Browse POLICY Project (1995-2006) Materials
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List entries are alphabetical by title and contain the title, abstract, language, and then the filename which is hyperlinked and will open in a new browser window. Many files are PDFs but some of the older ones are Word documents.
As HIV/AIDS has evolved from being viewed as a public health issue-to be dealt with primarily by doctors and scientific researchers-to being recognized as an epidemic that affects every aspect of a country's national and socioeconomic development, the need for strong commitment and leadership has become even more apparent. The need for strong leadership is acutely felt in low prevalence countries where there is still an opportunity to contain the spread of the epidemic. But for many reasons, isolating, defining, and measuring what "political commitment" really is has been difficult. This paper reflects on key questions surrounding political commitment and leadership in the HIV/AIDS arena. It begins with a review of what we know about political commitment today-why it matters, what its characteristics are, how it has been measured to date, and how it can be strengthened. The paper then turns attention to the multi-country pilot assessment study in Asia, reviewing common themes from the country studies, analyzing lessons learned, and providing concluding thoughts and recommendations for future study and action.
Political commitment and leadership are essential for creating an enabling environment that promotes the development and growth of appropriate, sustainable HIV/AIDS policies and programs. The need for strong leadership is acutely felt in low HIV prevalence countries where there is still an opportunity to contain the spread of the epidemic. However, “political commitment” is a term that is often used without a clear sense of what it means, how it affects programs, when it can be most effective, and how it can be strengthened by advocates and policymakers. Building on experience with monitoring national program efforts in the family planning/reproductive health, maternal health, and HIV/AIDS fields, the POLICY Project developed a questionnaire that assesses various aspects of political commitment. POLICY then worked with local counterparts to pilot test the questionnaire in four low-prevalence countries in Asia. The pilot studies show that the political commitment assessment guide can serve as a useful tool for helping HIV/AIDS advocates and policymakers analyze a country’s national political commitment and leadership for confronting HIV/AIDS. In-country researchers can use the assessment guide to tailor questions to their country’s unique context. Such research can lay the foundation for identifying areas of strength and weakness in the country’s HIV/AIDS program and highlighting areas for future advocacy and policy change efforts.
The volume presents information on the status of RCH financing in Rajasthan. It rests on the multifaceted research endeavor that encompassed: 1) a comprehensive literature review of health financing studies in India; 2) a detailed analysis of cost recovery through Medical Relief Societies; 3) an analysis of public sector health expenditure based on a review of government budget and expenditure reports at both the state and district levels; 4) an RCH expenditure and utilization survey of 1,100 households in the district of Udaipur, Rajasthan; and 5) an inventory of public and private sector health facilities for seven districts in Rajasthan; and provider interviews on time allocation at health facilities in Udaipur, Rajasthan.
Although user fees are increasingly being used in government health programs to alleviate the pressure on constrained budgets as demand for services increases, results in developing countries thus far have been mixed and concerns that fees reduce access to services among the poor have led to the promotion of fee exemption mechanisms. These exemptions, however, may not be an effective response because (1) informal fees and other costs associated with seeking and receiving services are not alleviated by most exemption mechanisms, and (2) exemption mechanisms are often poorly implemented. The low proportion of formal fees to total costs to the consumer and the unpredictable nature of informal fees may actually work against formal fee exemption mechanisms. Thus, it is important to assess whether these mechanisms alone hold promise for protecting access among the poor, or whether they need to be supplemented with other strategies. The objectives of this study were to: (1) survey actual costs to consumers for reproductive health (RH) care services including antenatal care (ANC), delivery care, family planning (FP), postabortion care (PAC), child healthcare, and reproductive tract infection (RTI) treatment; (2) review fee and waiver mechanisms; (3) assess the degree to which these mechanisms function as intended; (4) assess the degree to which residual costs to consumers (after accounting for fee exemptions) may constitute a barrier to these services; and (5) review current policies and practices on setting charges and collecting, retaining, and using fee revenue.
India Maternal Health User Fee Paper.Country Report.FINAL.doc
The IFPS Project sought to design, test, and expand innovative approaches for improving quality of and access to family planning and reproductive and child health services, particularly for women, rural populations, and other underserved groups. This document reviews lessons learned from this project to help policymakers and program planners improve RCH services in India or other countries.
