Welcome to the Publication Archives of USAID-funded Health Policy Projects.

Browse Health Policy Project (2010-2016) Materials

↑ top


Files will load from www.healthpolicyproject.com.

List entries are alphabetical by title and contain the title, abstract, and then the filename which is hyperlinked and will open in a new browser window. Most files are PDFs. There may be multiple files per abstract.

Governance, Stewardship & Accountability

HP+ More recent Governance, Stewardship & Accountability publications are available.

  • 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 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.

  • 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.

  • For several decades, civil society organizations (CSOs) in Nigeria have been advocating for increased resources for reproductive health (RH) and family planning (FP) services and commodities. Many people assume that once policymakers make a public commitment to provide funding for a specific purpose, the funds are assured. However, such a commitment is only the first step in securing budgetary allocation. The necessary steps include formal approval for the budgetary allocation, inclusion of the funds in the approved budget, release of the funds for the program, and expenditure of the funds intended.

    CSOs can play a key role in ensuring that public funds are used for the intended purpose and actually reach the intended beneficiaries. To do so, they need to understand the budgetary process and the role of nongovernmental stakeholders in the process. The inner workings of the state-level budget process in Nigeria are not well understood, and there is little documentation of the process to provide guidance.

    To help CSOs in Nigeria understand and actively participate in the budget process, the Health Policy Project conducted an assessment to identify the differences between theory and practice in state-level budgeting. In doing so, several entry points emerged for CSOs to make a difference in FP/RH funding; the key tasks identified include

    • Advocate for increased funds for FP/RH programs and commodities
    • Ensure that adequate funds are budgeted, obligated, and released in a timely manner
    • Track state-level budget expenditures, especially funds actually expended for FP/RH services and commodities
    • Hold policymakers and program managers accountable for the effective use of public funds

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

  • In June 2014, government of Haiti passed a new law against human trafficking. The main purpose of the legislation was to minimize the incentives for people to become human traffickers. The act establishes penalties for trafficking-related crimes, including imprisonment for up to 15 years, and fines of more than US$30,000. Prior to the passage of this law, there were no provisions in the Haitian legal framework that criminalized trafficking in persons. The USAID-funded Health Policy Project AKSE program published this law to disseminate the content of this important legal instrument and help protect survivors of trafficking. It is intended for use by judges, lawyers, and human rights-focused NGOs, and is used by HPP AKSE to train judicial actors, in partnership with the Haitian governmen

  • 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. 

  • 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

  • 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.  

  • HPP worked with the Kenya Ministry of Health to create 47 County Health Fact Sheets that provide a county-level snapshot of selected health indicators in Kenya. They display county-specific health data and compare those data to national figures. The fact sheets bring together data from a wide array of sources and are intended to be a quick reference for a broad audience, including advocates, policymakers, health sector stakeholders, and development partners. The facts sheets were last updated July, 2015.

    You may download individual fact sheets on this page.

  • 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.

  • In 2010, the new Kenyan constitution mandated the devolution of power to 47 counties. This process has had wide-ranging implications for the health sector in Kenya as stakeholders struggle to understand the impact of the new political structure on their programs and services. Starting in 2012, the Health Policy Project (HPP)/Kenya began working with various governmental and non-governmental stakeholders to guide public management and structural reform, in line with the devolution process. This brief gives an overview of HPP/Kenya’s role in the devolution of Kenya’s health system including supporting national level stakeholders to consider the implications of devolution; incorporating legislative guidance on decentralization into health sector planning; facilitating county-level institutional reform; and ensuring that county health management teams have the structures necessary to respond to the challenges of devolution. Finally, the brief highlights challenges to the devolution process and illustrates how the Government of Kenya, HPP/Kenya, and other key stakeholders are working together to overcome these challenges.

  • 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.

