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Health Financing

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  • 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.

  • This USAID-funded Health Policy Project analysis summarizes how one strategy— reducing the unmet need for family planning in line with Malawi’s FP2020 goals—can make achieving and sustaining the MDGs more affordable in Malawi, in addition to directly contributing to the goals of reducing child mortality and improving maternal health. Calculations show that for every dollar invested in family planning between 2013 and 2025, the government of Malawi could save five dollars in other social services such as education, immunization, malaria, maternal health, and water and sanitation.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide family planning services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing family planning by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide family planning services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing family planning by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide family planning services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing family planning by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide family planning services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing family planning by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide family planning services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing family planning by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide family planning services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing family planning by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide family planning services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing family planning by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide FP services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing FP by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide family planning services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing family planning by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide family planning services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing family planning by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide family planning services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing family planning by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide family planning services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing family planning by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide family planning services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing family planning by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide family planning services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing family planning by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide family planning services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing family planning by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide family planning services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing family planning by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide family planning services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing family planning by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide family planning services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing family planning by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide family planning services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing family planning by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

  • Updated analyses on the costs of meeting the Millennium Development Goals (MDGs) indicate that countries would save money by investing in family planning programs. For example, in the nine francophone countries in West Africa, if governments provide family planning services to women who want to space or limit future births, countries would realize considerable savings in programs designed to address MDGs for maternal and child health, environmental sustainability, communicable diseases, and primary education. The savings in reduced costs outweigh the additional costs of providing family planning by a factor of 3 to 1 for the nine francophone countries as a whole. Summaries of the findings for the region in each country are available in English and French.

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

  • With support from the USAID-funded Health Policy Project, the White Ribbon Alliance for Safe Motherhood (WRA) is striving to promote midwifery and improve midwives' working conditions by (1) influencing policymakers, (2) involving the media, (3) engaging youth, (4) mobilizing the community, and (5) strengthening the capacity of midwives as advocates at the global, national, and local levels. This brief demonstrates how advocacy approaches can lead to a more supportive environment for midwives and ultimately better maternity care and birth outcomes. Advocates need to inform policymakers of the priority issues needing their attention and the steps necessary to improve midwifery. The brief includes a number of examples for advocates to learn from and include in their advocacy strategies. It also provides an opportunity for WRA to share advocacy learning and models with global partners to foster continued and additional advocacy efforts that are needed to further position midwifery as a central component of integrated maternal and newborn health systems.  

  • 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

  • When it was established, Kenya’s Inter-Agency Coordinating Committee on Health Care Financing (ICC-HCF) was intended to provide a forum for health financing stakeholders to share knowledge, deliberate, and reach consensus on contentious issues. Yet the ICC-HCF became stalled in 2011. Shortly after, the Kenya government requested assistance from the Health Policy Project (HPP) to revitalize the forum. This brief provides an assessment on the impact of HPP’s support to the ICC-HCF, the constraints that affected Kenya finalizing its healthcare financing strategy, and offers a series of recommendations for how best to support the work of the ICC-HCF going forward.   

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

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

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

  • In 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.  

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

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

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

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

  • This series of Capacity Development Resource Guides was produced by the Health Policy Project as part of an Organizational Capacity Assessment (OCA) Suite of Tools. The guides highlight the key technical areas of expertise needed to effectively influence health policy design, implementation, and monitoring and evaluation. Each guide identifies the specific skills, knowledge, and capacities that individuals and organizations should possess in the technical area. The guides also include individual and organization capacity indicators mapped to HPP’s Capacity Indicators Catalog, which can be used for facilitated organizational capacity assessments in the areas of policy, advocacy, governance, and finance. In addition, they provide illustrative activities and useful resources for designing and delivering capacity development technical assistance.

  • This brief describes the Health Policy Project’s perspective on systems change, the expertise needed for effective engagement in the policy process, implementation steps for capacity initiatives, and evaluation. It will be of particular use for those interested in capacity-strengthening approaches specific to policy, advocacy, governance, and finance. For sustained change, HPP encourages its partners to take a systems approach that addresses capacity needs at interrelated levels: individual, organizational, and systems.

