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2013

  • Developed with support from the USAID-funded Health Policy Project, A Guide for Advocating for Respectful Maternity Care is a comprehensive resource centered on the Respectful Maternity Care charter, a groundbreaking consensus document that demonstrates the legitimate place of maternal health rights within the broader context of human rights. Written for national-level advocates, this guide presents a variety of ways to (1) build a sense of entitlement among women and communities regarding respectful maternity care (RMC) and (2) advocate for the institutionalization of RMC as a core value of the maternal care system. Specifically, the guide provides information and user-friendly tools and techniques to help advocates

    • Raise awareness and generate demand from civil society for RMC rights;
    • Mobilize communities to hold local leaders and service providers accountable for RMC rights; and
    • Secure commitment at the national level to institutionalize RMC as the standard of care.

    Also available for download as individual documents are the charter, titled Respectful Maternity Care: The Universal Rights of Childbearing Women, and accompanying brochure and poster (in English, Arabic, French, and Spanish).

  • Civil society organizations (CSOs) can make an important contribution to health programs and public welfare by encouraging governments to involve citizens and technical specialists in identifying and addressing important human needs. Good governance exists when decisionmakers are accountable to the public; processes are transparent; institutions and information are directly accessible; and the government is able to serve the needs of its people effectively. The Health Policy Project prepared this brief to provide leaders of CSOs working in family planning, HIV care and treatment, and maternal health with guidance on ensuring good governance, social accountability, and transparency.

    This is one of two briefs focused on advancing country ownership for improved health. The other brief can be accessed here: Networking and Coalition Building for Health Advocacy: Advancing Country Ownership.

  • Over the past decade, large scale global health initiatives have had great successes in supporting improved health outcomes in many countries. Each country is unique in building its approach to public health programming, but these partnerships are beginning to identify common principles toward working together. In fall 2012, a consultation cosponsored by amfAR, the Health Policy Project (HPP), International Planned Parenthood Federation (IPPF) Africa Region, and Planned Parenthood Global brought together multi-disciplinary stakeholders to identify priorities and models for ensuring civil society engagement in health decision making. This report presents the findings of the consultation, examines civil society’s role in sustaining public health and transitioning to the country ownership model, and offers recommendations for civil society, governments, donors, and international development partners.

  • 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.  

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

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

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

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

  • 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.

  • 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

  • In December 2012, the Health Policy Project (HPP) supported the ARC Coalition to bring together 20 consortium members and project partners to develop a common advocacy plan. Facilitators from HPP and the Advance Planning Project led the process by building focus, commitment, and consensus among consortium partners on a common advocacy issue. At the end of two days, the consortium members had identified key areas for policy advocacy that have the highest probability of success for ARC in the next year, identified the relevant key stakeholders, and began to develop action plans. Within the broader goal of contraceptive choices being expanded, the key areas identified included expanding the mix of spacing methods and increasing access to current methods of spacing.

  • Costed Implementation Plans (CIPs) are concrete, detailed plans for achieving the goals of a national family planning program over a set number of years. A CIP details the program activities necessary to meet the goals and the costs associated with those activities, thereby providing clear program-level information on the resources a country must raise both domestically and from donors. The Health Policy Project, with various partners, has developed a collaborative, 10-step approach to creating a CIP that aligns with ongoing government planning and coordination efforts. This brief outlines these 10 steps, which when implemented, should result in a consensus-driven strategy, roadmap, and budget for achieving family planning targets under the Ouagadougou Partnership, FP2020, and/or other national programs. To date, the following countries have completed CIPs for family planning: Senegal, Burkina Faso, Niger, Togo, Mauritania, Guinea, and Zambia.

  • Knowledge of HIV status is essential for achieving universal access to HIV services. As such, HIV testing and counseling (HTC) are fundamental elements of all HIV prevention, care, and treatment programs. As the need for HTC expands in Kenya and resources dwindle, the efficiency and effectiveness of HIV spending is of utmost importance. One method to reduce HTC costs involves re-working the testing algorithm. The Health Policy Project (HPP) was invited by the National AIDS and STI Control Programme (NASCOP) to help conduct an analysis, whereby incremental costs, defined as the costs in addition to that of the current algorithm, were calculated for three newly proposed algorithms. Based on the results of this analysis, which highlights the cost savings of each option, a recommendation for a more cost-efficient algorithm was proposed.

