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Browse Health Policy Project (2010-2016) Materials

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2016

  • In this brief, the USAID- and PEPFAR-funded Health Policy Project (HPP) offers analysis on the GOT’s tax revenue collection prospects and explores tax reforms that the GOT may implement in the future. Growth in tax revenue has been linked with countries’ progress on universal health coverage (UHC), especially in countries with low tax bases (Reeves et al., 2015). In Tanzania, the HSSP IV and HFS both identify tax reform as an important mechanism to raise the total allocation to health, and reduce the resource gap in the health sector. As has been experienced in other countries, earmarked tax revenues, from a growing overall tax base, can help secure financing for health. This brief also investigates the process by which Tanzania’s Ministry of Labor (MOL) and the Ministry of Infrastructure and Communication (MOIC) were able establish tax “set-asides” for programs in their sectors, and whether it is feasible for something similar to be done for the MOHCDGEC that would pool tax revenue specifically for health and HIV and AIDS. For example, such a set-aside was accomplished in Zimbabwe with the AIDS Levy, introduced in 1999, which is charged on individuals, companies, and trusts at a rate of 3% of taxable income or profits. This revenue, estimated at US$157 million collected over 2009-2014 (Kutyauripo, 2015), is allocated to the National AIDS Trust Fund in Zimbabwe to be managed and disbursed for HIV programming, including 50% for antiretrovirals (ART).  

  • In 2015, in order to examine the implications for key populations of reduced donor funding in Bangladesh and to provide guidance for future transitions, the USAID- and PEPFAR-funded Health Policy Project (HPP) conducted a desk review and 20 key informant interviews with civil society, local government, and international donors. The resulting case study offers lessons learned on how donors can ensure the resiliency of HIV programming for key populations while undergoing funding transitions.

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

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

  • The USAID- and PEPFAR-funded Health Policy Project (HPP) conducted a budget analysis to examine the GOT’s final FY 2015/16 health sector budget. HPP’s analysis examined the trends in budget allocations for health, patterns of distribution, and funding sources. Findings from this analysis may be used to advocate for efficient and effective budget allocations for HIV and essential medicines, and can be shared with key stakeholders, including decisionmakers from the Ministry of Health and Social Welfare (MOHSW), the National AIDS Control Program (NACP), TACAIDS, national- and district-level elected leaders, the media, and the public.

  • As donor budgets for HIV have flat-lined, funding for HIV services and programming has decreased, particularly in countries with higher income status and concentrated HIV epidemics. To examine the impact of recent or ongoing PEPFAR funding transitions on key populations, the USAID- and PEPFAR-funded Health Policy Project (HPP) hosted a global consultation with key population civil society networks and developed case studies on PEPFAR’s transitions in four countries: Bangladesh, Botswana, China, and Guyana. The case studies offers lessons learned on how donors can ensure the resiliency of HIV programming for key populations while undergoing funding transitions.

    In addition, HPP developed the Readiness Assessment: Moving Toward a Country-led and –financed HIV Response for Key Populations. This guide is designed to assess the ability of a country’s stakeholders (including government, development partners, and civil society) to lead and sustain HIV epidemic control among key populations as donors transition to different levels and types of funding. The guide is a flexible tool that assesses readiness across four domains and focuses on the specific vulnerabilities of key populations.

  • The Kenya AIDS Strategic Framework 2014/15–2018/19 (KASF) is the overarching strategic document guiding the HIV response in Kenya’s devolved governance system. The implementation of KASF goals will contribute to the achievement of Vision 2030 targets by ensuring universal access to comprehensive HIV prevention, treatment, and care. Kenya has also committed to reaching UNAIDS’ ambitious 90-90-90 targets by 2019. These targets call for 90 percent of all people living with HIV (PLHIV) to know their status, 90 percent of those diagnosed to be on antiretroviral therapy (ART), and 90 percent of people on ART to be virally suppressed. Several resource gaps for HIV programs have been estimated in the past. This brief attempts to harmonize the methodologies used in estimating HIV commodity gaps in the past. To do so, major stakeholders (Clinton Health Access Initiative, National AIDS & STI Control Programme, and National AIDS Control Council) were consulted in arriving at the assumption and targets used in the resource-gap estimation model. In this model, two scenarios are considered: financial needs for key commodities under the current guidelines, and a more ambitious “scale-up” scenario. In addition to harmonizing the way Kenya estimates HIV commodities gaps, the model will also support the mobilization of resources toward attaining the 90-90-90 targets.

  • As part of the USAID-led PEPFAR Sustainable Financing Initiative to increase domestic resources for HIV, the USAID- and PEPFAR-funded Health Policy Project created 31 macro-fiscal and health financing profiles for 18 countries that are transitioning to a higher income status, have high HIV burdens, and/or rely heavily on donor funding. These country profiles assess past trends and future projections in key indicators related to a country's ability to grow economically and dedicate more financial resources to health, including HIV.

