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.

2012

  • 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.

  • The Crosswalk of Family Planning Tools provides a comparison of 19 commonly used family planning costing, planning, and impact analysis tools. The Health Policy Project designed the guide to help advocates, program planners, decisionmakers, and others to (1) select which tool might best fit their goals or questions and (2) interpret the outputs of each tool. The guide contains information on each tool's overall goal; intended use; primary target audience; interventions included; unit costing approach (if applicable); and health, cost, economic, or demographic outputs. In addition, the guide compares the requirements for each tool related to data needs, training and skills, and usability.

    The guide is accompanied by a chart to use as a quick reference for general information and comparison. To print the chart, 11 x 17 paper is required and "fit to page" and "landscape orientation" must be selected under printer properties.

  • Effectively capturing and reporting discrimination data can help an organization or government administration gauge the level of discrimination in a country and ensure effective responses. However, there is currently no standard design for a discrimination monitoring and reporting system. In this report, the Health Policy Project brings together known international best practices; research on relevant, existing legal codes and systems in Ukraine; and information from consultations with key stakeholders to determine priorities and approaches for monitoring discrimination. The project also documents a process for defining the scope and scale of a potential system, which both incorporates these best practices as well as considers local needs, resources, and policy environments. The report serves as the beginning of a conversation on monitoring, reporting, and resolving cases of discrimination for vulnerable populations.

  • 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.

  • 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 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.

  • For a country to successfully achieve its family planning goals and targets, stakeholders must fully understand the investment needed to attain them. The Health Policy Project, in collaboration with Ghana's National Population Council, recently reviewed data on demographic patterns, family planning costs, and projected funding to inform an application of the GAP (Gather, Analyze, and Plan) Tool. The tool is designed to project the contraceptive, service provision, and program support funding gaps in a country to ultimately help policymakers, decisionmakers, and development partners understand the costs involved in reaching national family planning goals and addressing challenges to progress. This presentation and brief summarize the current policy environment in Ghana for family planning, the targets set by the National Population Policy, and the gap in current and estimated resources needed. These evidence-based advocacy materials aim to bolster financial and political support for the family planning program in Ghana.

    For more information on the GAP Tool, visit the Software and Models page of the Health Policy Project website.

  • The Health Policy Project assembled a technical team to facilitate a three-day workshop on integrating gender and gender-based violence (GBV) into HIV prevention and OVC programs for Mozambican organizations in Maputo in February 2012. The worshop applied five participatory and interactive modules to build the capacity of participants to use practical skills and tools to integrate GBV prevention and responses into existing HIV programs. The training methodologies sought to explicitly reveal the links between GBV and HIV risk and increase skills to integrate evidence-based gender and GBV practices into existing HIV programs. The workshop's results demonstrated the great interest in and need for GBV integration into current programs. They also informed the development of capacity-strengthening plans for each of the seven participating NGOs and provided a foundation for addressing gender and GBV in HIV programs for staff of the FHI-360 Capable Partners Program (CAP). 

  • 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

  • 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.

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

    These projections demonstrate the impact that rapid population growth can have on various sectors, such as education, health, agriculture and food security, environment and land use, and the labour force and employment.

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

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

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

  • For people living with and affected by HIV, stigma and discrimination within health facilities are serious barriers to healthcare access and engagement. Researchers have documented numerous instances worldwide of people living with HIV receiving substandard care or being deterred from seeking care. Although progress has been made in training and other interventions to reduce HIV-related stigma in healthcare facilities, these programs have not been institutionalized as routine practice or implemented on a large scale. Moreover, the tools for measuring stigma tend to be lengthy and time-consuming to administer, thus infeasible for use in facilities.

    To address these issues, an international team of researchers developed and piloted a brief, globally standardized questionnaire for measuring stigma and discrimination in health facilities. This tool can help facilitate routine monitoring of HIV-related stigma as well as the expansion and improvement of programming and policies at the health-facility level.

    Based on the pilot's findings, two final questionnaires are now available: a brief version for program evaluation and a comprehensive version for research purposes. Each questionnaire can be used for high-prevalence or low-prevalence settings.

  • “Population, Development, and Family Planning: The Urgency to Act” highlights the health benefits and cost savings associated with meeting all unmet need for family planning in nine francophone West African countries by 2030. If governments invested in meeting family planning needs, an estimated 500,000 infant deaths and 7,400 maternal deaths could be averted over the next decade. Similarly, if the nine governments invested US$84 million in family planning services over the next decade, they would save $195 million needed for programs to reach the Millennium Development Goals by 2020. In other words, for every dollar invested in family planning programs, governments could save US$2.30 in reduced expenditures for maternal health, malaria, immunization, education and water and sanitation programs.

