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Policy

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  • The Uganda Family Planning Costed Implementation Plan, 2015–2020, published by the Ministry of Health, was launched by the government in November 2014. Its objective is to reduce unmet need for family planning to 10 percent and to increase the modern contraceptive prevalence rate among married women to 50 percent by 2020. The plan includes strategies to improve demand creation; service delivery and access; contraceptive security; policy and enabling environment; financing; and stewardship, management, and accountability. The cost of the total plan is $235 million USD between 2015 and 2020, which will increase the number of women in Uganda currently using modern contraception from approximately 1.7 million users currently in 2014 to 3.7 million in 2020.

    Uganda's gap analysis found a total financial gap of about $113 million for all six years of the FP-CIP. As the total cost for the FP-CIP is $235.8 million, less than half of the activity costs in the CIP are covered by currently planned funding between 2015 and 2020. The size of the gap in Uganda differs by year; the largest gap is in 2019, with a gap of $21.8 million. The larger gaps in the later years are due to a steady increase in reach of activities within Uganda in line with projected scale-up of demand and services for FP in line with the country’s goal to reach a 50% modern contraceptive prevalence rate among married women by 2020. In addition, government and development and implementing partners often have insufficient knowledge of what would be funded past the initial first few years of the FP-CIP due to funding cycles and programme timelines.

    The gap analysis provides clear evidence that the Ugandan government and in-country development partners are focusing significant effort on financing the purchase of contraceptives. However, evidence has shown that for family planning interventions to be effective, financial support and efforts need to be dedicated to providing a holistic rights-based FP programme that includes demand generation efforts, improvement in the quality of service provision, supply chain improvements, strong policies and financing, and coordinated planning, management and supervision at national and decentralized levels.

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

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

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

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

  • The presence of supportive FP/RH policies is considered an integral component to successful programs. However, much remains to be known about how policies are implemented, especially in a complex political, sociocultural and economic environment. Based on a review of academic and programmatic/applied literature, this paper outlines the various methodologies that can be used to study policy implementation, which include descriptive methodologies such as literature reviews and case studies; analytic methodologies such as stakeholder mapping and analysis, cross-sectional surveys and system dynamics; quasi-experimental and experimental studies; studies describing policy implementation within complex adaptive systems, such as, path dependence; and mixed methods as well including focus groups, document analysis and interviews. This USAID- and PEPFAR-funded Health Policy Project study further highlights the challenges of using rigorous research methods to determine the link between policy implementation and health systems and outcomes. Finally, the paper recommends that further research using rigorous methodologies is needed to study policy implementation.

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

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

  • The demographic dividend is an important opportunity for economic development that arises through population change. As fertility rates fall and the share of working-age adults rises, the dividend can boost economic growth and productivity, raising incomes and allowing families and governments to invest more in the health, education, and well-being of future generations. There is the potential for a dividend in Malawi based on demographic trends such as its age structure and dependency ratio. To open the window of opportunity and achieve a demographic dividend, sustained and integrated investments in demographic, economic, and social policies and programs are required beginning today.

  • 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

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

  • 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.

  • This annotated bibliography, prepared by the USAID-funded Health Policy Project, is a collection of hundreds of articles, reports, books, and tools to communicate the available knowledge, evidence, and best practices for health policy. Health-related policy is the critical first step along the way to strengthening health systems and improving health outcomes, so it is important for policymakers to understand the processes and complexities involved in health policy. This bibliography contains the necessary knowledge for effective policy development, implementation and evaluation.

  • 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.  

  • To achieve the greatest possible improvement in family planning (FP) and maternal, neonatal, and child health (MNCH) outcomes, successful interventions, practices, and approaches must be "scaled up," that is, implemented on a larger scale and incorporated into the laws, policies, and structures that govern health systems. In recent years, growing recognition of the importance of scale-up has led to intensified efforts to identify and scale up best practices in FP/MNCH and improve scale-up processes. Policy development and implementation are central to successful and sustainable scale-up.