    For information on the project's implementation of this approach, see the Capacity Development Topics page, which also includes practical resources such as HPP's recently developed Organizational Capacity Assessment (OCA) Suite of Tools. The tools are specifically designed to assist organizations with building their capacity related to health policy by 

    • Establishing a baseline of the organization’s capacity in key areas
    • Promoting organizational dialogue, learning, and standard setting
    • Informing the development of a capacity-strengthening plan for addressing organizational priorities

  • 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.

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

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

  • 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 Crosswalk of Family Planning Tools provides a comparison of 19 commonly used family planning costing, planning, and impact analysis tools. The Health Policy Project designed the guide to help advocates, program planners, decisionmakers, and others to (1) select which tool might best fit their goals or questions and (2) interpret the outputs of each tool. The guide contains information on each tool's overall goal; intended use; primary target audience; interventions included; unit costing approach (if applicable); and health, cost, economic, or demographic outputs. In addition, the guide compares the requirements for each tool related to data needs, training and skills, and usability.

    The guide is accompanied by a chart to use as a quick reference for general information and comparison. To print the chart, 11 x 17 paper is required and "fit to page" and "landscape orientation" must be selected under printer properties.

  • The Kenya Ministry of Medical Services and the Ministry of Public Health and Sanitation, in partnership with the Health Policy Project of the U.S. Agency for International Development (USAID), convened two meetings to discuss Kenya’s devolution of power from the central government to the counties and its impact on the health sector. The second meeting on October 24, 2012, brought together many representatives of government, development partners, and other sectors who have a stake in the implementation of this significant change in Kenya’s Constitution. The participants discussed the steps the ministries of health and other government authorities have undertaken to move the devolution process along, as well as identified priority activities as part of a roadmap for going forward. This report summarizes the meeting’s proceedings and the country's key next steps.

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

  • 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. 

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

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

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

    The report is available in English and Portuguese.

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

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

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

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

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

  • The 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.

  • From May through July 2015 HPP conducted a financial gap analysis of CIPs in six West African countries: Burkina Faso, Cameroon, Côte d’Ivoire, Mauritania, Niger, and Togo. This allowed HPP to compare the annual funding available from the government and partners for family planning relative to each of the CIP budgets. In this study, “funding available” can be defined as any future funding that is promised, expected or estimated to be allocated to FP; in the case of past years, “funding available” refers to actual funds spent on FP, excluding overhead costs. The CIP Gap Analysis Tool, developed by Futures Group, was used to estimate additional resources needed to fully implement each thematic area identified in the CIP (contraceptive commodities, demand creation, service delivery and access etc.).

  • The Partners in Population and Development global alliance, through its Africa Regional Office (PPD ARO), uses South-to-South dialogue as an effective mechanism to hold leaders and countries accountable for stated international and regional commitments related to health. Through the Health Policy Project, PPD ARO is sharing expertise, best practices, effective models, and high-level policy dialogue surrounding population and health issues with African policymakers and partners at the national and regional levels. Specifically, to raise awareness among parliamentary health committees on the linkages between improving family planning/reproductive health and achieving national development goals, PPD ARO is developing and disseminating policy briefs on family planning in Ethiopia, Ghana, Malawi, and Uganda.

    At the request of and in partnership with Ethiopia’s Federal Ministry of Health (FMOH), PPD ARO developed a policy brief for initial dissemination at the Women Parliamentarians Meeting: Enhancing Leadership for Family Planning and Reproductive Health in Kampala, Uganda, August 27–28, 2012. The brief highlights the important role of family planning in achieving maternal health and other development goals, as well as presents policy recommendations for increasing family planning use. FMOH stakeholders contributed to the recommendations, which focus on increasing financing for family planning commodities, especially long-acting methods (permanent and non-permanent). Expanded dissemination to policymakers across Ethiopia will help foster more champions of family planning as the country builds momentum for further progress.

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

  • 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.

