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Equity

HP+ More recent Equity publications are available.

  • The 2013 Kenya Household Health Expenditure and Utilisation Survey (2013 KHHEUS), explores the health-seeking behavior, use of healthcare services, out-of-pocket health spending, and health insurance coverage of Kenyan households. The first health survey to take place since Kenya decentralized its government; the 2013 KHHEUS collects data from the country’s 47 newly-created counties. By interviewing members of 33,675 households and comparing results with those of previous years (2003 and 2007), the 2013 survey provides important insights into how healthcare utilization, spending, and insurance coverage have changed in Kenya over the past decade. The 2013 KHHEUS was conducted by the Kenya Ministry of Health with support from the USAID-funded Health Policy Project and in conjunction with the Kenya National Bureau of Statistics. The survey provides critical evidence to inform the development of Kenya’s latest health financing strategy and policy decisions related to the future universal health coverage and the National Hospital Insurance Fund, and will support the wider national health accounts estimation process.

  • 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.

  • 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 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.

  • For several decades, civil society organizations (CSOs) in Nigeria have been advocating for increased resources for reproductive health (RH) and family planning (FP) services and commodities. Many people assume that once policymakers make a public commitment to provide funding for a specific purpose, the funds are assured. However, such a commitment is only the first step in securing budgetary allocation. The necessary steps include formal approval for the budgetary allocation, inclusion of the funds in the approved budget, release of the funds for the program, and expenditure of the funds intended.

    CSOs can play a key role in ensuring that public funds are used for the intended purpose and actually reach the intended beneficiaries. To do so, they need to understand the budgetary process and the role of nongovernmental stakeholders in the process. The inner workings of the state-level budget process in Nigeria are not well understood, and there is little documentation of the process to provide guidance.

    To help CSOs in Nigeria understand and actively participate in the budget process, the Health Policy Project conducted an assessment to identify the differences between theory and practice in state-level budgeting. In doing so, several entry points emerged for CSOs to make a difference in FP/RH funding; the key tasks identified include

    • Advocate for increased funds for FP/RH programs and commodities
    • Ensure that adequate funds are budgeted, obligated, and released in a timely manner
    • Track state-level budget expenditures, especially funds actually expended for FP/RH services and commodities
    • Hold policymakers and program managers accountable for the effective use of public funds

  • In 2013, the government of Kenya abolished all user fees in public dispensaries and health centers. In 2015, the Health Policy Project conducted a nationally representative study to examine how the removal of user fees affected health utilization; whether facilities were adhering to the policy; how health workers and clients perceived the policy; and whether quality of service before and after the policy’s implementation had changed. This evaluation report provides findings from the study and recommendations for the successful implementation of Kenya’s abolition of user fees policy.  

  • 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.

  • Healthcare in many developing countries, including those in sub-Saharan Africa, is predominantly funded through out-of-pocket spending by households. Providing financial protection from exorbitant out-of-pocket expenses is an important tool for a country’s health system to ensure equitable access to care and ensure families are not unnecessarily faced with financial catastrophe and impoverishment. Using data from the Kenya Household Health Expenditure and Utilization Surveys and descriptive analysis, the Health Policy Project, with support from USAID and PEPFAR, estimated the incidence and intensity of catastrophic healthcare expenditure and impoverishment in Kenya in 2003 and 2007. Among other findings, the Catastrophic Health Expenditures and Impoverishment in Kenya analysis revealed that in 2007 an estimated 2.5 million people were pushed below the national poverty threshold as a result of paying for healthcare. Results from this analysis provide strong evidence for the need to implement policies that offer more financial protection to the poor and vulnerable in order to achieve the country’s overall goal of universal health coverage.

  • The Government of Ghana in 2012 included family planning commodities and services in the benefit package of the National Health Insurance Scheme and thus the need to assess the cost. The analysis in this report focuses on costing family planning services provided in the National family planning protocol of 2007 which are currently being delivered in health facilities and NGOs in Ghana. The objective of the study was to determine the unit cost (direct and indirect) of providing family planning services in Ghana and also project the resource requirements for scaling up family planning services in Ghana from 2012 to 2016.