    This package of materials presents a programming approach designed to help countries advance the integration and measurement of policy development and implementation into the scale-up of FP/MNCH interventions and best practices. The approach provides planners and implementers with initial guidance and suggestions on how to systematically address policy development and implementation as they scale up FP/MNCH programs.

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

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

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

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

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

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

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

  • 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

  • In December 2012, the Health Policy Project (HPP) supported the ARC Coalition to bring together 20 consortium members and project partners to develop a common advocacy plan. Facilitators from HPP and the Advance Planning Project led the process by building focus, commitment, and consensus among consortium partners on a common advocacy issue. At the end of two days, the consortium members had identified key areas for policy advocacy that have the highest probability of success for ARC in the next year, identified the relevant key stakeholders, and began to develop action plans. Within the broader goal of contraceptive choices being expanded, the key areas identified included expanding the mix of spacing methods and increasing access to current methods of spacing.

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

  • Costed Implementation Plans (CIPs) for family planning are concrete, detailed plans for achieving the goals of a national family planning program over a set number of years. A CIP details the program activities necessary to meet stated goals and the costs associated with those activities, thereby providing clear program-level information on the resources a country must raise both domestically and from donors to achieve their goals. The CIP addresses and budgets for all components of a family planning program—demand, service delivery and access, procurement and supply chain, policy and enabling environment, financing, supervision, and monitoring and evaluation. The USAID-funded Health Policy Project’s 10-step approach creates a CIP aligned with ongoing government planning and coordination efforts. By including processes to ensure inclusion of often-marginalized populations and civil society groups, this approach ensures that the national CIP is collaborative, country-owned, and country-driven from inception. The 10-step approach also utilizes custom tools to develop detailed cost estimates, to identify financing gaps, and to estimate the demographic, health, and economic impacts of successful CIP implementation (e.g., number of women’s and children’s lives saved, healthcare costs saved, etc.). The CIP process culminates in a consensus-driven strategy, as well as a detailed activity roadmap and budget to make the strategy actionable. The 10-step approach results in strategies that promote people-centered health systems that improve healthcare outcomes through respecting rights, addressing social exclusion and inequities (with a focus on gender, adolescents, and people living in rural and underserved areas). This presentation is relevant to a wide cross-section of the Symposium’s diverse target audiences, particularly policy-makers, managers, and civil society participants, who would benefit from learning about the experiences of various countries in developing costed health strategies that are participatory and inclusive.

  • This PowerPoint presentation was used to present HPP's new DemDiv model for projecting the demographic dividend, and preliminary results for the pilot application in Kenya. It will be presented to members of the Technical Working Group in Kenya for validation, scenario development, and refinement. 

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

  • The 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.

  • 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.

  • 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.

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

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

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

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

    Related resources: 

    The Policy Dimensions of Scaling Up Health Initiatives

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

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

  • 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.

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

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

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

  • 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.

  • ImpactNow is an Excel-based model that estimates the health and economic impacts of family planning (FP) in the near term. It is designed to model the impacts of different policy scenarios, and to compare the results of those scenarios in advocacy materials. It can help to estimate the impacts of many “what if” questions about policy options. ImpactNow is designed to analyze impacts in the two- to seven-year time horizon; for example, it could be used to estimate the impacts of meeting Family Planning 2020 (FP2020) commitments. The outcomes are focused on reproductive health metrics, as well as economic metrics, such as cost-benefit ratios and incremental cost-effectiveness ratios (ICER).

    ImpactNow was adapted from Marie Stopes International’s (MSI) Impact 2 as a collaboration between MSI and the Health Policy Project (HPP), with support from USAID. The ImpactNow Manual: Estimating the Health and Economic Impacts of Family Planning Use is also available to help health analysts use the ImpactNow model to estimate the health and economic impacts of FP programs.

  • ImpactNow is an Excel-based model that estimates the health and economic impacts of family planning in the near term. It is designed to model the impacts of different policy scenarios and to compare the results of those scenarios in advocacy materials. It is designed to estimate the impacts of many "what if" questions about policy options in the two- to seven-year time horizon; for example, it could be used to estimate the impacts of meeting Family Planning 2020 (FP2020) commitments. The outcomes are focused on reproductive health metrics, as well as economic metrics, such as cost-benefit ratios and incremental cost-effectiveness ratios.

