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Health Systems Strengthening

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

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

  • With support from the USAID-funded Health Policy Project, the White Ribbon Alliance for Safe Motherhood (WRA) is striving to promote midwifery and improve midwives' working conditions by (1) influencing policymakers, (2) involving the media, (3) engaging youth, (4) mobilizing the community, and (5) strengthening the capacity of midwives as advocates at the global, national, and local levels. This brief demonstrates how advocacy approaches can lead to a more supportive environment for midwives and ultimately better maternity care and birth outcomes. Advocates need to inform policymakers of the priority issues needing their attention and the steps necessary to improve midwifery. The brief includes a number of examples for advocates to learn from and include in their advocacy strategies. It also provides an opportunity for WRA to share advocacy learning and models with global partners to foster continued and additional advocacy efforts that are needed to further position midwifery as a central component of integrated maternal and newborn health systems.  

  • Community-based models for HIV treatment and care have shown promise in some sub-Saharan countries, especially for improving patient outcomes and increasing the sustainability of the overall program. The Health Policy Project, in collaboration with the National AIDS and STI Control Programme, reviewed the state of evidence for implementing community-based approaches to care and treatment in Kenya. While some of the evidence suggests that such models can be applicable and beneficial, more data and Kenya-specific evaluations are required before concrete recommendations can be made. This brief serves a research agenda for Kenya in this regard.

  • In 2011, the USAID-funded Health Policy Project (HPP) provided technical assistance to support gender integration in the Mali National Health and Social Development Program (PRODESS). As part of this effort, HPP conducted a gender and health analysis using available data to inform PRODESS working groups. To facilitate the analysis, HPP developed a systematic gender data analysis process and identified data sources, including the Demographic and Health Survey (DHS) and the National Multiple Indicator Cluster Survey (MICS), to elucidate gender-specific cultural attitudes and practices and gender-related barriers with the potential to impact health outcomes for women and girls in Mali.

    This document presents this secondary data analysis process, along with findings from Mali, to facilitate its possible application in other settings. We provide step-by-step procedures for using existing data sources to analyze key gender and health data and to illustrate the links between gender disparities and health outcomes. This process serves as a practical, easy-to-follow method for conducting a low-cost, data-informed gender analysis that can be used to provide concrete, quantifiable examples of the impact of gender on health and other development outcomes

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

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

  • 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. 

  • 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 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.  

  • Health financing was the theme of a major national conference held in Calabar, Nigeria in November 2011. The specific focus of the three-day conference was “Improving Financial Access to Health Services for the Poor in Nigeria.” Participants shared information on a wide range of health financing strategies and mechanisms employed in Nigeria as well as other countries. The 255 participants represented a broad range of expertise; they included health managers and providers, insurance specialists, health economists, government officials, and media representatives from all 36 states and the national capital. State representatives met in regional groups to discuss the approaches most applicable to their area and formulate plans to apply these approaches at the state or community level. The conference generated many “actionable” policy and program initiatives that the states and federal government can adopt.

    This presentation was one of five presentations made by the Health Policy Project. The presenter gave a brief overview of various software models available to help health planners and managers to estimate and project costs for various health services. These tools can be adapted for use at the state and local level and used to estimate costs to reach a specific goal or to expand or upgrade services.

  • 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.

  • The Discrimination Reporting System User Guide outlines how civil society organizations in Ghana can use a web-based platform to report cases of discrimination to the country's Commission on Human Rights and Administrative Justice (CHRAJ). The system, developed with the support of the USAID- and PEPFAR-funded Health Policy Project, links civil society to CHRAJ through case tracking, follow-up, and data reporting. The user guide provides civil society organizations with a visual description of how to navigate the online system, submit complaints on behalf of clients, track the progress of complaints, and generate reports. It will be distributed to civil society organizations in Ghana that support people living with HIV and key populations.