  • Costed Implementation Plans (CIPs) are concrete, detailed plans for achieving the goals of a national family planning program over a set number of years. A CIP details the program activities necessary to meet the goals and the costs associated with those activities, thereby providing clear program-level information on the resources a country must raise both domestically and from donors. The Health Policy Project, with various partners, has developed a collaborative, 10-step approach to creating a CIP that aligns with ongoing government planning and coordination efforts. This brief outlines these 10 steps, which when implemented, should result in a consensus-driven strategy, roadmap, and budget for achieving family planning targets under the Ouagadougou Partnership, FP2020, and/or other national programs. To date, the following countries have completed CIPs for family planning: Senegal, Burkina Faso, Niger, Togo, Mauritania, Guinea, and Zambia.

  • Health financing was the theme of a major national conference held in Calabar, Nigeria in November 2011. The specific focus of the three-day conference was “Improving Financial Access to Health Services for the Poor in Nigeria.” Participants shared information on a wide range of health financing strategies and mechanisms employed in Nigeria as well as other countries. The 255 participants represented a broad range of expertise; they included health managers and providers, insurance specialists, health economists, government officials, and media representatives from all 36 states and the national capital. State representatives met in regional groups to discuss the approaches most applicable to their area and formulate plans to apply these approaches at the state or community level. The conference generated many “actionable” policy and program initiatives that the states and federal government can adopt.

    This presentation was one of five presentations made by the Health Policy Project. The presenter gave a brief overview of various software models available to help health planners and managers to estimate and project costs for various health services. These tools can be adapted for use at the state and local level and used to estimate costs to reach a specific goal or to expand or upgrade services.

  • 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.

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

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

  • 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.

  • These evidence-based advocacy materials, based on Spectrum projections, were produced under the USAID-funded Health Policy Project by the White Ribbon Alliance Nigeria to support national- and state-level advocacy efforts aimed at increasing access to family planning.

  • The 2013 Kenya Household Health Expenditure and Utilisation Survey (2013 KHHEUS), explores the health-seeking behavior, use of healthcare services, out-of-pocket health spending, and health insurance coverage of Kenyan households. The first health survey to take place since Kenya decentralized its government; the 2013 KHHEUS collects data from the country’s 47 newly-created counties. By interviewing members of 33,675 households and comparing results with those of previous years (2003 and 2007), the 2013 survey provides important insights into how healthcare utilization, spending, and insurance coverage have changed in Kenya over the past decade. This brief summary highlights the key findings from the survey which will be used to inform Kenya health and health financing policy and will support the national health accounts estimation process. The 2013 KHHEUS was conducted by the Kenya Ministry of Health with support from the USAID-funded Health Policy Project and in conjunction with the Kenya National Bureau of Statistics.

  • In June 2013, President Uhuru Kenyatta of Kenya announced policies to remove user fees in dispensaries and health centers and to provide free maternal health services in all public health facilities. This report presents the findings of a study conducted in Kenya by the USAID-funded Health Policy Project (HPP) to establish baseline measures for evaluating the impact of these policies. The Kenya Ministry of Health, with support from HPP, identified the need to monitor and evaluate the impact of the policies on utilization, service provision, and revenue collection, among other indicators.

  • In order to expand and ensure widespread access to healthcare services and protect households from what are termed "catastrophic" health expenditures, Kenya needs alternative and sustainable healthcare financing mechanisms. The Health Policy Project supported the government of Kenya to analyze the long-term health delivery costs and health financing options available to the country. Employing a number of economic and health financing tools, the analysis, Healthcare Financing Options for Kenya: FY 2013/14–2029/30, revealed a need to increase domestic financing and improve the efficiency of the service delivery and social health insurance systems. Results from the analysis will be used to support the country’s move toward universal health coverage.

  • 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 November 2011 in Nigeria, a landmark national conference, "Improving Financial Access to Maternal, Newborn, and Child Health Services for the Poor in Nigeria," was held. The conference organizers included three federal agencies, the African Health Economics and Policy Association, four United Nations agencies, three donor countries, and five health projects, including the Health Policy Project. A total of 255 experts from all 36 Nigerian states and the Federal Capital Territory came together to discuss strategies to improve financial access to integrated MNCH services, with the aim of achieving universal health coverage. These strategies highlighted the need for advocacy and policy change, innovation in the design and implementation of health financing schemes, strengthening of the social health insurance scheme, and collaboration with private sector health providers.

    A complete list of sponsoring agencies and all conference materials and presentations are available on the conference website at http://www.healthfinancenigeria.org.

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

  • 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.

  • 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.