    ImpactNow was adapted from Marie Stopes International's Impact 2 in collaboration with the Health Policy Project, with support from USAID. The USAID-funded Health Policy Project authored the users’ manual to help health analysts apply the ImpactNow model to estimate the health and economic impacts of family planning programs at national and subnational levels.

    Under Health Policy Plus, ImpactNow was revised in September 2018. This 2.0 version of ImpactNow features the following additions:

    • Youth-only option: users now have the option to calibrate the model for a youth population only (either all youth ages 15–19 or only youth in union, ages 15–19)
    • New default database: the model now features an updated database, with the latest available values for each country or region across model input data categories
    • New display features: the model features an infographic option, embedded in the results section, allowing users to present model results in a visually compelling way for diverse audiences
    • Expanded methodological alignment: the ImpactNow 2.0 methodology has been revised in an effort to harmonize the computation of select outputs with other family planning modeling efforts

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

  • Injectable contraception has been available in the private sector in India since 1986, but is not accessible to public sector clients. With support from the USAID-funded Health Policy Project, the Policy Unit of the National Institute of Health and Family Welfare conducted a stakeholder analyses to understand the barriers to introducing injectables in the package of methods available through the public sector. This descriptive brief combines primary and secondary data to provide a status update and policy analysis to stakeholders advocating for policy change to expand the basket of contraception in the public sector.

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

  • In 2013, the Health Policy Project conducted a series of trainings for government leaders, local media, and other stakeholders in Jordan. The effort aimed to highlight the importance of policy in strengthening family planning programs to advance the health of Jordanians. The first workshop focused on HPP's policy framework, which links family planning policy to health outcomes. The team

    • Presented global initiatives that affect family planning and discussed how they relate to Jordan
    • Presented new advances in health policy analysis—linking health policy, health systems, and health outcomes
    • Discussed policy analysis, from problem identification to impact assessment
    • Built capacity for policy
    • Discussed FP policy issues in Jordan, including barriers to FP

    The second workshop, held at the request of Jordan's Higher Population Council, focused on examining the framework in the context of the country's Demographic Opportunity Policy. Challenges and recommendations in meeting the goals of the policy were discussed, followed by the identification of which aspects of the framework could be applied to help implement those recommendations. The next step is to identify the appropriate authority to ensure implementation and coordination of follow-up efforts.

  • 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.

  • Energy is extremely expensive in Jordan, and 97 percent of all energy used in Jordan is imported. Energy costs are equivalent to nearly 21 percent of the total annual gross domestic product; energy costs are equivalent to 32 percent of the value of all annual imports; and energy costs are equivalent to the value of 83 percent of all exports. As the population grows, so will the consumption of energy, and consequently, the expenses to provide the amount of energy required in the future. If Jordan is to meet its future needs for energy, it must address multiple issues, including the scarcity of local oil, rising prices of oil in the international market, critical and serious supply-demand imbalances, costly new sources (infrastructure and operating), and the increasing pressure on resources from changes in population, development, and lifestyles. Resolving these issues will take a concerted effort and commitment from the government and the people of Jordan; and each of these issues needs to be addressed in multiple and different ways. One of the least expensive approaches that can be taken immediately, and is the underlying theme of this presentation, is to reduce population growth. 

    This RAPID presentation, developed by the Health Policy Project in collaboration with the Jordan Higher Population Council, demonstrates that future population growth will directly affect the ability of Jordan to provide sufficient energy resources. While reducing population growth will not be sufficient in eliminating all of the energy issues facing the country, it is a necessary step that needs to be taken in combination with many others if Jordan is to successfully resolve its pressing energy situation.

  • Jordan’s continued economic development and concomitant population growth is putting increased pressure on natural resources and the environment. Over the past 40+ years, the gap between the ecological footprint and the local capacity has grown, and this deficit has largely been made up for by importing goods, especially food and energy, from abroad.

