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Gender

HP+ More recent Gender publications are available.

  • 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.

  • Developed with support from the USAID-funded Health Policy Project, A Guide for Advocating for Respectful Maternity Care is a comprehensive resource centered on the Respectful Maternity Care charter, a groundbreaking consensus document that demonstrates the legitimate place of maternal health rights within the broader context of human rights. Written for national-level advocates, this guide presents a variety of ways to (1) build a sense of entitlement among women and communities regarding respectful maternity care (RMC) and (2) advocate for the institutionalization of RMC as a core value of the maternal care system. Specifically, the guide provides information and user-friendly tools and techniques to help advocates

    • Raise awareness and generate demand from civil society for RMC rights;
    • Mobilize communities to hold local leaders and service providers accountable for RMC rights; and
    • Secure commitment at the national level to institutionalize RMC as the standard of care.

    Also available for download as individual documents are the charter, titled Respectful Maternity Care: The Universal Rights of Childbearing Women, and accompanying brochure and poster (in English, Arabic, French, and Spanish).

  • The Millennium Development Goals (MDGs)—a set of eight important, time-bound goals ranging from reducing poverty in developing countries to providing universal primary education—represent a blueprint for global development agreed to by member states of the United Nations and international development institutions. Uganda has made significant progress in reducing maternal and child mortality, but areas such as improved sanitation coverage, malaria, and universal primary education have seen less improvement. This analysis by the USAID-funded Health Policy Project shows how one strategy— reducing the unmet need for family planning (FP) in line with Family Planning 2020 (FP2020) goals—can make achieving and sustaining the MDGs more affordable in Uganda, and directly contribute to further reducing child mortality and improving maternal health.

  • 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.

  • In 2011, the USAID-funded Health Policy Project (HPP) provided technical assistance to support gender integration in the Mali National Health and Social Development Program (PRODESS). As part of this effort, HPP conducted a gender and health analysis using available data to inform PRODESS working groups. To facilitate the analysis, HPP developed a systematic gender data analysis process and identified data sources, including the Demographic and Health Survey (DHS) and the National Multiple Indicator Cluster Survey (MICS), to elucidate gender-specific cultural attitudes and practices and gender-related barriers with the potential to impact health outcomes for women and girls in Mali.

    This document presents this secondary data analysis process, along with findings from Mali, to facilitate its possible application in other settings. We provide step-by-step procedures for using existing data sources to analyze key gender and health data and to illustrate the links between gender disparities and health outcomes. This process serves as a practical, easy-to-follow method for conducting a low-cost, data-informed gender analysis that can be used to provide concrete, quantifiable examples of the impact of gender on health and other development outcomes

  • This Health Policy Project case study methodology involves reviewing policy documents and plans, and conducting key informant interviews with the Ministry of Women’s Affairs (MOWA) to understand their role in monitoring NAPWA’s implementation, highlight challenges in gender mainstreaming and understand coordination efforts across other ministries’ gender units.

  • To achieve the greatest possible improvement in family planning (FP) and maternal, neonatal, and child health (MNCH) outcomes, successful interventions, practices, and approaches must be “scaled up”—that is, implemented on a larger scale and incorporated into the laws, policies, and structures that govern health systems. Gender equality is central to successful and sustainable scale-up because it significantly influences health outcomes, and many barriers to program scale-up are related to inequitable gender norms.

    The Health Policy Project’s Gender, Policy, and Measurement program (GPM) has designed an approach to help countries advance the systematic integration of gender equality into the scale-up of FP/MNCH interventions and best practices. The approach draws heavily on the process for integrating gender equality into programs and policies—the steps of which include

    • Conduct gender assessments
    • Prepare for gender-integrated scale-up
    • Develop a gender-integrated scale-up strategy
    • Implement and monitor gender-integrated scale-up
    • Evaluate gender and health outcomes

  • 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.

  • HPP worked with the Ministry of Women’s Affairs and Women’s Rights (MCFDF) to publish the White Paper on the status of women in Haiti, which presents findings and recommendations from county and national-level participatory fora on 5 key themes for women in Haiti: education, health, leadership and political participation, economy, and justice. The briefs present key findings and bring together data from a wide array of sources. They are intended to be a quick reference for a broad audience, including advocates, policymakers, health sector stakeholders, and development partners. 

  • 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. 