  • For a country to successfully achieve its family planning goals and targets, stakeholders must fully understand the investment needed to attain them. The Health Policy Project, in collaboration with Ghana's National Population Council, recently reviewed data on demographic patterns, family planning costs, and projected funding to inform an application of the GAP (Gather, Analyze, and Plan) Tool. The tool is designed to project the contraceptive, service provision, and program support funding gaps in a country to ultimately help policymakers, decisionmakers, and development partners understand the costs involved in reaching national family planning goals and addressing challenges to progress. This presentation and brief summarize the current policy environment in Ghana for family planning, the targets set by the National Population Policy, and the gap in current and estimated resources needed. These evidence-based advocacy materials aim to bolster financial and political support for the family planning program in Ghana.

    For more information on the GAP Tool, visit the Software and Models page of the Health Policy Project website.

  • This brief provides an overview of the USAID-funded Health Policy Project's work in health financing in Afghanistan.

  • Households in Afghanistan contribute more than 70% of the country’s health care spending. These funds come directly from households through out of pocket (OOP) payments for health care services.  Such high costs of medical care can result in catastrophic expenditures where households may be forced to sell their land, sell their agricultural or animal livelihoods, or prevent children from obtaining education due to extra fees). Alternatively, poor households may choose not to seek care to avoid impoverishment, prolonging ill-health. These decisions may lead to further impoverishment for households. Yet, currently there are no risk protection mechanisms for households.  The Government of the Islamic Republic of Afghanistan (GIRoA) has the opportunity to protect all Afghans from catastrophic health payments; the opportunity to ensure that all Afghans have access to health care services; and the opportunity to ensure that all Afghans can use health care services. This opportunity is called health insurance.  This brief provides policy recommendations for introducing health insurance to Afghanistan.

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

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

  • 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.

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

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

  • Access to maternal health services in Ghana has improved significantly over the past 15 years—most dramatically since 2008, when the government began providing free general care for pregnant women, as well as a maternal benefit package covering deliveries, antenatal and postnatal care, and pediatric care for the first three months of life. The National Health Insurance Fund finances all of these services. To help Ghana’s policymakers anticipate the health and economic benefits at varying levels of investment in family planning from 2014–2020, the USAID-funded Health Policy Project (HPP) conducted this analysis, using its new ImpactNow model.

  • 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 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.

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

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

  • To improve FP services and availability in Jordan, the Higher Population Council (HPC), with support from the Health Policy Project and in cooperation with all stakeholders, developed the National Reproductive Health/Family Planning Strategy 2013–2017. The strategy assesses the reproductive health (RH)/family planning (FP) environment in Jordan and describes the interventions required to improve RH/FP services and use and ultimately achieve the goals of the Demographic Opportunity Policy.

    This brief summarizes the three main challenges to Jordan’s FP program—policy, access, and beliefs and behaviors—and outlines the interventions planned to address them.

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

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

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

  • Published by the Kenya Ministry of Health, the Kenya National Health Accounts 2012/13 (NHA 2012/13) details the flow of resources in the country’s health sector. The NHA 2012/13, which tracks who provides goods and services and how resources are distributed across the health system, presents data by total health expenditure and by major disease area. Findings from the NHA 2012/13 will help to inform policy processes and form the basis for policy dialogue in health financing.

  • This report is the product of a budget tracking study regarding the engagements for family planning completed by the USAID-funded Health Policy Project in Niger, Mauritania, Burkina Faso and Togo. The study examined the budget cycle process, identified  budget line items dedicated to family planning and analyzed financial commitments to family planning in each of the four countries through key informant interviews and a literature review. Stakeholders can use these results for informed and effectively timed advocacy for resources for family planning. 

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

  • In 2011, the Health Policy Project, in collaboration with the Family Planning Action Group (FPAG), supported the development of a Nigeria RAPID application. The FPAG, comprising governmental and nongovernmental organizations, focuses on the state of family planning in Nigeria and the need for more support and funding for the national family planning program. “RAPID” stands for “Resources for the Awareness of Population Impacts on Development,” and it is a tool designed to help policymakers understand the relationships between fertility, population growth, health, education, agriculture, economic growth, and national security. This package of materials uses RAPID projections to highlight the impact of Nigeria's population growth on national development and its ability to provide education, health, and nutrition to all its citizens. By lowering average fertility, savings in primary education and health could amount to $37 billion and $45 billion, respectively, by 2040.