For the first time in the country, four states have taken initiative on their own and formulated state specific population policies. Processes followed to prepare population policies varied from one state to another and also the strategies selected for achieving population stabilization within a stipulated time period within the broad framework of reproductive and child health programme. All the four states, Andhra Pradesh, Rajasthan, Madhya Pradesh and Uttar Pradesh, tried to set realistic objectives, integrate family planning services with maternal and child health services, encourage informed choice, address gender issues and decentralize the programme implementation to a large extent. Processes followed to formulate the policies largely included preparation of background papers, consultations with a wide range of stakeholders including women, adolescent, non-government organizations and private sector, discussions within the department of health and family welfare and with other development departments and involvement of political leaders and policy makers from the beginning in policy development. Given the involvement of diverse groups in consultative processes, building consensus is a difficult, cumbersome and time-consuming process. It is to the credit of these states who selected a difficult path of consultative processes and consensus building to formulate policies than the usually employed short cut method of producing a confidential document and getting it formally approved by the Cabinet and then announcing to the world the arrival of new era. More often than not, policies formulated without openness and broad consensus failed at implementation stages although policies formulated with consultation processes do not automatically guarantee success without implementation plans and follow up with the help of strengthened and effective monitoring systems. This paper illustrates the way UP Government has converted UP Population Policy into an implementation plan.
This report assesses how the Greater Involvement of People Living with HIV/AIDS (GIPA) Principle is being implemented in the ANE region. Five USAID Missions and 12 implementing agencies (IAs) in the region participated in the assessment, which was undertaken in May and June 2003 in Cambodia, India, Nepal, Philippines, and Viet Nam. The purpose of the assessment was to ascertain how Missions, IAs, and NGOs are incorporating GIPA principles into their organizations and into the programmatic work they support and implement. A self-administered questionnaire was completed by 23 respondents from Missions, IAs, and NGOs.
The document describes the goal and approach of the IFPS project in improving reproductive health services.
RAPID Booklet for Madhya Pradesh
User fees are gaining widespread use in government health programs as a means of alleviating pressure on constrained budgets as demand for services increases. Concerns that fees reduce access to services among the poor have led to the promotion of fee exemption mechanisms in order to protect those unable to pay for services. The exemptions, however, may not effectively ensure access among the poor because (1) informal fees and other costs associated with seeking and receiving services are not alleviated by most exemption mechanisms and (2) exemption mechanisms are poorly implemented. The low proportion of formal fees to total costs to the consumer and the unpredictable nature of informal fees and other costs of access may actually work against formal fee exemption mechanisms. Even though little is known about how well fee and waiver mechanisms function for maternal health services, it is important to understand whether exemption mechanisms alone hold promise for protecting access for the poor or whether the mechanisms need to be supplemented with other strategies. This study was conducted simultaneously in five countries: Egypt, India (Uttaranchal), Kenya, Peru, and Vietnam. The objectives were to survey actual costs to consumers for antenatal and delivery care; survey current fee and waiver mechanisms; assess the degree to which these mechanisms function; assess the degree to which informal costs to consumers constitute a barrier to service; and review current policies and practices regarding the setting of fees and the collection, retention, and use of revenue.
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The 1994 ICPD intensified the worldwide focus on reproductive health policies and programs. Officials in many countries have worked to adopt the recommendations in the ICPD Programme of Action and to shift their population policies and programs from an emphasis on achieving demographic targets for reduced population growth to a focus on improving the reproductive health of their population. This paper presents information from case studies carried out in Bangladesh, India, Nepal, Jordan, Ghana, Senegal, Jamaica, and Peru to assess each nation's process and progress in moving toward a reproductive health focus. The case studies show that within their unique social, cultural, and programmatic contexts, the eight countries have made significant progress in placing reproductive health on the national health agenda. All countries have adopted the ICPD definition of reproductive health either entirely or in part. Policy dialogue has occurred at the highest levels in all countries. The countries have also achieved considerable progress in broadening participation in reproductive health policymaking. Bangladesh, Senegal, and Ghana have been particularly effective in involving NGOs and civil society organizations in policy and program development. In some of the other countries, however, the level of participation and political support for reproductive health may not be sufficient to advance easily to the next crucial stage of implementation. The case studies indicate almost uniformly that countries are grappling with the issues of setting priorities, financing, and implementing reproductive health interventions. Bangladesh has made the greatest progress in these areas while India, Nepal, Ghana, Senegal, Jamaica, and Peru are beginning to take steps toward implementation of reproductive health activities. Jordan continues to focus primarily on family planning. Several challenges face these countries as they continue to implement reproductive heath programs. These challenges include improving knowledge and support of reproductive health programs among stakeholders; planning for integration and decentralized services; strengthening human resources; improving quality of care; addressing legal, regulatory, and social issues; clarifying the role of donors; and maintaining a long-term perspective regarding the implementation of the ICPD agenda. Despite many encouraging signs, limited progress has been achieved in actually implementing the Programme of Action; this finding is neither surprising nor unexpected. It took more than a generation to achieve the widespread adoption and implementation of family planning programs worldwide, and that task is far from complete. The key to continuing progress lies in setting priorities, developing budgets, phasing-in improvements, and crafting strategies for implementation of reproductive health interventions.
