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Browse Health Policy Project (2010-2016) Materials

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Efficiency & Effectiveness

HP+ More recent Efficiency & Effectiveness publications are available.

  • 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.

  • 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.

  • 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.

  • Kenya’s Health Sector Intergovernmental Forum (HSIF) brings together health sector managers from national and county governments, the Public Service Commission, the national treasury, and development partners to share experiences in managing devolved health services. In October 2014, the Health Policy Project/Kenya supported a two-day meeting of the HSIF to deliberate over issues affecting health service delivery under devolution, including management and financial inefficiencies. Published by the Government of Kenya, this report presents a summary of the meeting.

  • The USAID-funded Health Policy Project applied its new ImpactNow model to estimate the near-term health and economic benefits of achieving family planning goals in the Amhara region of Ethiopia. This report presents the proceedings of the preliminary results dissemination meeting, held in Bahir Dar in May 2014, attended by the Amhara Regional Health Bureau and representatives from the Federal Ministry of Health. Following presentation of the draft results, attendees' discussions and recommendations were recorded to inform the final ImpactNow analysis, to be completed in late 2014.

  • This report by the USAID- and PEPFAR-funded Health Policy Project provides and introduction to conditional grants and describes how Kenya can use them to strengthen its health systems during the transition to a devolved system of government and a decentralized health infrastructure.

  • 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.

  • 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.

  • In June 2014, the government of Haiti passed a new anti-trafficking law to fill a legal gap in the protection of survivors and to increase prosecution of perpetrators of human trafficking. These new legal provisions are particularly important in a country known for being an origin, transit point, and destination for human trafficking. This brief, published by the USAID-funded Health Policy Project AKSE program, aims to explain the rationale, scope, and implications of this new law. It is aimed at international and local organizations working in the field of human rights. This tool is part of a collection of materials developed by HPP AKSE to enhance the environment addressing child protection, trafficking, gender-based rights, sexual and gender-based violence, and to reinforce the capacity of actors in the protection chain and reference networks. 

  • 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.  

  • Afghanistan's Ministry of Public Health (MoPH) has prioritized the improvement of national hospitals in its Health and Nutrition Strategic Plan 2011-15 and in the Hospital Sector Strategy. Greater political and financial support is needed for the national hospitals to smoothly implement the hospital strategy and to ensure more efficient and effective delivery of tertiary services.  This policy brief provides recommendations to improve achieve greater hospital autonomy, which will contribute towards the efficient and effective delivery of tertiary services.

  • Tanzania’s sustained development and transition to middle-income status depend on the health of its people. In recognition of this fact, the Government of Tanzania (GOT) has prioritized reproductive, maternal, newborn, child, and adolescent health (RMNCAH), adopting a broad foundation of policies to inform RMNCAH programming. Yet, in recent years, progress toward achieving Millennium Development Goal (MDG) targets for child, maternal, and neonatal health has been uneven, in large part due to funding and implementation challenges. To overcome these challenges and accelerate progress, the GOT developed a National Road Map Strategic Plan to Improve Reproductive, Maternal, Newborn, Child and Adolescent Health in Tanzania (2016-2020): One Plan II. In 2015, the USAID-funded Health Policy Project (HPP) conducted an analysis to project the costs and health impacts of achieving the government’s new commitments outlined in the One Plan II, and to identify the remaining challenges for implementing the plan.

  • 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.

  • 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.

  • 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 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.

  • 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.