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

    You may download individual fact sheets on this page.

  • 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.

  • The public health community increasingly recognizes the importance of incorporating strategies to address gender equality in programs to improve health outcomes for women, men, and children. To strengthen gender integration efforts in the island nation of Timor-Leste, the Gender, Policy, and Measurement (GPM) program, funded by the USAID Asia and Middle East (A/ME) Bureaus, undertook a gender assessment. The GPM program is implemented by the Health Policy Project and MEASURE Evaluation. The assessment aimed to discover the normative, socioeconomic, and political variables that impede or facilitate utilization of health services in Timor-Leste. This analysis can be used by donors and implementing organizations to incorporate gender into the formulation, implementation, and evaluation of family planning and maternal, neonatal and child health programs.

  • A lack of comprehensive knowledge about HIV/AIDS and sexual reproductive health (SRH), financial insecurity, gender-based violence, and other risk factors can leave students of higher education institutions (HEIs), especially women, more vulnerable to HIV infection. It is therefore important to consider the specific needs of this population group when designing and implementing HIV interventions. In Ethiopia, the Health Policy Project (HPP) is supporting the Federal HIV/AIDS Prevention and Control Office and HEIs to prioritize and target HIV interventions in HEI settings. As part of this effort, HPP assisted the government's HEI Partnership sub-Forum against HIV/AIDS with developing a Planning, Monitoring, and Evaluation Framework for HIV/AIDS and SRH interventions in HEIs. Establishing a standardized system for planning, monitoring, and evaluating interventions will facilitate the generation and use of high-quality program-related data to inform decision making, thus helping to boost program effectiveness. Training and implementation of the framework has begun, and the next step will be to evaluate its effectiveness and standardization across HEIs in Ethiopia.

  • ImpactNOW, a new family planning advocacy model, generates evidence to make the case for immediate FP investments by modeling gains in maternal and child deaths averted, unintended pregnancies, and financial savings to the healthcare system as a result of FP uptake. ImpactNOW is currently being pilot-tested in Ethiopia's Amhara Region. On August 27, 2013, the Health Policy Project held a one-day stakeholders meeting to introduce ImpactNOW, provide a live demonstration of the model, and obtain feedback and impressions of it from family planning stakeholders, advocates, and policymakers. Stakeholders included representatives from the Amhara Regional Health Bureau (ARHB), the Regional Finance and Economic Development Bureau (BoFED), university partners, and nongovernmental organizations. Their primary focus in applying ImpactNOW will be the linkage between FP uptake and maternal and child deaths.

  • 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.

  • In 2013, the Health Policy Project conducted a series of trainings for government leaders, local media, and other stakeholders in Jordan. The effort aimed to highlight the importance of policy in strengthening family planning programs to advance the health of Jordanians. The first workshop focused on HPP's policy framework, which links family planning policy to health outcomes. The team

    • Presented global initiatives that affect family planning and discussed how they relate to Jordan
    • Presented new advances in health policy analysis—linking health policy, health systems, and health outcomes
    • Discussed policy analysis, from problem identification to impact assessment
    • Built capacity for policy
    • Discussed FP policy issues in Jordan, including barriers to FP

    The second workshop, held at the request of Jordan's Higher Population Council, focused on examining the framework in the context of the country's Demographic Opportunity Policy. Challenges and recommendations in meeting the goals of the policy were discussed, followed by the identification of which aspects of the framework could be applied to help implement those recommendations. The next step is to identify the appropriate authority to ensure implementation and coordination of follow-up efforts.

  • To improve FP services and availability in Jordan, the Higher Population Council (HPC), with support from the Health Policy Project and in cooperation with all stakeholders, developed the National Reproductive Health/Family Planning Strategy 2013–2017. The strategy assesses the reproductive health (RH)/family planning (FP) environment in Jordan and describes the interventions required to improve RH/FP services and use and ultimately achieve the goals of the Demographic Opportunity Policy.

    This brief summarizes the three main challenges to Jordan’s FP program—policy, access, and beliefs and behaviors—and outlines the interventions planned to address them.

