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.

Scale-up

HP+ More recent Scale-up publications are available.

  • To achieve the greatest possible improvement in family planning (FP) and maternal, neonatal, and child health (MNCH) outcomes, successful interventions, practices, and approaches must be "scaled up," that is, implemented on a larger scale and incorporated into the laws, policies, and structures that govern health systems. In recent years, growing recognition of the importance of scale-up has led to intensified efforts to identify and scale up best practices in FP/MNCH and improve scale-up processes. Policy development and implementation are central to successful and sustainable scale-up.

    This package of materials presents a programming approach designed to help countries advance the integration and measurement of policy development and implementation into the scale-up of FP/MNCH interventions and best practices. The approach provides planners and implementers with initial guidance and suggestions on how to systematically address policy development and implementation as they scale up FP/MNCH programs.

  • To achieve the greatest possible improvement in family planning (FP) and maternal, neonatal, and child health (MNCH) outcomes, successful interventions, practices, and approaches must be “scaled up”—that is, implemented on a larger scale and incorporated into the laws, policies, and structures that govern health systems. Gender equality is central to successful and sustainable scale-up because it significantly influences health outcomes, and many barriers to program scale-up are related to inequitable gender norms.

    The Health Policy Project’s Gender, Policy, and Measurement program (GPM) has designed an approach to help countries advance the systematic integration of gender equality into the scale-up of FP/MNCH interventions and best practices. The approach draws heavily on the process for integrating gender equality into programs and policies—the steps of which include

    • Conduct gender assessments
    • Prepare for gender-integrated scale-up
    • Develop a gender-integrated scale-up strategy
    • Implement and monitor gender-integrated scale-up
    • Evaluate gender and health outcomes

  • The government of Cote d'Ivoire is committed to the fight to gain control and turn the tide of the HIV epidemic. Striving to offer the best standard of HIV treatment, the country aims to adopt the new 90-90-90 target. The country also plans to roll out “test and offer” for the general population in the near future and begin piloting Option B+ for pregnant women in 2015. Such an intense scale-up of HIV treatment services will require intensified coordination to mobilize resources and effectively target those funds for treatment scale-up and sustainability.

    The aim of this cost-outcome analysis study was to estimate the cost of HIV treatment scale-up and the impact of such an expansion by estimating the cost of treatment for one person per year for adults, children, and pregnant women. Currently, limited data exist around the unit cost of HIV treatment in Cote d’Ivoire. To inform policy decisions on how best to finance scale-up of treatment with the limited resources available, understanding the outcome of HIV treatment—and the levers for improving the chances of successful treatment—is critical.

    The study found that the cost of the full year of treatment expected by following the national treatment guideline would be CFA142,431 (US$288) for adults, CFA217,603 (US$440) for children, CFA85,063 (US$172) for PMTCT Option B, and CFA 151,827 (US$207) for PMTCT Option B+. A total investment of approximately CFA147 billion (US$297 million) is required over the next five years, leading up to the year 2020, to achieve the 90-90-90 target and a 100 percent roll-out of the Option B+ approach for the prevention of mother-to-child transmission (PMTCT). This investment will save more than 35,000 lives and prevent more than 6,000 children from becoming infected via PMTCT compared to the status quo, in which treatment coverage increases at the historical pace.

  • 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

  • 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.  

  • Developed by the USAID-funded Health Policy Project, the Integrating Gender into Scale-up Mapping Tool is designed to provide program managers with a methodology to systematically integrate gender into scale-up initiatives. The process begins with a gender-based analysis to identify factors that influence women’s and men’s experiences related to health and the best practice to be scaled up. The findings from the analysis are then used to inform development of a scale-up road map with a gender lens. The mapping tool enables the user to identify when gender-based constraints may arise during the scale-up process, and develop strategies to address constraints and opportunities to reduce gender inequality during scale-up. Lastly, the user will develop indicators to monitor both the scale-up process and the gender strategies incorporated into the scale-up process. At the end of the mapping exercise, the user will have a concrete plan outlining the gender barriers that may arise throughout the scale-up process, strategies for addressing these barriers, and indicators to monitor both the scale-up process and the gender strategies incorporated into the process.

    This tool features a gender analysis template and the Integrating Gender into Scale-up Mapping template. Illustrative examples for completing the mapping template are also provided. 

  • International initiatives, including the Millennium Development Goals, are increasingly recognizing that gender strongly influences the health outcomes of women, men, and children. Relevant literature indicates that the incorporation of strategies to address gender inequality can lead to improved health and program outcomes. Many donors and program implementers have begun to incorporate strategies and approaches that address gender barriers and constraints. However, it is not clear that regular attention is being paid to gender factors during program scale-up.

    The Health Policy Project (HPP) conducted a literature review to identify and analyze whether systematic attention to gender factors during the planning and process of scaling up family planning (FP) and maternal, neonatal, and child health (MNCH) programs improves the effectiveness of that process. This working paper focuses on efforts to scale up interventions in FP and MNCH in developing countries. It defines “scale-up” and describes some of the frameworks and approaches to scaling up found in recent health literature and how they address gender. The paper also reviews the experience of selected organizations in scaling up best practices and addressing gender. It identifies a number of lessons learned from scale-up initiatives and lists key recommendations for systematically integrating gender into the scale-up process.

    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

    The Policy Dimensions of Scaling Up Health Initiatives

  • 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.

  • 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.

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

  • At the Ouagadougou Partnership and Family Planning 2020 (FP2020) meetings, governments committed to improving access to family planning services and information. Costed Implementation Plans (CIPs) for family planning services and information provide a framework and tools for governments to achieve their international family planning commitments. This booklet, prepared by the Health Policy Project, highlights the methodology behind CIPs, walks through 10 steps for designing and implementing a national CIP for family planning, and shares experiences from seven African countries that have developed national CIPs for family planning to inform their decision making. It is estimated that implementation of the CIPs will accelerate each country's progress toward both achieving its target contraceptive prevalence rate and reducing maternal and child mortality.  

  • The Ethiopian Ministry of Health, in collaboration with the Health Policy Project (HPP), recently used the FamPlan model to measure the impact of increased family planning use on the number of infant and child deaths. The results showed that family planning uptake is associated with decreases in high-risk births and infant and child mortality and that faster gains in the contraceptive prevalence rate lead to more dramatic health improvements. This poster—presented at the 2013 International Conference on Family Planning in Addis Ababa, Ethiopia—describes the methodology and results of the model application.

  • 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.

  • 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