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  • This report documents the advocacy campaign for Ukraine's 2014-2018 National HIV Program (NHP). The USAID- and PEPFAR-funded Health Policy Project (HPP) worked with the State Service of Ukraine on HIV/AIDS and Other Socially Dangerous Diseases to calculate the impact of funding decisions on Ukraine’s ability to reach the goals of the NHP using the Goals model. These data formed the basis of the advocacy campaign.

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

  • The 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.

  • 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

  • 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. 

  • 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.

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

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

  • 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.

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

  • The USAID-funded Health Policy Project applied its new ImpactNow model to estimate the near-term benefits of achieving family planning goals in Kenya. This PowerPoint presentation describes some key benefits associated with achieving these goals, and offers recommendations for the government of Kenya and development partners to increase investment in and improve family planning services in the country.

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

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

  • In 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.

  • 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.

  • 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. 

  • 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.

  • This briefing book aims to raise awareness about the impact of population growth on Malawi's development. It includes projections of population growth from 2008 to 2040 based on two hypothetical population scenarios. One scenario assumes that women in Malawi will continue to have 5.7 children on average during their lifetime, while the other scenario assumes a gradual decline in fertility to 3 children per women. The first scenario with continued high fertility shows the population growing from about 13 million in 2008 to 38 million in 2040. By contrast, the second scenario with lower fertility shows an increase from about 13 million in 2008 to 30 million in 2040. By 2040, Malawi would have more than 8 million fewer people if women were to have three children instead of nearly six. 

    These projections demonstrate the impact that rapid population growth can have on various sectors, such as education, health, agriculture and food security, environment and land use, and the labor force and employment. In the case of education and health, a slower population growth rate results in less pressure on the government budget to provide free primary education and public health services. 

  • This 2-page briefer aims to raise awareness about the impact of rapid population growth on Malawi's development. 

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

  • In 2014, the Health Policy Project, in collaboration with the United Nations Population Fund (UNFPA), supported the development of a subnational family planning advocacy materials in Adamawa, Nigeria.Using the Resources for the Awareness of Population Impacts on Development (RAPID) model, this brief highlights how smaller families would relieve pressure on the provision of primary education and public health services, and alleviate food insecurity as well as unemployment in Adamawa state by 2050.

  • 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. 

  • 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 USAID-funded Health Policy Project presentation aims to raise awareness about the impacts of rapid population growth on Mozambique's socioeconomic development. It includes projections of population growth from 2015–2040 based on three hypothetical fertility scenarios: high fertility (5.9 children per woman, or status quo based on a 2011 baseline figure), medium fertility (4.5), and low fertility (3.0). Continued high-fertility growth will increase the pressure on Mozambique’s health, education, economic, and agricultural sectors to meet the population’s demand for basic needs. However, slowing population growth through increased use of family planning will allow the country to invest more in long-term measures to improve the quality of health services, guarantee universal education, expand employment opportunities, and attain food security. If strategically implemented, these measures could catalyze progress toward a healthier, more prosperous country.

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

  • 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.

  • The USAID- and PEPFAR-funded Health Policy Project (HPP) supports health systems strengthening (HSS) by bringing together different actors and disciplines within the health system to improve policy and ultimately achieve more equitable and sustainable access to health services. The importance of HSS for HIV and AIDS, tuberculosis, and malaria programs is recognized in Tanzania’s national strategic plans.

    In May 2014, USAID/Tanzania approached HPP to assist the Ministry of Health and Social Welfare’s Directorate of Policy and Planning in conducting a rapid HSS assessment with two main objectives: to build initial consensus around priority HSS actions that will inform a new national HSS strategy, and to provide information for the ministry to advocate for additional HSS funding. The latter includes presenting HSS priorities, activities, and actions to the Global Fund’s Tanzania National Coordinating Mechanism to be considered for inclusion in the upcoming grant application process.

  • The USAID-funded Health Policy Project supports African women leaders through coaching, as part of a larger capacity development model. Too often knowledge and skills gained during training are eclipsed by the demands of returning to work—and to one's old habits. In order to nurture the seeds planted through the Empowering Women Leaders for Country-led Development program's three-week women's leadership workshop, HPP carefully matches each participant with a coach from her own country. Thus begins a year-long relationship that enables the participant to grow professionally and personally through prioritizing, networking, and learning. This brief describes workshop participants' experiences with their coaches, and includes guidance on the effective use of a coaching model for capacity development.

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

  • 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.

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