  • This brochure provides an overview of a web-based platform that civil society organizations in Ghana can use to report cases of discrimination to the country's Commission on Human Rights and Administrative Justice (CHRAJ). The system, developed with support from the USAID- and PEPFAR-funded Health Policy Project, links civil society to CHRAJ through case tracking, follow-up, and data reporting. The brochure provides information on why someone would submit a complaint, how to submit a complaint, and how to follow up on a complaint. It is meant solely for informational purposes. Step-by-step guidance on how to use the system is provided by the Discrimination Reporting System User Guide.

  • 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.

  • 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.

  • This report covers an evaluation of the collaboration between the Ministry of Health of the Indian State of Jharkhand and the Health Policy Project to conduct a program (Nov. 2012-July 2013) to strengthen capacities at state, district, and sub-district levels to effectively implement the 2010 family planning  strategy.  It included training, mentoring, and supportive supervision. A State Resource Group of master trainers from government and civil society supported the 4-person Family Planning Cell. A pre/post-implementation quantitative and qualitative assessment highlighted that although the implementation period was short, systems were strengthened and laid a solid basis for achieving  Jharkhand’s FP goals.  The assessment highlighted improvements in timely data updates (from 27% to 91%),  increased stocks of FP commodities and IEC materials, and wider availability of doctors trained in clinical services. Budget allocations for spacing methods increased and the FP Cell invested in training health staff on counseling and  IUD skills. Staff reported an improved attitude toward information sharing and joint problem solving.  The 3-district pilot program has been scaled up in 11 additional high-need districts.  

  • 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.

  • As countries increasingly make national commitments to family planning (FP), there is also a need to foster accountability for fulfilling them. In Tanzania, as in many countries, those commitments can be manifested in many different ways. Top-down, high-level policy documents, including poverty-reduction strategy papers and national development strategies, often include commitments to FP. Within the Ministry of Health, which bears the responsibility for implementing FP commitments, strategy documents, such as Tanzania’s One Plan for Maternal and Child Health, incorporate FP as a priority. In addition, Tanzania’s costed implementation plan (CIP) for FP-developed in 2010 and later rolled into the One Plan-identifies challenges to achieving commitments, presents appropriate strategies and the costs for implementing them, and estimates the benefits if the country is successful.

  • 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.

  • Discrimination against people living with HIV and key populations is a common and challenging problem. A year ago, the Commission on Human Rights and Administrative Justice (CHRAJ) in Ghana launched a web-based system to provide a simple way for reporting HIV- and key population–related discrimination with help from the USAID and PEPFAR-supported Health Policy Project (HPP). This brief describes the outcomes of the discrimination reporting system after one year and ways forward. 

    Click here to read a blog on HPP's work on the CHRAJ stigma and discrimination reporting portal.  

  • 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 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.

  • 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.

  • In October 2013, the Haitian government passed a law to regularize adoption. This new law focuses on children's best interests and aims to promote international adoption as a last-resort measure after reviewing all the national options. The USAID-funded Health Policy Project AKSE program reproduced the text of the law in this booklet to make it accessible to actors in the child protection chain and to promote its application through trainings for Haitian judicial actors and dissemination among human rights NGOs.

  • 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.

  • 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.

  • In June 2014, government of Haiti passed a new law against human trafficking. The main purpose of the legislation was to minimize the incentives for people to become human traffickers. The act establishes penalties for trafficking-related crimes, including imprisonment for up to 15 years, and fines of more than US$30,000. Prior to the passage of this law, there were no provisions in the Haitian legal framework that criminalized trafficking in persons. The USAID-funded Health Policy Project AKSE program published this law to disseminate the content of this important legal instrument and help protect survivors of trafficking. It is intended for use by judges, lawyers, and human rights-focused NGOs, and is used by HPP AKSE to train judicial actors, in partnership with the Haitian government

  •  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.

  • 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.  

  • 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.

  • 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 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. 

  • 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.

  • The Jamaican Network of Seropositives (JN+)—with support from the Jamaican Ministry of Health’s National HIV/STI Program (GIPA Unit) and the USAID- and PEPFAR-funded Health Policy Project—created a capacity-building curriculum led by people living with HIV (PLHIV). The curriculum aims to implement and advocate for Positive Health, Dignity, and Prevention (PHDP) and promote community leadership at the country level.