  • 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 October 2013, the Haitian government passed a law to regularize adoption. This new law focuses on children's best interests and aims to promote international adoption as a last-resort measure after reviewing all the national options. The USAID-funded Health Policy Project AKSE program reproduced the text of the law in this booklet to make it accessible to actors in the child protection chain and to promote its application through trainings for Haitian judicial actors and dissemination among human rights NGOs.

  • 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. 

  • 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.

  • 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 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 public expenditure tracking survey with service delivery indicators (PETS-Plus) survey was a comprehensive exercise conducted in 2012 by the Ministry of Health, Kenya in collaboration with the USAID- and PEPFAR-supported Health Policy Project, Kenya Institute of Public Policy Research and Analysis, the World Bank, and the Kenya Medical Research Institute. The PETS-Plus combines the expenditure tracking surveys previously conducted in Kenya with health service indicators (SDI) to provide a comprehensive view of health facilities' overall performance and the impacts of key policy reforms in the sector. Data collected from 294 sampled facilities across 15 counties provide information on the adequacy of infrastructure, medical equipment, medical drugs, human resources for health, and financial planning and management at the facility level. Levels of adherence to key health financing policies on user fees (10/20 policy) and the Health Services Sector Fund/Hospital Management Service Fund (HSSF/HMSF) were also measured, providing critical insights into levels of readiness for devolution in the health sector and the implementation of policies such as free maternal healthcare and removal of user fees at the primary level. 

    Results of the survey suggest that counties in Kenya need to pay urgent attention to essential drug availability and improve human resource levels by reducing absenteeism and through redeployment. Access to IT equipment and electronic data record systems is needed. Adherence to past user fee policies has been non-uniform, suggesting that implementation of current user fee removal policies should be carefully monitored, and the delivery of HSSF/HMSF funds needs to be improved and strengthened. The PETS-Plus report is supported by three focused policy briefs that examine the results from different perspectives, diving deeper into the findings: effective implementation of the health financing policies; quality of primary healthcare services (using the SDI results); and county readiness for healthcare delivery (a comprehensive look across health inputs). These briefs are available on this page alongside the main report.

  • Health financing was the theme of a major national conference held in Calabar, Nigeria in November 2011. The specific focus of the three-day conference was “Improving Financial Access to Health Services for the Poor in Nigeria.” Participants shared information on a wide range of health financing strategies and mechanisms employed in Nigeria as well as other countries. The 255 participants represented a broad range of expertise; they included health managers and providers, insurance specialists, health economists, government officials, and media representatives from all 36 states and the national capital. State representatives met in regional groups to discuss the approaches most applicable to their area and formulate plans to apply these approaches at the state or community level. The conference generated many “actionable” policy and program initiatives that the states and federal government can adopt.

    This is one of the five presentations made by the Health Policy Project. The presenter explains how to measure poverty and inequality, how to display poverty data to illustrate inequities in health status and use of health services, and, finally, how to understand and address common data challenges.

  • In close collaboration with IBESR, the USAID-funded HPP AKSE developed referral schematics and protocols will be developed for client service needs, safety, security, and confidentiality of existing child protection networks.

  • 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.

  • 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.

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

  • In 2012, the Government of Haiti worked in collaboration with the U.S. Centers for Disease Control (CDC) and Prevention to conduct the Violence Against Children Survey (VACS). The objective of the study was to measure the prevalence and consequences of physical, emotional, and sexual violence against children. The results would inform the design, implementation, and evaluation of a violence prevention program for children, and the building of systems for child protection. The USAID-funded HPP AKSE developed this brief to provide context and information to guide the Government of Haiti's strategies to respond VACS survey results and identify ways to strengthen child protection.

  • Health financing was the theme of a major national conference held in Calabar, Nigeria in November 2011. The specific focus of the three-day conference was “Improving Financial Access to Health Services for the Poor in Nigeria.” Participants shared information on a wide range of health financing strategies and mechanisms employed in Nigeria as well as other countries. The 255 participants represented a broad range of expertise; they included health managers and providers, insurance specialists, health economists, government officials, and media representatives from all 36 states and the national capital. State representatives met in regional groups to discuss the approaches most applicable to their area and formulate plans to apply these approaches at the state or community level. The conference generated many “actionable” policy and program initiatives that the states and federal government can adopt.

    This presentation is one of five presentations made by the Health Policy Project. The presenter gave an overview of a pilot project in Kenya, which found that the provision of subsidized vouchers for maternal health and family planning services were effective in reaching the poor at a reasonable cost; providers were paid for specific services (rather than supporting operating costs).