  • India's National Rural Health Mission (NRHM) is one of the world's largest government-funded primary healthcare programs. Improving the effectiveness of financing for this program is crucial for both the central and state governments in India. In partnership with the National Institute of Health and Family Welfare and the National Health System Resource Centre, the USAID-funded Health Policy Project examined the allocation and spending of funds for NRHM in Uttarakhand, one of the program's "high focus states." This report summarizes the results of the first phase of the analysis, which examined fund flows from the state to the 13 districts using financial records from fiscal years 2008–09 to 2011–12. The analysis explored three questions: 1) whether funds are allocated to districts according to their health needs, 2) whether districts are able to spend the funds allocated to them, and 3) how districts spend funds relative to health needs. Results indicate that NRHM funding in Uttarakhand could be made more efficient by aligning allocations and spending with health needs, and improving districts’ ability to spend all the funds available to them. 

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

    The report is available in English and Portuguese.

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

    Related resources: 

    The Policy Dimensions of Scaling Up Health Initiatives

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

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

  • In 2014, USAID requested the Health Policy Project (HPP) to undertake an assessment of the status and extent of FP-HIV integration in Malawi. Since integration at the policy level is important and the first step to a well-guided implementation of health service delivery (EngenderHealth, 2014), HPP undertook a policy analysis to determine the level of FP-HIV integration that appears in 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. Other research components on the status of FP-HIV integration, including stakeholder interviews and a facility-level assessment, are documented in separate reports (forthcoming).

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

  • 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.  

  • 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.

  • In support of the Global Fund’s New Funding Model, the President’s Emergency Plan for AIDS Relief (PEPFAR) worked in coordination with the United States Agency for International Development (USAID) through the Health Policy Project (HPP) to provide technical assistance to select high-impact countries. HPP supported the South Africa National AIDS Council (SANAC) and provincial health authorities in KwaZulu-Natal (KZN) on a proposal to map estimated HIV prevalence using routinely collected facility-level data and other related data in KZN province and the metro municipality of eThekwini (formerly known as Durban). These efforts were intended to help inform the country’s Concept Note submission, scheduled for June 2015. In addition to providing technical assistance in support of the analysis, HPP documented the methodology (Judice and Datar, 2014)—adapted from Dr. Frank Tanser’s work in Mpumalanga Province—so that SANAC might include a request to replicate this analysis in multiple municipalities throughout the country as part of the funding application to the Global Fund.This report documents the methodology, data sources, and statistical methods used to map and analyze routine data to examine HIV variation at subnational levels.

  • 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.

  • The Indian state of Jharkhand has shown commitment to improve the implementation of its family planning (FP) program and undertook a capacity-building program, with technical assistance from the USAID-funded Health Policy Project (HPP), to strengthen capacities of the state Family Planning Cell, civil society organizations, and district- and block-level health functionaries to operationalize the state's FP strategy and oversee its effective implementation. This program was piloted in three focus districts—Simdega, West Singhbhum, and Giridih—and followed an intensive approach that included a capacity needs assessment and development of a program that was in line with the findings of the needs assessment.

    This toolkit was developed as an aid for HPP’s capacity-building program in the Jharkhand. It consists of the Manager's Tool to record data during mentoring and supervisory visits; the Manual for District and Block Managers and accompanying PowerPoint slides that provide training and guidance to build capacity for a stronger health system that supports family planning programs; and the Training of Trainers Manual and accompanying PowerPoint presentations to build participants' skills to become trainers of district- and block-level managers in health systems strengthening and effective management to improve FP programming.

  • In order to expand and ensure widespread access to healthcare services and protect households from what are termed "catastrophic" health expenditures, Kenya needs alternative and sustainable healthcare financing mechanisms. The Health Policy Project supported the government of Kenya to analyze the long-term health delivery costs and health financing options available to the country. Employing a number of economic and health financing tools, the analysis, Healthcare Financing Options for Kenya: FY 2013/14–2029/30, revealed a need to increase domestic financing and improve the efficiency of the service delivery and social health insurance systems. Results from the analysis will be used to support the country’s move toward universal health coverage.

  • Access to maternal health services in Ghana has improved significantly over the past 15 years—most dramatically since 2008, when the government began providing free general care for pregnant women, as well as a maternal benefit package covering deliveries, antenatal and postnatal care, and pediatric care for the first three months of life. The National Health Insurance Fund finances all of these services. To help Ghana’s policymakers anticipate the health and economic benefits at varying levels of investment in family planning from 2014–2020, the USAID-funded Health Policy Project (HPP) conducted this analysis, using its new ImpactNow model.