    Productive land in Jordan is limited. Only 11 percent of the total land area can be considered agricultural land---of which less than 2 percent is arable; the rest is ranges and forests. As population size increases, so does the need for more land to produce food and build houses, businesses, recreation areas, schools and health facilities, roads, and mosques, as well as other supporting uses.

    This RAPID presentation, developed by the Health Policy Project in collaboration with Jordan's Higher Population Council, demonstrates that future population growth will directly affect the use of land in Jordan. While reducing population growth will not be sufficient in eliminating all the pressures being placed on the land, it is a necessary step that needs to be taken in combination with many others if Jordan is to successfully resolve its pressing land use situation.

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

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

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

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

  • 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. 

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

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

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

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

  • Following the 2010 earthquake, Haiti has attracted increased interest as a source for international adoptions. Yet groups interested in child welfare and protection feared irregularities in the child adoption process. In 2012, Haiti ratified the Hague Convention which enshrines the principle that international adoption should be considered a protective measure, to ensure a child's best interest. It took the establishment of a new law in Haiti to ensure that national legal provisions conformed with the Hague Convention. The Haitian government passed the "Loi réformant l'Adoption” (the law reforming adoption), which was published in October 2013. This brief explains the rationale for and the purpose of this new law. It also describes the Haitian Government’s efforts to reform the legal framework for child protection, with the technical support of international actors including the  HPP AKSE project, funded by the U.S. Agency for  International Development (USAID) and implemented by Futures Group.

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

  • In June 2014, the government of Haiti published a paternity act that recognizes equal rights for children born within and outside of marriage. This act represents an important legal shift, enshrining the principle that all children are on an equal footing. The USAID-funded Health Policy Project AKSE documented the gaps that the law fills and why this achievement is so important for the Ministry of Women’s Affairs, the women’s organizations that fought for it, and for children in Haiti. In support of the Haitian Government HPP AKSE develops training curriculum to disseminate the content of this new law to judicial actors and Human rights NGO.

  • In June 2014, the government of Haiti published a paternity act that recognizes equal rights for children born within and outside of marriage. This act represents an important legal shift, enshrining the principle that all children are on an equal footing. The USAID-funded Health Policy Project AKSE program documented the gaps that the law fills and why this achievement is so important for the Ministry of Women’s Affairs, the women’s organizations that fought for it, and for children in Haiti. 

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

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

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

  • 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.

  • With a current population exceeding 170 million, the Federal Republic of Nigeria is the seventh-largest country in the world and the most populous in Africa. Despite the introduction of policies and programs over the last 30 years to address Nigeria’s rapid population growth and the challenges it poses for development, the country is projected to become the third-largest nation in the world by mid-century (United Nations Population Division, 2015). These continuing demographic trends—coupled with emerging national priorities and new international development frameworks—created the need to assess the implementation of Nigeria’s 2004 Policy on Population for Sustainable Development (henceforth NPP, or the policy). Results from this USAID-funded Health Policy Project assessment are intended to guide the formulation of a revised policy and the approaches needed to realize its goals and objectives.

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

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

  • “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.

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

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

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

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

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

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

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

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

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

    Read the brief on this topic.

  • This report describes two pilot technical assistance programs implemented by the USAID-funded Health Policy Project to strengthen policy development and implementation related to contraceptive security at decentralized levels in Peru and the Dominican Republic. Over a two-year period, three regional and municipal committees engaged a multisectoral group of political leaders, technocrats, civil society representatives, and healthcare providers to collaboratively assess policy and funding barriers related to family planning and design and implement solutions. The compilation of experience and results is intended to inform programs to strengthen contraceptive security at the decentralized level in other settings, whether through committees or other mechanisms. As decentralization continues to evolve in Latin America and other regions, it is critical to strengthen subnational capacity in the public sector and civil society to ensure that high-quality and equitable services are demanded, delivered, and monitored at all levels of the health system in a manner that promotes sustainability and local ownership.