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This brief examines the extent to which the 1994 ICPD has shaped reproductive health policies and programs in Bangladesh, Ghana, India, Jamaica, Jordan, Nepal, Peru, and Senegal. Within their unique social, cultural, and programmatic contexts, the eight countries have made significant progress in placing reproductive health on their respective national health policy agendas. The progress illustrated by the case studies is a logical beginning for defining and adopting reproductive health policies and principles, while building political and popular support. However, whereas well-established reproductive health services, such as family planning and maternal and child health, have remained high priorities, the case studies indicate that a continued effort will be required to place more sensitive issues, such as gender-based violence and reproductive rights, on the policy agenda. In addition, in some countries, a greater level of participation and political support for reproductive health may need to be cultivated before the countries are able to advance to the next crucial stage of implementation. Countries also need sufficient financial resources to implement the expanded reproductive health programs and services envisioned by the ICPD—resources that most respondents suggested were not immediately forthcoming.
Proceedings from the workshop 'Prevention of HIV/AIDS in Uttar Pradesh', January 29-31, 2004. The workshop brought together policy makers, bureaucrats, program managers, people living with AIDS, academicions and activitist to discuss and debate the present state of affairs and discuss means of strengthening prevention and control of HIV/AIDS in the state. 25 papers were presented by experts on different themes and best practices.
This paper synthesizes the results of nine case studies carried out in: Andhrah Pradesh, Bihar, Gujarat, Karnataka, Madhya Pradesh, Maharashtra, Orissa, Rajasthan, and Uttar Pradesh. The objectives of the case studies were to: 1) examine the transition from the original target system to the target free approach, and subsequently the community needs assessment approach; 2) Analyze the countrywide implementation of CNA and the impact of the new system on programme performance 3) Identify programmatic shortcomings that affected the transition, draw lessons from the experiences of implementation, and identify steps that could be taken to improve the management and performance of the new client-oriented system.
USAID prepared pathways to achieve the strategic objective of reduced fertility and improved reproductive health in North India. Intermediate results to achieve the strategic objective have been prepared in December 1997 for the IFPS Project in Uttar Pradesh that covers 28 districts. Subsequently in January 1999, the SO2 Indicator survey was undertaken in five districts with a sample size of 5000 households to measure the progress made by the IFPS project during the calendar year 1998. In the following year, the study was undertaken in ten districts with a sample size of 10,000 households. Since the IFPS project was working in full gear in 15 priority districts and had started scaling-up its intervention in the 13 other PERFORM districts, it was desired to have separate estimates for priority and other PERFORM districts. Hence, the SO2 Indicator survey for year 1999 was undertaken with a sample size of 10,000 households covering 10 out of the 28 districts. The sample size was proportionally split between the priority and other PERFORM districts. As slightly over three-fifths of the population was in the priority districts, 6130 households from six districts were covered and the remaining 3870 households were from four other PERFORM districts. The selected priority districts were Etawah, Gorakhpur, Varanasi, Allahabad, Kanpur nagar and Meerut while the other PERFORM districts included Gonda, Azamgarh, Bareilly and Saharanpur.
The 1994 International Conference on Population and Development (ICPD) in Cairo stressed the importance of gender and noted that reproductive health programs should be implemented from a gender perspective. However, little has been written about how reproductive health programs that focus on improving quality of care and access to care can integrate gender. This paper describes the experiences of three types of programs (government, reproductive health NGO, and women’s health NGO) in Kenya, India, and Guatemala that integrate gender in their work and examines how they integrate gender into programs that improve quality of care and access to care. It should be emphasized that this report does not document whether gender integration results in higher quality and access, but rather documents how gender integration can take place. This report is based on data that were collected in the three countries, through interviews with a total of 27 program staff and 34 providers and through focus groups with 136 clients. These three types of programs engage clients in the clinic and community setting in a manner closely related to their mandates and perspectives on gender. In the government and reproductive health (RH) NGOs, the emphasis is on quality and access, with gender included as a means to reach those goals. The women’s NGOs have the mandate to first promote gender equity (primarily through women’s empowerment), and also to use it as a means to promote reproductive health care. The organizations with the strongest internal gender policies, namely the women’s and RH NGOs, are also the most committed to integrating gender into their programs for clients. The RH NGOs are most committed to gender equity or equal participation of women and men in the organization.