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

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

  • 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.

  • At the request of the USAID Mission in Malawi, the USAID-funded Health Policy Project (HPP) undertook a comprehensive facility-based assessment to ascertain the extent to which FP services have been integrated into HIV services in Malawi through different integration models and across various types of facilities (public and non-profit private). The study was also designed to examine how the reproductive rights of people living with HIV (PLHIV) are being respected and addressed through approaches such as PIFP and access to method choice. Finally, the study aimed to identify any systems-level barriers to integration and provide practical recommendations for the Ministry of Health (MOH) and other stakeholders to improve FP-HIV integrated services in Malawi.

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

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

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

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

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

  • Investing for impact is an explicit goal of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The institution’s strategy for 2012 to 2016 focuses on countries and populations where interventions promise maximum rewards for public health. As part of this “New Funding Model,” the Global Fund is asking applicant countries seeking financing to more accurately  demonstrate where and how their HIV programs will yield significant, measurable improvements in limiting the spread of the virus. Accomplishing this will depend to a great extent on each country’s ability to use geospatial analysis of epidemiological data to target resources to areas with the greatest need.

    Not all countries seeking Global Fund support have extensive experience with geospatial analysis. To address this gap, the Health Policy Project (HPP)—funded by the United States Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR)—is working with 9 countries eligible for Global Fund support to strengthen their use of geospatial analysis in HIV policymaking and in strategic, financial, and program planning.

  • 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.

  • 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.

  • Tanzania’s sustained development and transition to middle-income status depend on the health of its people. In recognition of this fact, the Government of Tanzania (GOT) has prioritized reproductive, maternal, newborn, child, and adolescent health (RMNCAH), adopting a broad foundation of policies to inform RMNCAH programming. Yet, in recent years, progress toward achieving Millennium Development Goal (MDG) targets for child, maternal, and neonatal health has been uneven, in large part due to funding and implementation challenges. To overcome these challenges and accelerate progress, the GOT developed a National Road Map Strategic Plan to Improve Reproductive, Maternal, Newborn, Child and Adolescent Health in Tanzania (2016-2020): One Plan II. In 2015, the USAID-funded Health Policy Project (HPP) conducted an analysis to project the costs and health impacts of achieving the government’s new commitments outlined in the One Plan II, and to identify the remaining challenges for implementing the plan.

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

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

  • In 2011, the Health Policy Project, in collaboration with the Family Planning Action Group (FPAG), supported the development of a Nigeria RAPID application. The FPAG, comprising governmental and nongovernmental organizations, focuses on the state of family planning in Nigeria and the need for more support and funding for the national family planning program. “RAPID” stands for “Resources for the Awareness of Population Impacts on Development,” and it is a tool designed to help policymakers understand the relationships between fertility, population growth, health, education, agriculture, economic growth, and national security. This package of materials uses RAPID projections to highlight the impact of Nigeria's population growth on national development and its ability to provide education, health, and nutrition to all its citizens. By lowering average fertility, savings in primary education and health could amount to $37 billion and $45 billion, respectively, by 2040.

    Also see the RAPID package of materials highlighting the impact of high fertility on maternal and child health: Nigeria RAPID Population and Development: Why Fertility Affects Health.

  • In 2011, the Health Policy Project, in collaboration with the Family Planning Action Group (FPAG), supported the development of a Nigeria RAPID application. The FPAG, comprising governmental and nongovernmental organizations, focuses on the state of family planning in Nigeria and the need for more support and funding for the national family planning program. “RAPID” stands for “Resources for the Awareness of Population Impacts on Development,” and it is a tool designed to help policymakers understand the relationships between fertility, population growth, health, education, agriculture, economic growth, and national security. This package of materials uses RAPID projections to highlight the large unmet need for family planning in Nigeria and its impact on maternal and child health. By lowering average fertility in the country, 31,000 maternal deaths and 1.5 million child deaths could be averted by 2021.

    Also see the RAPID package of materials highlighting the impact of rapid population growth on the country's development: Nigeria RAPID Population and Development: How Fertility Affects Development.

  • 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.

  • 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. 

