders to conduct a costing study of services to key populations in Ghana (males who have sex with males and female sex workers). This will ensure that Ghana has country-specific costing data available. The study team collected information from service providers at eight purposively selected facilities and from program managers at the regional and central levels. The costing data are now being used to update Ghana's Goals Model and for planning, budgeting, and decision-making purposes (e.g, in conjunction with the development of Global Fund proposals and development of operational plans and budgets). In addition, one of the purposes of analyzing unit costs is to understand what is driving costs and identify areas where there is potential to gain efficiencies and reduce costs without negative impacts on quality.

    The report does not include specific operational details on how each of these different levels may use study results for their individual planning, budgeting and resource mobilization, and/or allocation purposes. The accompanying Estimating the Unit Costs of Providing Key HIV Services to Female Sex Workers and Males Who Have Sex with Males in Ghana: A Data Use Guide summarizes key findings from the study and provides specific details on how study results may be best used to inform the evidence base for the Ghana HIV program.

  • As part of its overall effort to promote evidence-based policies, decision making, and planning and advocacy, the Health Policy Project has worked with the Ghana AIDS Commission (GAC) and other important stakeholders to conduct a costing study of services to prevent mother-to-child transmission of HIV. This will ensure that Ghana has country-specific costing data available. The study selected 14 sites within the country, including teaching, regional, and district hospitals providing PMTCT services. To understand differences in services being delivered at the community level, the study included three community-based health planning service sites and three maternity home sites. The study team interviewed two programmatic and finance staff at the 14 sites and central-level program managers and financial officers during data collection. The costing data are now being used to update Ghana's Goals Model and for planning, budgeting, and decision-making purposes (e.g., in conjunction with the development of Global Fund proposals).

    The report does not include specific operational details on how each of these different levels may use study results for their individual planning, budgeting and resource mobilization, and/or allocation purposes. The accompanying Estimating the Unit Costs of Providing HIV Prevention of Mother-to-Child Transmission Services in Ghana: A Data Use Guide summarizes key findings from the study and provides specific details on how study results may be best used to inform the evidence base for the Ghana PMTCT program.

  • This presentation,  "Why Does How Policy Is implemented Matter for Health Outcomes?" and poster, "How Do Health Policies Affect Health Systems and Outcomes," were given during a satellite session on policy implemenation hosted by the Health Policy Project at the Second Symposium on Health Systems Research, in Beijing, China, October 31, 2012.   

    Note: The conceptual framework presented during the session has since been updated; for the current version and more details on the framework, see the recently published paper, Linking Health Policy with Health Systems and Health Outcomes: A Conceptual Framework.