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

  • In order to evaluate the distribution of health workers across Tanzania, relative to health needs, the USAIDfunded Health Policy Project (HPP) examined existing sources and conducted new analyses of human resources for health (HRH). Drawing on the results of these analyses, HPP proposes within this brief specific policy actions to improve 1) supply and retention of skilled health workers; 2) distribution of health workers; and 3) processes for hiring skilled health workers.

  • 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.

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

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

  • Demographic pressures and lack of progress toward the Millennium Development Goals have encouraged countries in West Africa to "take a new look" at repositioning of family planning (RFP)---an initiative established to ensure that FP remains a priority for donors, policymakers, and service providers in sub-Saharan Africa. USAID requested that the Health Policy Project apply the newly developed "Framework for Monitoring and Evaluating Efforts to Reposition Family Planning" in Niger and Togo. The framework results represent a baseline that can subsequently be used to measure progress in RFP by country FP stakeholders. USAID also requested an assessment of policy barriers to community-based distribution of FP---the findings for which are included in this report. Niger’s family planning program has made considerable progress in the past five years. Signs of progress are a favorable policy environment, growing public support for family planning, and increased funding for contraceptive commodities. Family planning is provided free of charge and is included in the Minimum Package of Services that all public health facilities must provide. Still, challenges remain to meet unmet need for family planning, extend services to rural areas, and ensure that people have adequate information about contraceptive methods.

    To read the results of the application in Togo, view the report and brief, Repositioning Family Planning in Togo: A Baseline.

    Applications in six other countries (Benin, Burkina Faso, Guinea, Mali, Mauritania, and Senegal) were later conducted by Futures Group, with funding from the Hewlett Foundation. To access those reports and briefs, visit the Futures Group Publications webpage.

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  • Demographic pressures and lack of progress toward the Millennium Development Goals have encouraged countries in West Africa to "take a new look" at repositioning of family planning (RFP)---an initiative established to ensure that FP remains a priority for donors, policymakers, and service providers in sub-Saharan Africa. USAID requested that the Health Policy Project apply the newly developed "Framework for Monitoring and Evaluating Efforts to Reposition Family Planning" in Niger and Togo. The framework results represent a baseline that can subsequently be used to measure progress in RFP by country FP stakeholders. USAID also requested an assessment of policy barriers to community-based distribution of FP---the findings for which are included in this report. Although considerable progress has taken place in Togo in terms of RFP, much remains to be done. Efforts to date appear to have improved acceptance of FP and present opportunities for additional improvement.

    To read the results of the application in Niger, view the report and brief, Repositioning Family Planning in Niger: A Baseline.

    Applications in six other countries (Benin, Burkina Faso, Guinea, Mali, Mauritania, and Senegal) were later conducted by Futures Group, with funding from the Hewlett Foundation. To access those reports and briefs, visit the Futures Group Publications webpage.

     

  • The increasing demand for family planning (FP) services coupled with decreases resources highlights the need to develop and implement strategies to ensure access to FP services for all. One way for governments to do this is to enact policies that facilitate market segmentation for contraceptives to shift financial pressures on governments, donors, and non-profit organizations from the public to private, for-profit sector. This report highlights results from a desk review and key informant interviews in Burkina Faso which assess pricing policies for contraceptives and provide recommendations to ensure availability and sustainability of contraceptives.

  • The increasing demand for family planning (FP) services coupled with decreases resources highlights the need to develop and implement strategies to ensure access to FP services for all. One way for governments to do this is to enact policies that facilitate market segmentation for contraceptives to shift financial pressures on governments, donors, and non-profit organizations from the public to private, for-profit sector. This report highlights results from a desk review and key informant interviews in Togo which assess pricing policies for contraceptives and provide recommendations to ensure availability and sustainability of contraceptives.