  • 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.

  • Under the Gender Policy and Measurement (GPM) activity, funded by the Asia and Middle East Bureaus of USAID, the Health Policy Project (HPP) hosted an expert meeting in December 2012 on experiences with scaling up best practices in family planning and maternal, neonatal, and child health. The meeting, held in Washington, DC, focused on gender integration and policy implementation in the scale-up of programs. Experts identified the gaps, priorities, and entry points for addressing gender and policy in scale-up. Initiatives to scale up programs aim to strengthen health systems and expand the reach of essential services to those who need them most.

    Related resources: 

    The Policy Dimensions of Scaling Up Health Initiatives

    Integrating Gender into the Scale-Up of Family Planning and Maternal, Neonatal, and Child Health Programs

  • The public health community increasingly recognizes the importance of incorporating strategies to address gender equality in programs to improve health outcomes for women, men, and children. To strengthen gender integration efforts in the island nation of Timor-Leste, the Gender, Policy, and Measurement (GPM) program, funded by the USAID Asia and Middle East (A/ME) Bureaus, undertook a gender assessment. The GPM program is implemented by the Health Policy Project and MEASURE Evaluation. The assessment aimed to discover the normative, socioeconomic, and political variables that impede or facilitate utilization of health services in Timor-Leste. This analysis can be used by donors and implementing organizations to incorporate gender into the formulation, implementation, and evaluation of family planning and maternal, neonatal and child health programs.

  • The U.S. Government has embraced gender equality and female empowerment as core development objectives. These commitments are articulated through the USAID policy on Gender Equality and Female Empowerment, the President’s Emergency Plan for AIDS Relief gender program guidance for HIV, and the U.S. Global Health Initiative first principle on Women, Girls, and Gender Equality. This document is a tool for USAID country health offices to operationalize these commitments strategically and effectively.

  • The Health Policy Project (HPP), with support from USAID and in cooperation with national policymakers and advocates, undertook a systematic assessment to better understand and document the current policy environment, along with the challenges and opportunities Malawi faces in implementing more gender-responsive population and family planning policies. The assessment included both a desk review of current policies, and a series of key informant interviews that sought also to assess the role and impact of gender stewardship mechanisms on sexual and reproductive health-related policies and programs, and to document first-hand perspectives on policy implementation.

  • 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.

  • 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. 

  • 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.

  • 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). 

  • Developed by the USAID-funded Health Policy Project, the Integrating Gender into Scale-up Mapping Tool is designed to provide program managers with a methodology to systematically integrate gender into scale-up initiatives. The process begins with a gender-based analysis to identify factors that influence women’s and men’s experiences related to health and the best practice to be scaled up. The findings from the analysis are then used to inform development of a scale-up road map with a gender lens. The mapping tool enables the user to identify when gender-based constraints may arise during the scale-up process, and develop strategies to address constraints and opportunities to reduce gender inequality during scale-up. Lastly, the user will develop indicators to monitor both the scale-up process and the gender strategies incorporated into the scale-up process. At the end of the mapping exercise, the user will have a concrete plan outlining the gender barriers that may arise throughout the scale-up process, strategies for addressing these barriers, and indicators to monitor both the scale-up process and the gender strategies incorporated into the process.

    This tool features a gender analysis template and the Integrating Gender into Scale-up Mapping template. Illustrative examples for completing the mapping template are also provided. 

  • International initiatives, including the Millennium Development Goals, are increasingly recognizing that gender strongly influences the health outcomes of women, men, and children. Relevant literature indicates that the incorporation of strategies to address gender inequality can lead to improved health and program outcomes. Many donors and program implementers have begun to incorporate strategies and approaches that address gender barriers and constraints. However, it is not clear that regular attention is being paid to gender factors during program scale-up.

    The Health Policy Project (HPP) conducted a literature review to identify and analyze whether systematic attention to gender factors during the planning and process of scaling up family planning (FP) and maternal, neonatal, and child health (MNCH) programs improves the effectiveness of that process. This working paper focuses on efforts to scale up interventions in FP and MNCH in developing countries. It defines “scale-up” and describes some of the frameworks and approaches to scaling up found in recent health literature and how they address gender. The paper also reviews the experience of selected organizations in scaling up best practices and addressing gender. It identifies a number of lessons learned from scale-up initiatives and lists key recommendations for systematically integrating gender into the scale-up process.