  • Energy is extremely expensive in Jordan, and 97 percent of all energy used in Jordan is imported. Energy costs are equivalent to nearly 21 percent of the total annual gross domestic product; energy costs are equivalent to 32 percent of the value of all annual imports; and energy costs are equivalent to the value of 83 percent of all exports. As the population grows, so will the consumption of energy, and consequently, the expenses to provide the amount of energy required in the future. If Jordan is to meet its future needs for energy, it must address multiple issues, including the scarcity of local oil, rising prices of oil in the international market, critical and serious supply-demand imbalances, costly new sources (infrastructure and operating), and the increasing pressure on resources from changes in population, development, and lifestyles. Resolving these issues will take a concerted effort and commitment from the government and the people of Jordan; and each of these issues needs to be addressed in multiple and different ways. One of the least expensive approaches that can be taken immediately, and is the underlying theme of this presentation, is to reduce population growth. 

    This RAPID presentation, developed by the Health Policy Project in collaboration with the Jordan Higher Population Council, demonstrates that future population growth will directly affect the ability of Jordan to provide sufficient energy resources. While reducing population growth will not be sufficient in eliminating all of the energy issues facing the country, it is a necessary step that needs to be taken in combination with many others if Jordan is to successfully resolve its pressing energy situation.

  • Jordan’s continued economic development and concomitant population growth is putting increased pressure on natural resources and the environment. Over the past 40+ years, the gap between the ecological footprint and the local capacity has grown, and this deficit has largely been made up for by importing goods, especially food and energy, from abroad.

    Productive land in Jordan is limited. Only 11 percent of the total land area can be considered agricultural land---of which less than 2 percent is arable; the rest is ranges and forests. As population size increases, so does the need for more land to produce food and build houses, businesses, recreation areas, schools and health facilities, roads, and mosques, as well as other supporting uses.

    This RAPID presentation, developed by the Health Policy Project in collaboration with Jordan's Higher Population Council, demonstrates that future population growth will directly affect the use of land in Jordan. While reducing population growth will not be sufficient in eliminating all the pressures being placed on the land, it is a necessary step that needs to be taken in combination with many others if Jordan is to successfully resolve its pressing land use situation.

  • 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.  

  • Networks and coalitions can be effective in mobilizing political will, influencing policy and financing, and strengthening health programs. By sharing resources and workload, networks and coalitions can take advantage of their members' capabilities and skills to plan and implement joint advocacy campaigns, present a unified front, and make collective demands to government. The Health Policy Project prepared this brief to provide leaders of civil society organizations with guidance on working within networks and coalitions to advocate for improved family planning, HIV care and treatment, and maternal health policies and programs.

    This is one of two briefs focused on advancing country ownership for improved health. The other brief can be accessed here: Accountability and Transparency for Public Health Policy: Advancing Country Ownership.

  • 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. 

  • Males who have sex with males (MSM), transgender (TG) people, and sex workers (SWs) are at higher risk for HIV transmission than other individuals, even in generalized epidemics. Structural and policy issues have created barriers for MSM/TG/SWs in seeking services and adopting individual and community harm reduction strategies. Published by the Health Policy Project and the African Men for Sexual Health and Rights (AMSHeR), with support from the United States Agency for International Development (USAID) and US President’s Emergency Plan for AIDS Relief (PEPFAR), the Policy Analysis and Advocacy Decision Model for HIV-Related Services: Males Who Have Sex with Males, Transgender People, and Sex Workers is a collection of tools that helps users assess and address policy barriers that restrict access to HIV-related services for MSM/TG/SWs.

    Designed to help country stakeholders build a public policy foundation that supports access to and implementation and scale-up of evidence-informed services for MSM/TG/SWs, the Decision Model helps to clearly identify and address policy barriers to services. Its policy inventory and analysis tools draw from the extensive body of international laws, agreements, standards, and best practices related to MSM/TG/SW services, allowing the assessment of a specific country policy environment in relation to these standards. This customizable, in-depth, and standardized approach will build stakeholders’ capacity to identify incremental, feasible, near-term opportunities to improve the legal environment and the resulting quality of and access to services for MSM/TG/SWs while long-term human rights strategies are implemented.

    A companion decision model geared specifically toward people who inject drugs (Policy Analysis and Advocacy Decision Model for HIV-Related Services: People Who Inject Drugs) is also available in English and Russian. 