    Also see the RAPID package of materials highlighting the impact of high fertility on maternal and child health: Nigeria RAPID Population and Development: Why Fertility Affects Health.

  • In 2011, the Health Policy Project, in collaboration with the Family Planning Action Group (FPAG), supported the development of a Nigeria RAPID application. The FPAG, comprising governmental and nongovernmental organizations, focuses on the state of family planning in Nigeria and the need for more support and funding for the national family planning program. “RAPID” stands for “Resources for the Awareness of Population Impacts on Development,” and it is a tool designed to help policymakers understand the relationships between fertility, population growth, health, education, agriculture, economic growth, and national security. This package of materials uses RAPID projections to highlight the large unmet need for family planning in Nigeria and its impact on maternal and child health. By lowering average fertility in the country, 31,000 maternal deaths and 1.5 million child deaths could be averted by 2021.

    Also see the RAPID package of materials highlighting the impact of rapid population growth on the country's development: Nigeria RAPID Population and Development: How Fertility Affects Development.

  • In 2014, the Health Policy Project, in collaboration with the United Nations Population Fund (UNFPA), supported the development of a subnational family planning advocacy booklet in Adamawa, Nigeria. Using Resources for the Awareness of Population Impacts on Development (RAPID), this booklet highlights the impact of the state’s low contraceptive use and high population growth on its development prospects, principally its ability to provide education, health, nutrition and employment to all its citizens.

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

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

  • “Population, Development, and Family Planning: The Urgency to Act” highlights the health benefits and cost savings associated with meeting all unmet need for family planning in nine francophone West African countries by 2030. If governments invested in meeting family planning needs, an estimated 500,000 infant deaths and 7,400 maternal deaths could be averted over the next decade. Similarly, if the nine governments invested US$84 million in family planning services over the next decade, they would save $195 million needed for programs to reach the Millennium Development Goals by 2020. In other words, for every dollar invested in family planning programs, governments could save US$2.30 in reduced expenditures for maternal health, malaria, immunization, education and water and sanitation programs.

    Dr. Johanna Austin Lucinda Benjamin, Director of Primary Health Care and Disease Control of the West African Health Organization, presented these findings at the West Africa regional conference on Population, Development and Family Planning, held in Ougadougou, Burkina Faso, on February 8–11, 2011.

  • To improve understanding of political will for the devolution of Kenya’s health sector, the USAID- and PEPFAR-funded Health Policy Project (HPP) conducted a series of semi-structured interviews with key informants in January 2015—involving the national government, three county-level governments, and consultants—to explore what incentives are driving political will for the devolution of Kenya’s health sector. HPP found that the desire for improved health outcomes is one of many factors driving political will for health sector devolution. The need to meet constituents’ and political stakeholders’ expectations also influences political will. A greater understanding of the various factors that influence political will can help the national government take a leadership role to incentivize and encourage counties to make decisions for improving health outcomes, and move devolution forward.

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

  • Tanzania’s government recognizes that the country’s sustainable development and transition to middle-income status depends on the health of the Tanzanian people. To that end, the country has worked hard to achieve Millennium Development Goal (MDG) 4 to reduce child mortality and MDG 5 to improve maternal health. This USAID and PEPFAR-funded Health Policy Project brief explores the current policy framework for reproductive maternal, neonatal, child, and adolescent health (RMNCAH), and provides plans for intervention and strengthening of RMNCAH in the short, medium, and long term. 

  • A high proportion of Tanzania’s total health spending comes from foreign donors and households (out-of-pocket), rather than from sustainable sources such as government tax-based revenue or health insurance. While the country has made enormous strides in improving its population’s health, the Government of Tanzania and its development partners recognize that the current health financing structure is not sustainable. The government is now considering several crucial changes to how healthcare in Tanzania is financed; as part of this effort, the country is finalizing a health financing strategy and scaling up new programs to accelerate service delivery coverage and improve quality.

    In support of building a sustainable structure, the USAID- and PEPFAR-funded Health Policy Project reviewed the country’s healthcare financing situation to provide a baseline against which innovation and policy change can be gauged. This report provides a broad overview of the health financing landscape in Tanzania as of 2014 and aims to highlight those aspects suggesting a greater reliance on domestic and sustainable resources to accomplish Tanzania’s health goals. 