    Related resources:

    Expert Meeting on Policy Implementation and Gender Integration in the Scale-Up of Family Planning and Maternal, Neonatal, and Child Health Best Practices

    The Policy Dimensions of Scaling Up Health Initiatives

  • 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.

  • 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. 

  • In June 2014, the Government of Haiti passed a new anti-trafficking law in order to fill a fundamental legal vacuum for the protection of survivors and for prosecution of perpetrators of human trafficking. These new legal provisions particularly important in an island known for being a country of origin, transit, and destination for the trafficking of human beings. This brief, published by the HPP AKSE program, aims to explain the rationale, scope, and implications of this new law. It is especially intended to inform non-governmental organizations working in the field of human rights.

  • In June 2014, the government of Haiti passed a new law: the Responsible Paternity Act. With this law, Haiti sent a clear signal promoting the “protection of all children, without discrimination.” A significant implication of the act for parents is that children born within and outside of marriage must be afforded the same opportunities and rights (e.g., inheritance rights)—an important principle in a society with five forms of union. This booklet reproduces the text of the law, and was produced by the USAID-funded Health Policy Project AKSE program to educate parents and judicial actors about the new law and advocate for its concrete application. The law is not retroactive.

  • This policy brief highlights the USAID-funded Health Policy Project's in-depth analysis of fertility and family planning trends in the Amhara Region, based on the Ethiopia Demographic and Health Survey (EDHS) 2011. The findings demonstrate that early marriage is pervasive in Amhara (leading to earlier childbearing), and that 22 percent of married women in the region have an unmet need for family planning. There are disparities in the uptake of family planning, with rural women and those with no formal education being particularly difficult to reach. The quality of family planning services was also found to be a barrier to family planning use, with many women receiving inadequate counseling about available contraceptive methods or side effects. Based on the study's findings, crucial actions are recommended for expanding and improving family planning services and reducing fertility in the Amhara Region, which can inform family planning policy development and advocacy in the region.

  •  In June 2014, the government of Haiti passed a new law: the Responsible Paternity Act. With this law, Haiti sent a clear signal promoting the “protection of all children, without discrimination.” A significant implication of the act for parents is that children born within and outside of marriage must be afforded the same opportunities and rights (e.g., inheritance rights)—an important principle in a society with five forms of union. This booklet reproduces the text of the law, and was produced by the USAID-funded Health Policy Project AKSE program to educate parents and judicial actors about the new law and advocate for its concrete application. The law is not retroactive.

  • 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. 

  • Malawi's Ministry of Gender, Children, Disability and Social Welfare recognizes the breadth and seriousness of intimate partner violence and coordinates the national response to end this violence and strengthen support for survivors. To aid the ministry’s efforts, the Health Policy Project (funded by USAID and PEPFAR) reviewed research, program reports, and government documents to produce a profile of what is documented about intimate partner violence (and gender-based violence, more generally) in Malawi, how the problem has been handled to date, and where action is needed most urgently. The findings are the basis for this brief.

  • The USAID-funded Health Policy Project (HPP), in collaboration with the Family Health Division of the Ministry of Health and Population in Nepal, and members of the multi-sectoral technical working group (TWG), completed applications of three models: ImpactNow, DemDiv, and RAPID Women. The integrated modeling package provided evidence to reinvigorate support for family planning among national-level policymakers. 

    HPP developed three policy briefs to summarize model results around three key themes: family planning, education and gender equality. HPP also developed two booklets. The first booklet, Planning for Nepal’s Demographic Dividend, makes a case for increased investment in family planning, education and economic policies to promote health and development. The second booklet, Gender Equality and Social Inclusion: Investments for Improved Health and Development, presents results from the RAPID Women model and makes the case for investing in women-centered strategies for improved health outcomes. The materials represent the key messages developed by the TWG and family planning stakeholders that participated in HPP’s message development workshop. 

  • 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 checklist, developed by the USAID-funded Health Policy Project, draws from lessons learned and best practices moving from policy to action. It is meant to provide guidance to stakeholders on how to contribute to a policy environment that supports countries to fulfill their FP2020 commitments. The tool allows users to compare current policies with the best practices discussed in this document, to assess whether current policies need to be revised or better implemented, and whether new policies should be developed. 

  • 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.