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

  • Tanzania’s government recognizes that the country’s sustainable development and transition to middle-income status depends on the health of the Tanzanian people. To that end, the country has worked hard to achieve Millennium Development Goal (MDG) 4 to reduce child mortality and MDG 5 to improve maternal health. This USAID and PEPFAR-funded Health Policy Project brief explores the current policy framework for reproductive maternal, neonatal, child, and adolescent health (RMNCAH), and provides plans for intervention and strengthening of RMNCAH in the short, medium, and long term. 

  • A high proportion of Tanzania’s total health spending comes from foreign donors and households (out-of-pocket), rather than from sustainable sources such as government tax-based revenue or health insurance. While the country has made enormous strides in improving its population’s health, the Government of Tanzania and its development partners recognize that the current health financing structure is not sustainable. The government is now considering several crucial changes to how healthcare in Tanzania is financed; as part of this effort, the country is finalizing a health financing strategy and scaling up new programs to accelerate service delivery coverage and improve quality.

    In support of building a sustainable structure, the USAID- and PEPFAR-funded Health Policy Project reviewed the country’s healthcare financing situation to provide a baseline against which innovation and policy change can be gauged. This report provides a broad overview of the health financing landscape in Tanzania as of 2014 and aims to highlight those aspects suggesting a greater reliance on domestic and sustainable resources to accomplish Tanzania’s health goals. 

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

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

  • Health financing was the theme of a major national conference held in Calabar, Nigeria in November 2011. The specific focus of the three-day conference was “Improving Financial Access to Health Services for the Poor in Nigeria.” Participants shared information on a wide range of health financing strategies and mechanisms employed in Nigeria as well as other countries. The 255 participants represented a broad range of expertise; they included health managers and providers, insurance specialists, health economists, government officials, and media representatives from all 36 states and the national capital. State representatives met in regional groups to discuss the approaches most applicable to their area and formulate plans to apply these approaches at the state or community level. The conference generated many “actionable” policy and program initiatives that the states and federal government can adopt.

    This is one of the five presentations made by the Health Policy Project. The presenter explains how to measure poverty and inequality, how to display poverty data to illustrate inequities in health status and use of health services, and, finally, how to understand and address common data challenges.

  • 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.

  • Over the past five years, the USAID- and PEPFAR-funded Health Policy Project (HPP) has worked in collaboration with global and country-level institutions to advance understanding and approaches to measuring and addressing HIV-related stigma. At the global level, HPP led efforts to review, prioritize, adapt, test, and synthesize existing measures and programmatic tools for stigma reduction in health facilities. This resulted in the development of a comprehensive package for “stigma free” health facilities (HPP, 2015). The package was piloted in several Caribbean countries,2 and offers a complete response to S&D in health facilities—from research to action. Its total facility approach targets all health facility staff, from doctors to cleaning staff.

    In an effort to facilitate further scale-up and refinement of these successful approaches, HPP convened an expert meeting in Washington, DC on June 3, 2015 to discuss and strategize a way forward to scale up S&D reduction efforts in health facilities. These discussions yielded valuable insights and recommendations, which are presented in this brief.

  • 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.

  • Reducing HIV stigma and discrimination (S&D) in the healthcare setting is particularly important because it is here that people living with HIV seek care and treatment to remain healthy while others seek information, counseling, testing, and other prevention services. Despite this recognized need, programs to reduce HIV-related stigma and discrimination in healthcare facilities have yet to be routinely institutionalized and scaled up. A key factor contributing to this gap is the lack of a globally standardized set of measures for HIV-related stigma and discrimination in healthcare facilities and among healthcare workers.

    In response, the Health Policy Project (HPP) is leading an ongoing collaborative global effort to develop a brief, standardized set of HIV-related S&D measures for use in healthcare facilities. As part of this effort, the project examined and synthesized relevant literature and subsequently held an expert meeting to review existing measures and build consensus toward a recommended and consolidated set of measures. The central outcome was the creation of a framework for HIV-related S&D reduction programmatic intervention and measurement. The framework delineates key programmatic areas (drivers) for intervention and identifies the key points within the framework where measurement should occur.

    Measurement provides policymakers, governments, donors, and civil society advocates with data necessary to develop strategic policies, monitor and evaluate progress, and implement effective programs that uphold the rights of people living with HIV and other key populations affected by HIV. Data generated from valid and reliable indicators will allow programmers to monitor interventions in a timely manner and assess and evaluate programs to determine expansion strategies of successful implementation approaches.