    PHDP—a global policy framework authored by the Global Network of People Living with HIV (GNP+) and UNAIDS in 2011—advances a holistic framework for PLHIV to manage their health, advocate for high-quality HIV services, and prevent onward HIV transmission. PHDP provides a concrete framework and road map that is especially relevant to meeting current global and national care and treatment goals for HIV—and to making “combination prevention” a reality.

  • 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.

  • In close collaboration with IBESR, the USAID-funded HPP AKSE developed referral schematics and protocols will be developed for client service needs, safety, security, and confidentiality of existing child protection networks.

  • In close collaboration with MCFDF, the USAID-funded HPP AKSE conducted an assessment of the sexual and gender based violence (SGBV) referral monitoring and reporting system in Haiti. The following report includes results from the assessment and recommendation to strengthen the existing system.

  • This document is a report on the District Orientation meetings led by the Malawi Ministry of Gender, Children, Disability and Social Welfare (MoGCDSW) with support from the USAID-supported Health Policy Project. The orientation meetings were held to kick-start the implementation of the national Institutional Framework and the MoGCDSW Strategic Plan, in order to achieve the objectives of the Joint Sector Strategic Plan.

  • This report documents the process undertaken for the review and update of guidelines and standards for gender mainstreaming in Malawi, which was undertaken jointly by HPP and the Ministry of Gender, Children, Disability and Social Welfare. The report also documents the outcomes of this process.

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

  • Expanding access to health insurance is an important part of an overall strategy to achieve universal health coverage (UHC). Since its launch in 1999, the National Health Insurance Scheme (NHIS) has been Nigeria’s major initiative to expand health insurance in the country. To support this endeavor, the Health Policy Project conducted case studies of the experience of three countries—Colombia, India, and Thailand—as they developed government policies as a strategy to achieve universal health coverage (UHC). The lessons learned should be useful for Nigerian stakeholders involved in expanding and improving the NHIS, as well as for stakeholders in any country facing similar challenges. How health insurance expansion features in a UHC strategy depends on the resources available to the government via general taxation; the growth and maturity of private voluntary health insurance markets; and, most important, the state of the health system across primary, secondary, and tertiary healthcare. Our case studies suggest that pragmatic choices made by lower-middle and middle-income governments—a group where Nigeria may be placed—have involved hybrid health financing models.

  • 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.

  • 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. The ministries' ability to meet FP2020 goals depends on the strength of their stewardship functions, including collaboration with and support they generate from other actors and sectors. This brief describes how ministries of health can strengthen linkages with the private sector to achieve FP2020 goals. 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: 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 United States Agency for International Development (USAID) supports the implementation of the United States President’s Emergency Plan for AIDS Relief (PEPFAR), a United States government (USG) initiative to save the lives of people around the world who are suffering from HIV and AIDS, in almost 100 countries. Since 2003, PEPFAR has worked with these countries to create systems that have stabilized the HIV epidemic by preventing new infections and providing care, support, and treatment to those infected and affected by HIV. Due to the progress that has been made in Guyana, the PEPFAR program will transition from a service delivery model to one that provides targeted technical assistance over the next five years (2013–2017). This will also result in a shift in USG funding, inclusive of USAID.

    Within this context, there is an identified need to clearly define roles and responsibilities for all key stakeholders and delineate next steps in the transition to ensure long-term sustainability of HIV prevention, care, and support services and the continuum of care for people infected and affected by HIV and AIDS.  Toward this effort, the USAID- and PEPFAR-funded Health Policy Project (HPP) supported PEPFAR Guyana by conducting a high-level assessment of HIV and AIDS NGOs, relevant private sector entities, the Ministry of Health (MOH), the National AIDS Program Secretariat (NAPS), and other relevant line ministries in Guyana. The aim of this assessment was to document the country’s capacity gaps and needs to support the transition of HIV services from donors to the country, and suggest approaches for ensuring an ethical transition and sustainability of these services over time.

  • 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.

  • 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. 

  • 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

  • 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.

  • 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.