  • International health programs and donors throughout the world increasingly recognize the importance of promoting gender equality to improve health and development outcomes. International initiatives such as the Sustainable Development Goals include specific gender equality goals and targets. Yet, translating gender equality goals into action is challenging. Practical tools for integrating gender into health policies and programs are needed. The USAID-funded Health Policy Project (HPP) prepared this brief to provide policymakers, donors, and program managers with real examples of methods for promoting gender equality in family planning, maternal and child health, and gender-based violence policies and programs.

  • 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.

  • 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.

  • The Nepalese government has prioritized mainstreaming gender equality and social inclusion in the country’s health policies and programs in order to improve the quality of equal access to health services for all. In support of this goal, management of local health facilities was handed over to Health Facility Operation and Management Committees (HFOMCs) to increase the involvement of local communities in planning for the provision of high-quality health services. HFOMCs work to bridge the gap between communities and health providers and their guidelines require wide and inclusive community participation, especially of women and other disadvantaged groups. To strengthen the committees’ capacity to make health services more inclusive, the Gender Policy and Measurement Program (GPM), an activity of the Health Policy Project (HPP) and MEASURE Evaluation, has partnered with the Suaahara Project to design, implement, and evaluate a scalable intervention to overcome barriers to HFOMC participation for women and other disadvantaged groups. This intervention will ultimately strive to improve family planning and neonatal health outcomes among marginalized groups.

  • The Gender, Policy and Measurement (GPM) program, funded by the Asia bureau of the United States Agency for International Development (USAID), is collaborating with USAID and other partners in the Asia region to strengthen programs for scale-up in Family Planning and Maternal, Neonatal, and Child Health (FP/MNCH). As a part of this effort, the GPM program, under the USAID-funded Health Policy Project (HPP), along with partner institutions in India—the International Center for Research on Women and the Public Health Foundation of India—sought to examine how successful gender-integrated health programs (identified through a systematic review of gender-integrated health programs in low- and middle-income countries have been scaled up, with a focus on programs that were scaled up through government structures in India.

    This report assesses the processes, challenges, successes, and lessons learned from scaling up gender-integrated programs through government systems in India; it provides an in-depth, comparative analysis of the scale-up experiences of three programs: Gender Equity Movement in Schools, PRACHAR, and Avahan. It identifies wide variations in government motivations for adoption and scale-up, approaches to scale-up, partnerships and engagement with key stakeholders, resource mobilization, and the modification or lack of attention to important gender components or aspects of the original pilot program(s). Finally, the study offers distinct and critical snapshots of gender throughout scale-up.

  • In recent decades, Ethiopia has made impressive progress in improving socioeconomic outcomes and reducing child and maternal mortality. This brief, prepared by the Health Policy Project, outlines the current status of women and girls in Ethiopia and provides recommendations on how to improve girls' education, gender norms, and family planning to benefit women, their families, and the country.

  • 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.

  • The USAID-funded Health Policy Project (HPP) conducted a readiness assessment in Mozambique to see if would be possible and useful to conduct a costing study of post-GBV Care Services. Broadly the readiness assessment was designed to assess if there is a shared understanding about GBV and the need to scale up services. On a narrower level, the readiness assessment looked specifically at whether the data and information needed to apply HPP’s GBV Cost Calculator are available . The Calculator was initially developed and tested using the GBV management guidelines for the Ministry of Health and Social Welfare for the United Republic of Tanzania, which has invested heavily in standardized care protocols, training and data collection. The assessment highlights several important challenges to conducting a GBV costing study in Mozambique as well as some clear opportunities. The challenges include a lack of agreement about what constitutes GBV, a lack of protocols on what constitutes a GBV facility, and  a deficiency in national data collection protocols. The opportunities are reflected in a policy environment that offers a range of multisectoral and health sector policy documents and in the commitment by donors and the government of Mozambique to expand the quality and accessible of support for GBV survivors. 

  • 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.

  • In every country and community worldwide, pregnancy and childbirth are momentous events in the lives of women and families and represent a time of intense vulnerability. As part of an overall effort to promote respectful maternity care, the Health Policy Project and White Ribbon Alliance have launched the Respectful Maternity Care Charter, based on the principle that respectful maternity care is every woman's right. A broad group of stakeholders representing research, clinical, human rights, and advocacy perspectives came together in a community of concern to develop this charter, which addresses the issue of disrespect and abuse among women seeking maternity care and provides a platform for improvement through seven distinct articles that clarify the rights of childbearing women. Improving the quality of care for women is an essential component in our work to improve maternal health worldwide.

