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

  • Tracking health budget allocations is critical in assessing whether resources allocated in the health sector are aligned to key policy objectives as articulated in policy documents. In Kenya, the Constitution requires that at least 15 percent of the national revenues should be allocated to the county governments to fund the devolved functions that include health. This study assessed the trends in allocations between 2013/14 and 2014/15, and sought to establish whether the allocations were aligned to sector priorities both at the national and county level.

  • In response to the need for a standard analytical framework by which to evaluate PHE programs, the USAID-funded Health Policy Project (HPP) developed the present tool to define the interactions between interventions in each of the three sectors—population, health, environment—and to show the synergies that can result from an integrated, multisectoral approach. HPP built a generalized PHE computer model/framework that can be applied to any PHE program. To access the PHE Framework, please contact the Health Policy Project, www.healthpolicyproject.com. 

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

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

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

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

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

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

    The report is available in English and Portuguese.

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

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

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

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

  • In 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 Barbados and Jamaica, the PEPFAR- and USAID-funded Health Policy Project (HPP) has delivered two-day stigma-reduction trainings to health facility staff. Adapted from a longer curriculum, the trainings comprehensively address stigma and discrimination by involving all health facility staff (including receptionists, pharmacists, nurses, and administration staff). HPP is also helping facility staff develop posted “codes of conduct” which outline the expectations for stigma-free services, regardless of HIV status, sexual orientation, or gender.

    The codes of conduct posters feature health facility staff photos and contact information for clients to report instances of discrimination. The codes of conduct are being rolled out across health facilities in Jamaica, Barbados, and other countries across the Caribbean.

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

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

  •  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.

  • Through this case study, the USAID- and PEPFAR-funded Health Policy Project (HPP) seeks to share Thailand’s experience implementing the AIDS Zero Portal (AZP) and its initial impact at the national and provincial levels. The AZP offers a potential model for other countries looking to institutionalize and leverage information systems as part of their routine monitoring and evaluation, strategic planning, and resource allocation efforts.

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

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

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

  • 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.

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

  • 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.