    The macro-fiscal profiles provide overviews of each country's economic growth, political economy, and government revenue and expenditure. The health financing profiles analyze government, external, and out-of-pocket spending on health; health financing functions, including revenue contribution and collection, pooling, and purchasing; and HIV financing trends.

    You may download individual briefs on this page.

  • This two-day training was adapted from the USAID- and PEPFAR-funded Health Policy Project’s 2013 document, Understanding and Challenging HIV and Key Population Stigma and Discrimination: Caribbean Facilitator's Guide. The overall training objectives are

    1. To foster an understanding of how stigma and discrimination towards men who have sex with men and other key populations affects the HIV epidemic
    2. To increase understanding of the different identities of sexual minorities
    3. To increase understanding of how stigma and discrimination towards men who have sex with men impedes access to health services

  • In 2010, Kenya adopted a new constitution which both guaranteed the right to health and devolved health service delivery to Kenya’s 47 counties. A few years later, in 2014, counties became responsible for delivering health services. Although funding to support service delivery has also been devolved to the counties, it remains inadequate for county health needs, forcing the health sector to compete with other priority sectors for scarce resources.

    To help County Departments of Health secure greater allocations for the health sector, this how-to guide provides a summary of each of the main stages of the budget cycle and key milestones, suggests actions that county leaders can take during the budget process to influence county budgets, and highlights some of the potential bottlenecks at each stage. 

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

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

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

  • This USAID- and PEPFAR-funded Health Policy Project report synthesizes the findings of the County Health Accounts (CHAs) of 12 selected counties for financial years (FY) 2013/14 and 2014/15. The 12 counties are Bomet, Isiolo, Kakamega, Kisumu, Makueni, Migori, Mombasa, Nairobi, Nyeri, Siaya, Tharaka Nithi, and Turkana. The report compares health expenditures in the 12 counties to provide evidence of a pattern for sources and uses of health funds. It pays special attention to key financing sources for healthcare, the role of financing agents in managing healthcare funds, providers of healthcare goods and services, and the services purchased with these funds.

  • As part of its aim to deliver “the right thing at the right place at the right time,” in 2015 PEPFAR implemented a strategic pivot in the alignment of its resources in Tanzania. This pivot shifts the focus to high-volume and high-burden sites and districts, diverting resources from generalized, country-wide responses to focused geographic areas and key populations. As a result, districts and facilities with low HIV burden and low yield are experiencing a reduction in support from PEPFAR beginning at the start of the 2015/16 fiscal year. While the pivot aims to accelerate scale-up of antiretroviral therapy (ART) by prioritizing high-prevalence and high-yield populations, additional ART scale-up will be required in non-priority districts in order to reach national treatment targets that are now more ambitious.

    It is important that the Government of Tanzania (GoT), local government authorities, PEPFAR, and other partners understand the extent to which continued scale-up will be required in non-priority districts to achieve both the UNAIDS’s 90-90-90 goal in Tanzania as well as national ART targets based on adoption of “test and offer” guidelines. This brief aims to define the geographic and programmatic shifts under the PEPFAR pivot, identify activities that may face a reduction in PEPFAR support and require alternative sources of funding to support continued scale up, and clarify future scale-up targets in non-PEPFAR priority districts.

  • The USAID- and PEPFAR-funded Health Policy Project (HPP) conducted this analysis to explore the current status of benefit packages and the feasibility of incorporating HIV services, including ART, into insurance schemes in Tanzania. We used structured interviews of insurance providers to collect qualitative data and also gathered secondary data from insurers and other sources to provide a basis for profiling different schemes and insurers. Our main objectives were to understand what services and benefits are currently being covered and what barriers prevent insurers from including HIV services within benefit packages, and to offer conclusions on the plausibility of financing HIV services through health insurance in Tanzania. Unlike previous studies, which looked only at the private insurance sector, this analysis also includes schemes managed by the National Health Insurance Fund (NHIF) as well as a micro-insurance provider.

  • As global leaders look more critically at how to simultaneously advance women’s health and rights, particularly in light of the Sustainable Development Goals, it is important to examine where the momentum for respectful maternity care has led thus far, lessons learned in the process, and essential components that must be prioritized moving forward. This USAID-funded Health Policy Project and White Ribbon Alliance policy brief – informed by program documents, global and national policies, and interviews with key stakeholders who have worked for years to advance attention to this issue – seeks to review progress and provide recommendations for advancing maternity care that places women at the center. 