  • The increasing demand for family planning (FP) services, coupled with scarce resources highlights the need to develop and implement strategies that ensure access to FP services for all. One way governments more effectively target decreasing resources is to enact policies that shift FP users who can pay for services from the public to the the private, for-profit sector, thereby lessening financial pressures on governments, donors, and non-profit organizations. In order to assess pricing barriers for contraceptives in Mauritania, HPP conducted a desk review and key informant interviews to develop comprehensive recommendations to revised pricing policies for contraceptives to ensure availability and sustainability of contraceptives.

  • This policy brief highlights the USAID-funded Health Policy Project's application of the RAPID model to forecast integrated data and evidence on population and socioeconomic projections for the Amhara region. The analysis can support experts and policymakers to engage in data-driven decision making, planning, budgeting, and monitoring and evaluation of regional population issues linked with related factors such as the economy, education, health, agriculture, and urbanization. The projections were made according to the Central Statistical Agency 2012 Intercensal Population Survey’s low and high variants for 2007 to 2037.

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

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

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

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

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

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

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

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

  • La graduación de USAID fue un proceso planificado que permitió enfocar acciones hacia cuestiones estratégicas, sin embargo también se constituyó en una oportunidad de mejora y crecimiento que fue identificada por el gobierno de Paraguay y sustentada por su voluntad y compromiso político hacia la planificación familiar. Este documento recopila la experiencia del Comité para la Disponibilidad Asegurada de Insumos Anticonceptivos (DAIA) en Paraguay para comprender cómo su desempeño desembocó en resultados exitosos y describe cuáles fueron los factores clave y su interacción, para obtener tales resultados. Los logros alcanzados reforzaron la confianza de los integrantes del Comité DAIA y naturalmente trascendieron el ámbito de trabajo del mismo. Obteniendo el reconocimiento de las autoridades e incluso traspasando las fronteras, puesto que hoy en día el caso de Paraguay está considerado como un modelo para los demás países que impulsan la DAIA en la región.

    Un sumario de este informe en ingles, está disponible en: Promoting Country Ownership through Latin American Contraceptive Security Committees: Paraguay Case Study.

  • The right to freely and responsibly decide if, when, and how many children to have has been enshrined in numerous international treaties, conventions, and political consensus documents. Governments are obligated to manifest their international commitments to family planning and reproductive health and rights through their policies and funded programs, at the national, state/province, and local level. Yet the reality on the ground is that for most countries worldwide, from the least to the most developed countries, governments fail in many respects to operationalize these international commitments.

    In recent years, the international development community has turned its attention to the role of accountability in achieving greater impact of development interventions.Social accountability is characterized primarily by the active involvement of citizens engaging with government decision-making processes to ensure government fulfills its commitments and implements policies and programs appropriately. While the FP/RH community has a long-standing commitment to advocacy and social mobilization to advance reproductive rights, some social accountability concepts and interventions are relatively new to the FP/RH community. This guidance document is a primer for CSOs working in health that are looking to initiate or expand activities aimed to hold government entities accountable for delivering on their national and international commitments related to family planning/reproductive health and rights.

    This document provides:

    • An overview of current concepts of social accountability.

    • A synopsis of common methodologies and tools used by civil society to engage in social accountability.

    • Ideas and examples on how social accountability can be used to further FP/RH within a country.

    • Suggestions on what elements CSOs might take into consideration when deciding to implement a particular methodology

    • A selection of documents and resources that may be helpful in implementing social accountability activities.

  • Ministries of health are largely responsible for achieving the commitments that their national governments have made as part of the FP2020 initiative. As stewards, ministries of health are responsible for fostering effective policy implementation. Yet, putting policies into practice is challenging, and all too often policy implementation is weak. This brief identifies three ways for ministries of health to address barriers to policy implementation and strengthen their role as stewards of national FP2020 efforts. It is part of a series of three briefs produced by the USAID-funded Health Policy Project to provide guidance to MOH officials and members of parliament (MPs) on three different approaches to strengthen MOHs’ stewardship functions for FP2020. The other briefs in the series are Stewardship for FP2020 Goals: The Role of Parliamentarians, and Stewardship for FP2020 Goals: Working with the Private Sector.