    This brochure summarizes the key points and articles of the charter, titled Respectful Maternity Care: The Universal Rights of Childbearing Women, and is accompanied by a poster. Also available is A Guide for Advocating for Respectful Maternity Care, which provides national-level advocates with information, tools, and techniques to (1) raise awareness and demand for respectful maternity care (RMC), (2) hold local leaders and services providers accountable, and (3) secure commitments to institutionalize RMC as the standard of care.

  • In every country and community worldwide, pregnancy and childbirth are momentous events in the lives of women and families and represent a time of intense vulnerability. As part of an overall effort to promote respectful maternity care, the Health Policy Project and White Ribbon Alliance have launched the Respectful Maternity Care Charter, based on the principle that respectful maternity care is every woman's right. A broad group of stakeholders representing research, clinical, human rights, and advocacy perspectives came together in a community of concern to develop this charter, which addresses the issue of disrespect and abuse among women seeking maternity care and provides a platform for improvement through seven distinct articles that clarify the rights of childbearing women. Improving the quality of care for women is an essential component in our work to improve maternal health worldwide.

    This charter is accompanied by a summary brochure and poster and is supported by A Guide for Advocating for Respectful Maternity Care, which provides national-level advocates with information, tools, and techniques to (1) raise awareness and demand for respectful maternity care (RMC), (2) hold local leaders and service providers accountable, and (3) secure commitments to institutionalize RMC as the standard of care.

  • In every country and community worldwide, pregnancy and childbirth are momentous events in the lives of women and families and represent a time of intense vulnerability. As part of an overall effort to promote respectful maternity care, the Health Policy Project and White Ribbon Alliance have launched the Respectful Maternity Care Charter, based on the principle that respectful maternity care is every woman's right. A broad group of stakeholders representing research, clinical, human rights, and advocacy perspectives came together in a community of concern to develop this charter, which addresses the issue of disrespect and abuse among women seeking maternity care and provides a platform for improvement through seven distinct articles that clarify the rights of childbearing women. Improving the quality of care for women is an essential component in our work to improve maternal health worldwide.

    This poster presents the central articles of the charter, titled Respectful Maternity Care: The Universal Rights of Childbearing Women, and is accompanied by a summary brochure. Also available is A Guide for Advocating for Respectful Maternity Care, which provides national-level advocates with information, tools, and techniques to (1) raise awareness and demand for respectful maternity care (RMC), (2) hold local leaders and services providers accountable, and (3) secure commitments to institutionalize RMC as the standard of care.

  • This document sets out the strategy for monitoring and evaluation of scale-up of a gender-integrated health governance project in Nepal. The Gender, Policy, and Measurement (GPM) Program (jointly implemented by the Health Policy Project and MEASURE Evaluation) has partnered with the Suaahara Project, a community-focused program dedicated to improving the health of pregnant and lactating women and children under two years of age. The partnership aim is to design, implement, and evaluate a scalable capacity strengthening intervention for Health Facility Operation and Management Committees (HFOMCs) in Nepal to ensure issues related to gender and social inclusion (GESI) are addressed as part of the delivery of quality health services. As part of this endeavor, GPM and Suaahara have created a strategy to prospectively monitor and evaluate the scale-up of this intervention.

  • 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.

  • 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.

  • To support gender integration efforts in the Philippines, the Gender, Policy, and Measurement (GPM) program of the USAID-funded Health Policy Project (HPP) conducted a gender assessment of health-related laws, policies, and programs, in collaboration with USAID/Philippines staff and stakeholders. The analysis was designed to help the health office of USAID/Philippines determine how the government, donors, and nongovernmental organizations are responding to gender inequality, norms, and barriers. This report presents the gender assessment’s results. It analyzes the country’s resources and capacity to develop and implement gender-responsive health programs, suggesting entry points and opportunities for investing in gender equality for improved family planning and maternal, neonatal, and child health outcomes. The report also recommends ways to incorporate gender-integrated interventions in the country’s health portfolio: for example, adapting or developing tools and training materials and adopting strategies for monitoring and evaluating gender-integrated 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.

  • 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.