  • Over the past decade, the performance of Tanzania’shealth system has been mixed. The country will achieve many of its 2015 targets for malaria, HIV and AIDS, tuberculosis, and child health, but progress in reproductive health is lagging. Currently, nearly half of the country’s health budget is covered by donor funding—the largest share in the world. This USAID and PEPFAR-funded Health Policy Project brief provides an overview of Tanzania's existing health system, including: human resources for health, health financing, commodities and supplies, and monitoring and evaluation and health management information systems.

  • 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.

  • 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 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.

  • Health financing was the theme of a major national conference held in Calabar, Nigeria in November 2011. The specific focus of the three-day conference was “Improving Financial Access to Health Services for the Poor in Nigeria.” Participants shared information on a wide range of health financing strategies and mechanisms employed in Nigeria as well as other countries. The 255 participants represented a broad range of expertise; they included health managers and providers, insurance specialists, health economists, government officials, and media representatives from all 36 states and the national capital. State representatives met in regional groups to discuss the approaches most applicable to their area and formulate plans to apply these approaches at the state or community level. The conference generated many “actionable” policy and program initiatives that the states and federal government can adopt.

    This presentation is one of five presentations made by the Health Policy Project. The presenter gave an overview of a pilot project in Kenya, which found that the provision of subsidized vouchers for maternal health and family planning services were effective in reaching the poor at a reasonable cost; providers were paid for specific services (rather than supporting operating costs).

  • This presentation is one of five made by the Health Policy Project at a national health financing conference held in Calabar, Nigeria, in November 2011. Participants, including health managers and providers, insurance specialists, health economists, government officials, and media representatives, shared information on a wide range of health financing strategies and mechanisms employed in Nigeria and other countries.

    The Equity Framework is an approach that targets family planning and reproductive health resources to the poor—a segment of the population that is often overlooked in health program planning. The presentation examines a case study in Jharkhand, India—one of India’s poorest states—where health planners applied the Equity Framework to develop a voucher scheme to enable low-income women to access reproductive health services. Conference participants were able to learn from the success garnered in India and adopt similar policy and program initiatives to expand access to family planning and reproductive health services to the poor in Nigeria.

  • Health financing was the theme of a major national conference held in Calabar, Nigeria in November 2011. The specific focus of the three-day conference was “Improving Financial Access to Health Services for the Poor in Nigeria.” Participants shared information on a wide range of health financing strategies and mechanisms employed in Nigeria as well as other countries. The 255 participants represented a broad range of expertise; they included health managers and providers, insurance specialists, health economists, government officials, and media representatives from all 36 states and the national capital. State representatives met in regional groups to discuss the approaches most applicable to their area and formulate plans to apply these approaches at the state or community level. The conference generated many “actionable” policy and program initiatives that the states and federal government can adopt.

    This presentation is one of five presentations made by the Health Policy Project. The presenter gave an overview of an activity in Peru, where family planning advocates analyzed the needs of low-income women and successfully tapped into funding sources at the local, regional, and national level to increase access to FP services.

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

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

  • Classified as an upper-middle-income country in 2010, Jamaica is reorganizing its HIV response to heighten efficiency and financial sustainability. A key challenge involves sustaining the program, given declining external assistance and a government in fiscal crisis. Facing this challenge, the Jamaican Ministry of Health has integrated elements of its HIV program into its family planning program to create a new national Ministry of Health (MOH) agency for sexual health. In undertaking this reform, the MOH found a dearth of guidance about national-level integration. Thus, the MOH collaborated with the USAID- and PEPFAR-funded Health Policy Project to assess lessons to date and map next steps. This poster about the study was presented at the 20th International AIDS Conference in Melbourne, Australia, in July 2014.

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

  • Developed by the USAID- and PEPFAR-funded Health Policy Project, this guide is a training tool that provides a standard for stigma reduction. It is a resource for facilitators seeking to train participants to reduce HIV and key population stigma and discrimination, and for leaders of community dialogue and policy development in this area. The guide has been piloted in the Caribbean and other settings and can be readily adapted for other contexts.

  • 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.