  • This USAID-funded assessment, conducted in Togo, is the second country application of the Health Policy Project (HPP) and African Men for Sexual Health and Rights (AMSHeR) Policy Analysis and Advocacy Decision Model for HIV-Related Services: Males Who Have Sex with Males, Transgender People, and Sex Workers (Beardsley et al., 2013). The current application of the Decision Model in Togo complements the pilot application conducted in 2012 in Burkina Faso. It was designed as an in-depth policy analysis of the legal, regulatory, and policy environment related to sex workers (SW), men who have sex with men (MSM), and prison populations in Togo to uncover gaps in policy and practical challenges to policy implementation. Beginning in June 2013, the HPP principal investigator, a legal expert from AMSHeR, and a team of local consultants conducted a document review and assessment. The team collected an inventory of 116 source policy and program documents and previous policy and program research related to HIV and/or key populations. Upon completion of the inventory, the team conducted 21 key informant interviews to examine the policy environment and assess dissemination and implementation of current policies, particularly gaps in dissemination and implementation that pose barriers to service access for key populations. The HPP policy analysis and key informant interviews confirmed that positive changes related to HIV prevention, care, and treatment are occurring in Togo. Initial steps are being taken to develop policies that recognize key populations and aim to improve access to services for them. Significant opportunities exist to further progress, including the USAID-funded Regional Project for the Prevention and Care of HIV/AIDS in West Africa (PACTE-VIH) and open support from the president of Togo and the permanent secretary for the National AIDS Council. However, critical gaps in policy, dissemination, and implementation remain and are highlighted in this report.

    Read the brief on this topic.

  • This report describes two pilot technical assistance programs implemented by the USAID-funded Health Policy Project to strengthen policy development and implementation related to contraceptive security at decentralized levels in Peru and the Dominican Republic. Over a two-year period, three regional and municipal committees engaged a multisectoral group of political leaders, technocrats, civil society representatives, and healthcare providers to collaboratively assess policy and funding barriers related to family planning and design and implement solutions. The compilation of experience and results is intended to inform programs to strengthen contraceptive security at the decentralized level in other settings, whether through committees or other mechanisms. As decentralization continues to evolve in Latin America and other regions, it is critical to strengthen subnational capacity in the public sector and civil society to ensure that high-quality and equitable services are demanded, delivered, and monitored at all levels of the health system in a manner that promotes sustainability and local ownership.

  • Like many sub-Saharan African countries, Kenya is exploring the adoption of the World Health Organization Option B+ strategy as the standard of care for its program to prevent mother-to-child transmission of HIV. The Health Policy Project (HPP) was invited by the National AIDS and STI Control Programme (NASCOP) to help conduct a cost-effectiveness analysis of scaling up Option B+ versus other strategies. Results of the analysis suggest that implementing a scale-up of Option B+ will avert infant and adult infections but at a significant additional cost. Kenya should consider these results to assess whether Option B+ is affordable given the available resources.

  • Since 2003, the U.S. Agency for International Development's Latin America and the Caribbean (LAC) Contraceptive Security (CS) Initiative has fostered country ownership through CS committees established in eight priority countries. Among the countries in the LAC region, Paraguay’s experience establishing and strengthening a national CS committee serves as a success story for the improvement of reproductive health indicators in a context of increased country ownership. This brief documents the steps taken to ensure that in less than a decade, the CS Committee in Paraguay successfully fostered an enabling policy environment that led to increased financing and political commitment to making contraceptive supplies more easily available.

    This brief is based on the following report (only available in Spanish): Sistemitización de la Experiencia del Comité DAIA Paraguay.

  • The Nepalese government has prioritized mainstreaming gender equality and social inclusion in the country’s health policies and programs in order to improve the quality of equal access to health services for all. In support of this goal, management of local health facilities was handed over to Health Facility Operation and Management Committees (HFOMCs) to increase the involvement of local communities in planning for the provision of high-quality health services. HFOMCs work to bridge the gap between communities and health providers and their guidelines require wide and inclusive community participation, especially of women and other disadvantaged groups. To strengthen the committees’ capacity to make health services more inclusive, the Gender Policy and Measurement Program (GPM), an activity of the Health Policy Project (HPP) and MEASURE Evaluation, has partnered with the Suaahara Project to design, implement, and evaluate a scalable intervention to overcome barriers to HFOMC participation for women and other disadvantaged groups. This intervention will ultimately strive to improve family planning and neonatal health outcomes among marginalized groups.