  • While Tanzania has made significant progress on priority health indicators, the limited effectiveness of health financing constrains its ability to achieve more.Despite challenges Tanzania is making progress toward sustainable financing. This USAID and PEPFAR-funded Health Policy Project brief explores the country's prospects for sustainable financing and explores the linkages between financing and universal health coverage. 

  • 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 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.

  • In order to assess the pricing policies of family planning (FP) products and understand the impact of these policies on the accessibility of family planning services, the USAID-funded Health Policy Project (HPP), collaborated with the USAID | DELIVER Burkina Faso, Mauritania, Niger and Togo to formulate regional and national recommendations for improving contraceptive pricing policies to ensure the availability and sustainability of FP programs in West Africa.

  • This policy brief  highlights (1) the advocacy process used to generate increased funding commitments for  family planning and reproductive health (FP/RH) commodities in Uganda, (2) the steps needed to ensure that the allocated funds fully translate into procurement of FP commodities, and (3) how advocates can sustain the momentum over the coming years. The information can be used to guide advocates in sub-Saharan Africa on addressing critical issues in the financing of FP/RH.

  • This policy brief is intended to guide Ugandan parliamentarians in addressing critical issues related to family planning and reproductive health (FP/RH) financing to ensure that increased budget commitments for RH commodities already realized are sustained over the coming years and that funds are disbursed and fully expended. Parliamentarians at the country level can fulfill three essential functions: (1) provide oversight to ensure that current allocations are maintained, (2) ensure that allocated funds from the World Bank RH Systems Strengthening Project are released and spent in FY 2013/14, and (3) track allocations to ensure the 100 percent expenditure of funds.

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

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

  • In 2013, each of Kenya’s 47 newly established county governments created a county department of health (CDOH) to oversee the delivery of health services, as outlined out in Schedule IV of the 2010 Constitution. To deliver health services and meet the challenge and promise of devolution, county governments require strong and accountable departments of health. As they strive to create effective governance and financing mechanisms, these departments can benefit from the experiences of other county governments. Counties have attempted to create new health management structures that provide strong organizational management.Unfortunately, many of these efforts have been weakened by political intransigence, entrenched interests, and bureaucracy. Mombasa County, however, overcame these hurdles to create a unified CDOH with defined staffing structures aimed at achieving a clear set of objectives. This brief reviews the factors that made this organizational restructuring possible.

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

  • 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.

  • Over the past decade, the performance of Tanzania’shealth system has been mixed. The country will achieve many of its 2015 targets for malaria, HIV and AIDS, tuberculosis, and child health, but progress in reproductive health is lagging. Currently, nearly half of the country’s health budget is covered by donor funding—the largest share in the world. This USAID and PEPFAR-funded Health Policy Project brief provides an overview of Tanzania's existing health system, including: human resources for health, health financing, commodities and supplies, and monitoring and evaluation and health management information systems.

  • At the Ouagadougou Partnership and Family Planning 2020 (FP2020) meetings, governments committed to improving access to family planning services and information. Costed Implementation Plans (CIPs) for family planning services and information provide a framework and tools for governments to achieve their international family planning commitments. This booklet, prepared by the Health Policy Project, highlights the methodology behind CIPs, walks through 10 steps for designing and implementing a national CIP for family planning, and shares experiences from seven African countries that have developed national CIPs for family planning to inform their decision making. It is estimated that implementation of the CIPs will accelerate each country's progress toward both achieving its target contraceptive prevalence rate and reducing maternal and child mortality.  

  • Part of an Organizational Capacity Assessment (OCA) Suite of Tools and developed by the Health Policy Project, the Strengthening Capacity in Policy, Advocacy, Governance, and Finance: A Facilitator Guide for Organizational Capacity Assessments is a facilitated self-assessment tool tailored to an organization’s mission as it relates to health policy. The participatory capacity assessment process supports an organization by

    • Establishing a baseline of the organization’s capacity in key areas
    • Promoting organizational dialogue, learning, and standard setting
    • Informing the development of a capacity-strengthening plan for addressing organizational priorities

    The process outlined in the guide supports staff members and other key stakeholders to share their perspectives about the organization’s functioning, strengths, and challenges to undertake work related to health policy. Accompanying the guide are a Capacity Indicators Catalog that identifies the key capacities needed to support relevant technical policy areas and an OCA Results Spreadsheet that creates an electronic report and visual depictions of the capacity assessment based on the indicators chosen from the catalog and a participatory scoring process.