  • This presentation is one of five made by the Health Policy Project at a national health financing conference held in Calabar, Nigeria, in November 2011. Participants, including health managers and providers, insurance specialists, health economists, government officials, and media representatives, shared information on a wide range of health financing strategies and mechanisms employed in Nigeria and other countries.

    The Equity Framework is an approach that targets family planning and reproductive health resources to the poor—a segment of the population that is often overlooked in health program planning. The presentation examines a case study in Jharkhand, India—one of India’s poorest states—where health planners applied the Equity Framework to develop a voucher scheme to enable low-income women to access reproductive health services. Conference participants were able to learn from the success garnered in India and adopt similar policy and program initiatives to expand access to family planning and reproductive health services to the poor in Nigeria.

  • Health financing was the theme of a major national conference held in Calabar, Nigeria in November 2011. The specific focus of the three-day conference was “Improving Financial Access to Health Services for the Poor in Nigeria.” Participants shared information on a wide range of health financing strategies and mechanisms employed in Nigeria as well as other countries. The 255 participants represented a broad range of expertise; they included health managers and providers, insurance specialists, health economists, government officials, and media representatives from all 36 states and the national capital. State representatives met in regional groups to discuss the approaches most applicable to their area and formulate plans to apply these approaches at the state or community level. The conference generated many “actionable” policy and program initiatives that the states and federal government can adopt.

    This presentation is one of five presentations made by the Health Policy Project. The presenter gave an overview of an activity in Peru, where family planning advocates analyzed the needs of low-income women and successfully tapped into funding sources at the local, regional, and national level to increase access to FP services.

  • This manual provides the user with step-by-step instructions to apply the GAP Tool (Gather, Analyze, and Plan). The GAP Tool is a simple Excel-based tool to help policymakers, ministry officials, health officials, and advocates understand and plan for the costs associated with expanding family planning to achieve their country's contraceptive prevalence or fertility goals. The two main outputs produced by the tool are the country’s funding gaps for a national family planning program and for family planning commodities. 

    The U.S. Agency for International Development (USAID) supported development of the GAP Tool through the USAID | Health Policy Initiative, Task Order 1, and continues to support work on the tool, as well as this manual, through the Health Policy Project. 

  • In developing countries, governments are increasingly turning to innovative policy measures to improve access to basic health services. In Guatemala, policies were introduced to protect the financing and provision of family planning and reproductive health (FP/RH) services. Follow-on legislation earmarked 30 percent of the alcohol tax revenue for the Ministry of Health (MOH) to purchase contraceptives. To determine the impact of the revenue on the FP/RH budget, the Health and Education Policy Project (HEPP) evaluated whether the funds were available and used as legislated. HEPP gathered data on MOH funds and alcohol tax funds retrospectively to see if the policy was working as intended. Budget tracking constitutes a practical, sustainable tool for non-experts to assess transparency.

  • 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.

  • The  Malawi government  introduced  the  Youth  Friendly  Health  Services (YFHS) program in  2000 and  in  2007  the  Ministry of Health-Reproductive Health Directorate (MOH-RHD)  developed  Youth  Friendly  Health  Services Standards  with  the aim of providing  quality services  to young  people. In 2014, the MOH-RHD and the Centre for Social Research, University of Malawi, with assistance from the USAID-supported Evidence to Action project, conducted its first comprehensive evaluation of the YFHS program. The evaluation assessed the quality of YFHS compared to the existing national standards, in the context of the current sexual and reproductive health (SRH) needs of Malawian youth.  

    This brief summarizes the implementation of YFHS standards in Malawi and suggests key questions for policy makers and program managers to consider in order to improve YFHS in Malawi.

  • The  Malawi government  introduced  the  Youth  Friendly  Health  Services (YFHS) program in  2000 and  in  2007  the  Ministry of Health-Reproductive Health Directorate (MOH-RHD)  developed  Youth  Friendly  Health  Services Standards  with  the aim of providing  quality services  to young  people. In 2014, the MOH-RHD and the Centre for Social Research, University of Malawi, with assistance from the USAID-supported Evidence to Action project, conducted its first comprehensive evaluation of the YFHS program. The evaluation assessed the quality of YFHS compared to the existing national standards, in the context of the current sexual and reproductive health (SRH) needs of Malawian youth.  

    This brief summarizes the sexual knowledge and behaviour of youth in Malawi and suggests key questions for policy makers and program managers to consider in order to improve YFHS in Malawi.