    Dr. Johanna Austin Lucinda Benjamin, Director of Primary Health Care and Disease Control of the West African Health Organization, presented these findings at the West Africa regional conference on Population, Development and Family Planning, held in Ougadougou, Burkina Faso, on February 8–11, 2011.

  • The Policy Analysis and Advocacy Decision Model for Services for People Who Inject Drugs (PWID) is a collection of tools designed by the USAID-funded Health Policy Project and the Eurasian Harm Reduction Network to help stakeholders create an inventory of country policies, analyze these policies against international best practices and human rights frameworks, assess policy implementation, and create a strategic advocacy plan. The primary goal of the model is to identify the policies that most directly affect access to and sustainability of key PWID services and the needs and opportunities for policy advocacy that will improve access to services, even while larger, long-term human rights policies remain deficient.

    The Decision Model is intended for global application but includes special attention to the policy issues facing Eastern Europe and Central Asia. Stakeholders can use the tools to identify restrictive, poorly written, and absent policies that impact the access to and sustainability of key services for PWID including HIV counseling and testing, antiretroviral therapy, hepatitis and tuberculosis services, opioid substitution therapy, and needle and syringe programs. These services are analyzed within the settings of community-based programs, pre-trial detention, prison, and institutions that have custody of minors. The policy areas under consideration are extensive, with more than 1,300 policy points for analysis. Policy areas include service coordination; data use and decisionmaking; participation of PWID in decisionmaking, service delivery and evaluation; consent; personal data; stigma and discrimination; criminal sanctions; gender-based violence; human rights; procurement and supply management; eligibility; funding; and service delivery protocols.

    A companion decision model geared specifically toward males who have sex with males, transgender people, and sex workers (Policy Analysis and Advocacy Decision Model for HIV-Related Services: Males Who Have Sex with Males, Transgender People, and Sex Workers) is also available. 

  • HIV, hepatitis A, hepatitis C, and syphilis are all transfusion-transmissible infections that can arise from the use of unscreened blood. In collaboration with Kenya's National Blood Transfusion Services (NBTS), the Health Policy Project examined the current status of blood screening in Kenya and two key steps that could help reduce the risk of transmissible infections. Relevant research questions revealed that Kenya, like other sub-Saharan African countries, needs to completely screen, in both facilities and donation centers, the blood of all family replacement donors as well as voluntary donors. It also needs to increase the total supply of screened blood to meet the needs of a growing population. This brief summarizes the analysis conducted, presents the cost-benefit results of completely screening the existing blood supply (in terms of infections averted), and outlines cost-efficient steps for increasing the total screened blood supply.

  • 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.

  • Maternal deaths and infant HIV infections continue despite improved regimens for maternal health and prevention of mother-to-child transmission (PMTCT) and increases in PMTCT services. Service uptake and retention drop off significantly at each step in the PMTCT cascade. Key social factors limiting the successful completion of the cascade are stigma and discrimination. The Health Policy Project conducted a comprehensive literature review to examine the current evidence on stigma and discrimination and their negative impact on PMTCT, as well as the potential benefits of integrating PMTCT into antenatal care (ANC) and maternal, neonatal, and child health (MNCH) services.

    Substantial evidence indicates that stigma and discrimination affect (1) initial use of ANC services, (2) uptake of HIV testing during ANC, (3) initial participation in programs for PMTCT and HIV care, (4) use of skilled delivery services, (5) adherence to recommended infant feeding practices, (6) participation in early infant diagnosis, and (7) retention in and adherence to these programs during and after pregnancy.

    It will be impossible to reduce HIV-related maternal mortality without lowering the barriers of stigma and discrimination. Integrating maternal health and HIV services may not be enough to overcome social barriers that keep women, partners, and infants from fully accessing health services. Alongside important modifications to make clinical services more effective, convenient, and accessible for pregnant women and families; PMTCT, maternal, neonatal, and child health services must address HIV-related stigma and discrimination.

  • At the request of the Ghana AIDS Commission and other in-country stakeholders, the Health Policy Project (HPP) updated an analysis of the effects of various funding scenarios on program impact and HIV incidence and coverage. The project used the Goals Model to develop these scenarios, which were based on new fiscal realities and provided stakeholders with information to revise a proposal to the Global Fund to Fight AIDS, Malaria and Tuberculosis. HPP’s Goals Model helps countries respond to the HIV epidemic by showing how the amount and allocation of funding is related to the achievement of national goals, such as the reduction in HIV prevalence and expansion of care and support. The information from this analysis will continue to guide ongoing decision making and planning in Ghana regarding the country's HIV treatment, care, and support programs.

  • 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

  • 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.