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

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

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

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

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

  • 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.

  • The Ethiopian Ministry of Health, in collaboration with the Health Policy Project (HPP), recently used the FamPlan model to measure the impact of increased family planning use on the number of infant and child deaths. The results showed that family planning uptake is associated with decreases in high-risk births and infant and child mortality and that faster gains in the contraceptive prevalence rate lead to more dramatic health improvements. This poster—presented at the 2013 International Conference on Family Planning in Addis Ababa, Ethiopia—describes the methodology and results of the model application.

  • The Expenditure Management Information System (EMIS) is an information system that collects contract, budget, and expenditure information on the health sector in a Microsoft Access database. The database produces financial reports for the Ministry of Public Health (MoPH) and donors, as necessary. This document will assist MoPH HEFD to advocate EMIS internally and at other ministries for buy-support and better understanding.

  • The GAP Tool (Gather, Analyze, and Plan) is a simple Excel-based tool designed to help policymakers, ministry officials, health officials, and advocates understand and plan for the costs associated with expanding family planning (FP) to achieve their country's contraceptive prevalence or fertility goals. This PowerPoint presentation provides a brief overview of the benefits of and major steps for applying the GAP Tool and includes highlights from a pilot application of the tool in Ethiopia and Nigeria.  

  • The GAP Tool (Gather, Analyze, and Plan) is a simple Excel-based tool designed to help policymakers, ministry officials, health officials, and advocates understand and plan for the costs associated with expanding family planning (FP) to achieve their country's contraceptive prevalence or fertility goals. This brief provides a brief overview of the benefits of and major steps for applying the GAP Tool and includes highlights from a pilot application of the tool in Ethiopia and Nigeria.  

  • 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. 

  • The Health Policy Project (HPP) in Jordan focuses on supporting national-level awareness raising, resource mobilization, and policy reform to improve the quality of and access to family planning and reproductive health (FP/RH) services. HPP supports the Higher Population Council (HPC), Ministry of Health (MOH), and other key stakeholders to create an enabling environment for FP/RH through improved multisectoral engagement and coordination, data use, and policy reform. A particular area of focus is healthy birth spacing. Nearly one third of all births in Jordan are spaced less than two years apart, and more than half are spaced less than three years apart. Statistics show that an interval between births shorter than 33 months lowers the chance of survival for the mother and child. The higher rates of maternal and child mortality and morbidity associated with short birth intervals create burdens for families and society as a whole. The practice of healthy birth spacing is increasing in Jordan, but not fast enough. Wide adoption of healthy birth spacing in Jordan will reduce neonatal, infant, child and maternal mortality; improve the health of mothers and their offspring; enhance the ability of fathers to care for their families; and make communities healthier and stronger. This package of materials present the research evidence for healthy birth spacing and suggest what Jordan can do in the spheres of policy, education, and health services to promote the practice.

  • Using the ImpactNow model, the USAID-funded Health Policy Project collaborated with the Amhara Regional Health Bureau (RHB) to estimate the near-term benefits of achieving Ethiopia’s ambitious family planning goals in the region. This brief summarizes key health and economic benefits associated with achieving these goals and offers recommendations for the Regional Health Bureau to increase investment in and improve family planning services. The analysis found that if the contraceptive prevalence rate (CPR) in the Amhara Region increases from 46 percent in 2014 to 73 percent in 2020 and if women adopt more long-acting and permanent methods (LAPMs), family planning would save the lives of 13,000 mothers and 112,000 children over that time period. Moreover, compared to current trends in the CPR, the Amhara Region would save an additional US$19 million in maternal and child healthcare costs. Using these results, the RHB promotes data-driven FP policy development and can advocate for increased access to family planning and LAPMs to achieve national FP goals in the region. 

  • 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.

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

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

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

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