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Browse Health Policy Project (2010-2016) Materials

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Urban and Rural Poor

HP+ More recent Urban and Rural Poor publications are available.

  • 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.  

  • Stigma and discrimination against people living with HIV (PLHIV) and key populations, such as sex workers and men who have sex with men, reduces access to critical services, adversely affects health outcomes, and undermines human rights. Legal services, however, are poorly resourced in low- and middle-income countries, and access is often limited to the wealthiest people.

    Drawing on lessons learned from other contexts, the Health Policy Project (HPP) collated international best practices, research on legal codes and systems in Ghana, and consultations with key stakeholders to determine approaches to monitoring discrimination. Using this information, the report the describes internet- and text message-based platforms for reporting HIV-related discrimination to the Commission on Human Rights and Administrative Justice (CHRAJ), providing a mechanism for civil society organizations to report cases to CHRAJ, track case progress, and use data on stigma and discrimination to guide future advocacy on HIV- and other related policies in Ghana.

  • 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.

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

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

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

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

  • 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 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.

  • 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.

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

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