  • In Côte d'Ivoire (CdI), the Health Policy Project (HPP) supported national institutions to estimate the unit cost of HIV programs targeting key populations such as males who have sex with males and sex workers. This final report provides estimates for the cost of delivering HIV services to key populations in CdI as well as projections of how costs could change over time in varying scenarios of program scale-up and service packages. These results can be used by stakeholders at all levels of the country to better plan and budget for HIV service delivery.

  • Demographic pressures and lack of progress toward the Millennium Development Goals have encouraged countries in West Africa to "take a new look" at repositioning of family planning (RFP)---an initiative established to ensure that FP remains a priority for donors, policymakers, and service providers in sub-Saharan Africa. USAID requested that the Health Policy Project apply the newly developed "Framework for Monitoring and Evaluating Efforts to Reposition Family Planning" in Niger and Togo. The framework results represent a baseline that can subsequently be used to measure progress in RFP by country FP stakeholders. USAID also requested an assessment of policy barriers to community-based distribution of FP---the findings for which are included in this report. Niger’s family planning program has made considerable progress in the past five years. Signs of progress are a favorable policy environment, growing public support for family planning, and increased funding for contraceptive commodities. Family planning is provided free of charge and is included in the Minimum Package of Services that all public health facilities must provide. Still, challenges remain to meet unmet need for family planning, extend services to rural areas, and ensure that people have adequate information about contraceptive methods.

    To read the results of the application in Togo, view the report and brief, Repositioning Family Planning in Togo: A Baseline.

    Applications in six other countries (Benin, Burkina Faso, Guinea, Mali, Mauritania, and Senegal) were later conducted by Futures Group, with funding from the Hewlett Foundation. To access those reports and briefs, visit the Futures Group Publications webpage.

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  • Demographic pressures and lack of progress toward the Millennium Development Goals have encouraged countries in West Africa to "take a new look" at repositioning of family planning (RFP)---an initiative established to ensure that FP remains a priority for donors, policymakers, and service providers in sub-Saharan Africa. USAID requested that the Health Policy Project apply the newly developed "Framework for Monitoring and Evaluating Efforts to Reposition Family Planning" in Niger and Togo. The framework results represent a baseline that can subsequently be used to measure progress in RFP by country FP stakeholders. USAID also requested an assessment of policy barriers to community-based distribution of FP---the findings for which are included in this report. Although considerable progress has taken place in Togo in terms of RFP, much remains to be done. Efforts to date appear to have improved acceptance of FP and present opportunities for additional improvement.

    To read the results of the application in Niger, view the report and brief, Repositioning Family Planning in Niger: A Baseline.

    Applications in six other countries (Benin, Burkina Faso, Guinea, Mali, Mauritania, and Senegal) were later conducted by Futures Group, with funding from the Hewlett Foundation. To access those reports and briefs, visit the Futures Group Publications webpage.

     

  • This policy brief  highlights (1) the advocacy process used to generate increased funding commitments for  family planning and reproductive health (FP/RH) commodities in Uganda, (2) the steps needed to ensure that the allocated funds fully translate into procurement of FP commodities, and (3) how advocates can sustain the momentum over the coming years. The information can be used to guide advocates in sub-Saharan Africa on addressing critical issues in the financing of FP/RH.

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

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

  • La investigación tiene como objetivo principal analizar mediante cuadros y gráficos, el perfil socio demográfico, actitudes de las mujeres en edad fértil en el Perú, frente a la planificación familiar de acuerdo a su quintil de bienestar, así como la segmentación económica de las fuentes de métodos anticonceptivos, que permita la evaluación del programa de salud familiar.

  • La graduación de USAID fue un proceso planificado que permitió enfocar acciones hacia cuestiones estratégicas, sin embargo también se constituyó en una oportunidad de mejora y crecimiento que fue identificada por el gobierno de Paraguay y sustentada por su voluntad y compromiso político hacia la planificación familiar. Este documento recopila la experiencia del Comité para la Disponibilidad Asegurada de Insumos Anticonceptivos (DAIA) en Paraguay para comprender cómo su desempeño desembocó en resultados exitosos y describe cuáles fueron los factores clave y su interacción, para obtener tales resultados. Los logros alcanzados reforzaron la confianza de los integrantes del Comité DAIA y naturalmente trascendieron el ámbito de trabajo del mismo. Obteniendo el reconocimiento de las autoridades e incluso traspasando las fronteras, puesto que hoy en día el caso de Paraguay está considerado como un modelo para los demás países que impulsan la DAIA en la región.