  • Ministries of health (MOHs) are largely responsible for achieving the commitments that their national governments have made as part of the FP2020 initiative, which aims to enable 120 million more women and girls to use contraceptives by 2020. However, MOHs’ ability to meet FP2020 goals depends on the strength of their stewardship functions, including the support they generate from and collaboration with other actors and sectors.This brief describes four skills that parliamentarians can develop and strengthen to become more effective at lobbying for, demanding, and securing additional funding for FP. It is part of a series of three briefs produced by the USAID-funded Health Policy Project to provide guidance to MOH officials and members of parliament (MPs) on three different approaches to strengthen MOHs’ stewardship functions for FP2020. The other briefs in the series are Stewardship for FP2020 Goals: Working with the Private Sector, and Stewardship for FP2020 Goals: MOH Role in Improving FP Policy Implementation.

  • 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.

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

  • 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.

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

  • Decentralization of family planning is a critical concern for policymakers as international family planning commitments and the expansion of decentralization reforms become more common. Building on the latest research, this paper presents a family planning and decentralization analytical framework that was developed by the USAID-funded Health Policy Project to help key stakeholders better understand family planning decentralization processes, identify potential challenges and opportunities, and guide decentralization reforms. 

  • 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.  

  • 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. 

  • Adopting new practices in health on a large scale requires systematic approaches to planning, implementation, and follow-up, and often calls for profound and lasting changes in health systems. Without attention to the policies that underlie health systems and health services, the scale-up of promising pilot projects is not likely to succeed and be sustained. Because of the urgency to rapidly expand effective interventions to improve the health of mothers, children, and families, particularly the poor and underserved, there exists a growing interest in scale-up among the international public health community and others involved in health policy and programs.

    To explore best practices and guide the scale-up of these practices, the Health Policy Project (HPP) reviewed the literature on scale-up, interviewed key experts involved in scaling up initiatives, and hosted a meeting on relevant policy and gender issues. This paper focuses on efforts to scale up interventions in family planning (FP) and reproductive health, and maternal, neonatal, and child health (MNCH) in developing countries. It defines “scale-up” and describes some of the frameworks and approaches to scale-up found in recent health literature and how such approaches address policy. The paper, developed with support from the U.S. Agency for International Development, also reviews the experience of selected organizations in scaling up best practices and how they have addressed policy issues. It identifies a number of lessons learned from scale-up initiatives and lists six recommendations for ensuring supportive policies to strengthen scale-up.

    Related resources:

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

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

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

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

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

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

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

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

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

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

  • Universities and research centers have traditionally been places of knowledge generation rather than knowledge translation. Though they produce important research findings, these institutions have not traditionally played a strong role in disseminating this information to key decisionmakers. In many cases, this paradigm is changing. Advances in information technology and globalization have eased the flow of technical information between researchers and policymakers, amplifying their voices in important policy discussions. However, there are currently no clear guidelines on how universities can ensure their research findings are utilized in health decision making. Documenting the ways in which universities have sought to bridge the research-to-policy divide can provide useful guidance to institutions looking to do the same. This white paper, prepared by the Health Policy Project with support from USAID and PEPFAR, provides an overview of three models of university engagement in advocacy and examples of each approach. It also describes practices from non-educational institutions whose frameworks could be useful for linking research to policy or opportunities for partnerships. Finally, it identifies key points for universities to consider when designing an approach to health advocacy. 

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

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

  • The Empowering Women Leaders for Country-Led Development program fostered yearly cadres of women champions from Ethiopia, Ghana, Kenya, Malawi, Tanzania, and Uganda to engage in family planning and reproductive health decision making and to advocate for policy change. The 70 alumnae represent civil society organizations, government ministries, faith-based organizations, and elected bodies at local and national levels and comprise a wide range of backgrounds and experience. The program included a three-week intensive skills-building workshop focused on personal leadership, advocacy, and networking skills; seed funds to implement local advocacy; one year of south-to-south coaching by a Plan USA-trained coach; and ongoing technical assistance and networking support. This brief explores the program's methods, approach, and results. 

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

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

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

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