  • This USAID-funded Health Policy Project presentation aims to raise awareness about the impacts of rapid population growth on Mozambique's socioeconomic development. It includes projections of population growth from 2015–2040 based on three hypothetical fertility scenarios: high fertility (5.9 children per woman, or status quo based on a 2011 baseline figure), medium fertility (4.5), and low fertility (3.0). Continued high-fertility growth will increase the pressure on Mozambique’s health, education, economic, and agricultural sectors to meet the population’s demand for basic needs. However, slowing population growth through increased use of family planning will allow the country to invest more in long-term measures to improve the quality of health services, guarantee universal education, expand employment opportunities, and attain food security. If strategically implemented, these measures could catalyze progress toward a healthier, more prosperous country.

  • To understand programmatic challenges, promising practices, and potential solutions related to pediatric HIV in Tanzania, HPP conducted interviews with the NACP and two PEPFAR implementing partners that receive the majority of Tanzania’s ACT funding. Interviews addressed issues across the pediatric treatment cascade (see Figure 1). Interviewees identified overarching challenges, including the short implementation timeline under ACT (two years), insufficient financial resources for pediatric care and treatment, limited health worker capacity, supply chain weaknesses, lack of community and other linkages, and poor monitoring and data use. Many of the challenges reported in Tanzania are also seen in Kenya, where a more detailed qualitative analysis was under

  • About one-in-four Malawian women of reproductive age have an unmet need for family planning. The 2010 Demographic and Health Survey found that 26 percent of all births in the preceding five years had been unwanted and that an additional 19 percent were mistimed, indicating that nearly half of all women in Malawi are not adequately meeting their reproductive intentions. Unwanted and mistimed pregnancies contribute substantially to high maternal mortality and increase the strain on already limited resources for health, education, natural resources, and food security.

    With over 97 percent of Malawians belonging to an organized religion, faith leaders could be an important conduit of social change. In 2013, to support the Ministry of Economic Planning and Development’s strategy to raise awareness about population and development issues, HPP engaged  Malawi’s six major religious institutions (known locally as “mother bodies”)—the Episcopal Conference of Malawi, Evangelical Association of Malawi, Malawi Council of Churches, Muslim Association of Malawi, Seventh Day Adventists, and Quadria Muslim Association of Malawi—and their local faith leaders. HPP organized training and sensitization meetings with over 1000 faith leaders, to help them speak openly about population and family planning issues. After one year, Episcopal Conference of Malawi (ECM), the governing body of the Catholic Church in Malawi, decided they wanted to further institutionalize these activities and messages. They requested HPP’s assistance with drafting a booklet on family planning for use by Catholic marriage counselors. The booklet, which is available in both English and Chichewa, provides counselors with an introduction to population and development issues, as well as basic information on medical and natural family planning methods. 

  • Stigma and discrimination (S&D) remain critical barriers to achieving HIV prevention, care, and treatment targets, including zero new HIV infections and zero AIDS-related deaths. In Jamaica and elsewhere in the Caribbean, S&D falls hardest on key populations, including men who have sex with men (MSM) and sex workers (SW) and undermines access to testing and treatment.

    The Key Population Challenge Fund (KPCF) project aimed to improve the quality of and access to stigma-free HIV testing and counseling (HTC) services for key populations. Through this initiative, the Health Policy Projected (HPP) implemented a stigma-reduction toolkit for facility-based healthcare providers. Project outcomes included cultivating an enabling environment for key populations and the development of facility-level codes of conduct.

  • In the past decade, PEPFAR has committed significant technical and financial resources to the fight against HIV, working with local partners in target countries to promote prevention programs, increase the number of patients receiving ART, and strengthen national coordination and monitoring of programs. As donor funding stagnates and developing economies grow, it is critical to identify long-term, sustainable sources of domestic funding for HIV to maintain and build upon the successes achieved by low- and middle-income-countries in partnership with PEPFAR.

    As part of PEPFAR’s Sustainable Financing Initiative to increase domestic resource for HIV, HPP created a baseline assessment of the current state of HIV financing in Uganda against which future achievements in domestic resource mobilization can be measured. The assessment analyzes current resource commitments against projected need, estimates future domestic resource needs, and examines efficiency and equity in the use of funds.

  • In the past decade, the President’s Emergency Plan for AIDS Relief (PEPFAR) has committed significant technical and financial resources to the fight against HIV, working with local partners in target countries to promote prevention programs, increase the number of patients receiving antiretroviral therapy (ART), and strengthen national coordination and monitoring of programs. As donor funding stagnates and developing economies grow, it is critical to identify long-term, sustainable sources of domestic funding for HIV to maintain and build upon the successes achieved by low- and middle-income-countries in partnership with PEPFAR.

    As part of PEPFAR’s Sustainable Financing Initiative to increase domestic resource for HIV, the Health Policy Project (HPP) has created a baseline assessment of the current state of HIV financing in Zambia against which future achievements in domestic resource mobilization can be measured. The assessment analyzes current resource commitments from all sources, both domestic and external, against projected resource need under UNAIDS’ 90-90-90 target, to determine future need for new domestic resources in each country, as well examines efficiency and equity in the use of funds, with the goal of maximizing the impact of financial commitments.