    Un sumario de este informe en ingles, está disponible en: Promoting Country Ownership through Latin American Contraceptive Security Committees: Paraguay Case Study.

  • 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 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.

  • 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 presentation of the demographic dividend and implications for Nigeria and other sub-Saharan African countries was given at the 2nd Nigeria National Family Planning Conference in  Abuja, November 27-December 1, 2012. The demographic dividend is an opportunity for higher economic growth rates that occurs due to changes in the structure of a country’s population. In order for the dividend to be achieved, countries first have to open the “window of opportunity” by promoting demographic change. At the same time, they have to capitalize on the demographic opportunity through socioeconomic policies. The presentation reviews current demographic indicators for Nigeria, highlighting comparisons with other countries that have opened the window of opportunity and achieved the dividend, as well as presents some of the policy investments required now and in the future.

  • The Health Policy Project (HPP) in Jordan focuses on supporting national-level awareness raising, resource mobilization, and policy reform to improve the quality of and access to family planning and reproductive health (FP/RH) services. HPP supports the Higher Population Council (HPC), Ministry of Health (MOH), and other key stakeholders to create an enabling environment for FP/RH through improved multisectoral engagement and coordination, data use, and policy reform. A particular area of focus is healthy birth spacing. Nearly one third of all births in Jordan are spaced less than two years apart, and more than half are spaced less than three years apart. Statistics show that an interval between births shorter than 33 months lowers the chance of survival for the mother and child. The higher rates of maternal and child mortality and morbidity associated with short birth intervals create burdens for families and society as a whole. The practice of healthy birth spacing is increasing in Jordan, but not fast enough. Wide adoption of healthy birth spacing in Jordan will reduce neonatal, infant, child and maternal mortality; improve the health of mothers and their offspring; enhance the ability of fathers to care for their families; and make communities healthier and stronger. This package of materials present the research evidence for healthy birth spacing and suggest what Jordan can do in the spheres of policy, education, and health services to promote the practice.

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

  • As part of its overall effort to promote evidence-based policies, decision making, planning, and advocacy, the Health Policy Project has worked with the Ghana AIDS Commission (GAC) and other important  stakeholders to conduct a costing study of services to key populations in Ghana (males who have sex with males and female sex workers). This will ensure that Ghana has country-specific costing data available. The study team collected information from service providers at eight purposively selected facilities and from program managers at the regional and central levels. The costing data are now being used to update Ghana's Goals Model and for planning, budgeting, and decision-making purposes (e.g, in conjunction with the development of Global Fund proposals and development of operational plans and budgets). In addition, one of the purposes of analyzing unit costs is to understand what is driving costs and identify areas where there is potential to gain efficiencies and reduce costs without negative impacts on quality.

    The report does not include specific operational details on how each of these different levels may use study results for their individual planning, budgeting and resource mobilization, and/or allocation purposes. The accompanying Estimating the Unit Costs of Providing Key HIV Services to Female Sex Workers and Males Who Have Sex with Males in Ghana: A Data Use Guide summarizes key findings from the study and provides specific details on how study results may be best used to inform the evidence base for the Ghana HIV program.

  • As part of its overall effort to promote evidence-based policies, decision making, and planning and advocacy, the Health Policy Project has worked with the Ghana AIDS Commission (GAC) and other important stakeholders to conduct a costing study of services to prevent mother-to-child transmission of HIV. This will ensure that Ghana has country-specific costing data available. The study selected 14 sites within the country, including teaching, regional, and district hospitals providing PMTCT services. To understand differences in services being delivered at the community level, the study included three community-based health planning service sites and three maternity home sites. The study team interviewed two programmatic and finance staff at the 14 sites and central-level program managers and financial officers during data collection. The costing data are now being used to update Ghana's Goals Model and for planning, budgeting, and decision-making purposes (e.g., in conjunction with the development of Global Fund proposals).

    The report does not include specific operational details on how each of these different levels may use study results for their individual planning, budgeting and resource mobilization, and/or allocation purposes. The accompanying Estimating the Unit Costs of Providing HIV Prevention of Mother-to-Child Transmission Services in Ghana: A Data Use Guide summarizes key findings from the study and provides specific details on how study results may be best used to inform the evidence base for the Ghana PMTCT program.

  • 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.