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Browse POLICY Project (1995-2006) Materials

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Worldwide

  • Internal stigma is the product of the internalization of shame, blame, hopelessness, guilt, and fear of discrimination associated with being HIV-positive. It can affect caregivers and family members, who also may internalize feelings of shame, guilt, or fear. Internal stigma can have a profound effect on HIV prevention, treatment, and care. This document explores the difference between internal and external stigma, the contributing factors, and potential ways of addressing stigma, including indicators and steps to empowerment.
    English
    Internal_Stigma.pdf

  • This document has been compiled by the International Institute for Educational Planning (IIEP)/UNESCO HIV/AIDS Impact on Education Clearinghouse in cooperation with POLICY /Futures Group. It aims to bring together, for ease of access, national and education sector HIV/AIDS policies and strategies adopted by governments to manage the impact of HIV/AIDS on their country or more specifically their education systems, to help protect their populations from infection and to care for those who are infected or affected by HIV/AIDS. These resources are provided for information purposes only and inclusion of a policy or strategy in this document does not necessarily signify approval on the part of IIEP/UNESCO or POLICY/Futures Group.
    English
    IIEP_POLICY.pdf

  • Describes POLICY's approach to HIV/AIDS
    English
    POLICY_HIV.pdf

  • Describes POLICY's approach to human rights, stigma and discrimination
    English
    ATC_Human_Rights.pdf

  • Around the world, in myriad ways, individuals are working to fight stigma and discrimination and promote human rights in order to combat the HIV epidemic. 'Breaking Through' highlights the contributions of people who are speaking out against stigma, discrimination, and human rights violations. Some of those profiled are people living with HIV. It is our hope that readers will be inspired by the approaches and stories presented in this booklet. The individuals profiled represent a fraction of those who are confronting stigma and discrimination and promoting human rights. Their stories reflect the dedication and spirit of countless others who are working toward enabling environments that support the inclusion of people living with HIV and vulnerable groups and that foster effective, just responses to the epidemic.
    English
    Breaking Through.pdf

  • At long last, academics, researchers, activists, service providers, and people living with HIV are beginning to understand and articulate the consequences of addressing (or not addressing) and measuring HIV-related stigma and discrimination. This paper reviews the present understanding of HIV-related stigma and discrimination as they relate to vulnerability, and suggests approaches for stigma reduction. It explores and examines what constitutes HIV-related stigma and discrimination, what effects they have on behavior and HIV responses, and what we can do to reduce them.
    English
    Breaking_the_Cycle.pdf

  • At long last, academics, researchers, activists, service providers, and people living with HIV are beginning to understand and articulate the consequences of addressing (or not addressing) and measuring HIV-related stigma and discrimination. This paper reviews the present understanding of HIV-related stigma and discrimination as they relate to vulnerability, and suggests approaches for stigma reduction. It explores and examines what constitutes HIV-related stigma and discrimination, what effects they have on behavior and HIV responses, and what we can do to reduce them.
    French
    Breaking the cycle_FR.pdf

  • HIV-related stigma and discrimination (S&D) has accompanied the AIDS epidemic from the start. Fear of and actual experience with stigma and discrimination reduce an individuals willingness to practice prevention, seek HIV testing, disclose his or her HIV status to others, ask for (or give) care and support, and begin and adhere to treatment. As efforts to address S&D increase, so does the need for a set of standard tested and validated S&D indicators. Yet measures that can both describe an existing environment, and evaluate and compare interventions, are lacking. This report suggests ways to begin the process of quantitatively measuring HIV-related stigma in an effort to help practitioners, policymakers and donors evaluate their programs.
    English
    Measure HIV Stigma.pdf

  • POLICY, GNP+ and GTZ collaborated to develop new tools to increase PLHA involvement in the Global Fund CCMs. "Challenging, Changing, and Mobilizing: A Guide to PLHIV Involvement in Country Coordinating Mechanisms" is a handbook developed for use by PLHA already working on HIV/AIDS with some prior knowledge of the Global Fund. The handbook includes information on the Global Fund and CMM basics, how to be an effective CCM member and how to improve CCMs through the greater involvement of PLHAs. The handbook will be available in early 2005. The aim of the handbook is to increase and improve the meaningful participation of People Living with HIV (PLHIV) on Global Fund Country Coordinating Mechanisms (CCMs) across the world. This development will undoubtedly enhance the ability of the Global Fund to be an effective force in serving the communities most in need and will also contribute to facilitating PLHIV access to Global Fund resources. This handbook is the product of numerous consultations and input of over 400 people living with HIV (PLHIV) from more than 30 countries in every region of the world, with the vast majority of those involved living in developing countries and countries in transition. This handbook was created primarily for PLHIV who are already working on HIV/AIDS issues in their country and who have some prior knowledge of the Global Fund. It is anticipated that many in the target audience will already be involved in some aspect of work that is related to the Global Fund, perhaps through membership on a CCM, as members of networks represented on a CCM, or as sub-recipients of Global Fund grants. Some may not be directly involved at present, but may have an interest in learning more about the Global Fund and in advocating for inclusion of a network or organization on the CCM in a specific country or region.
    English
    CCM_Handbook.pdf

  • POLICY, GNP+ and GTZ collaborated to develop new tools to increase PLHA involvement in the Global Fund CCMs. "Challenging, Changing, and Mobilizing: A Guide to PLHIV Involvement in Country Coordinating Mechanisms" is a handbook developed for use by PLHA already working on HIV/AIDS with some prior knowledge of the Global Fund. The handbook includes information on the Global Fund and CMM basics, how to be an effective CCM member and how to improve CCMs through the greater involvement of PLHAs. The handbook will be available in early 2005. The aim of the handbook is to increase and improve the meaningful participation of People Living with HIV (PLHIV) on Global Fund Country Coordinating Mechanisms (CCMs) across the world. This development will undoubtedly enhance the ability of the Global Fund to be an effective force in serving the communities most in need and will also contribute to facilitating PLHIV access to Global Fund resources. This handbook is the product of numerous consultations and input of over 400 people living with HIV (PLHIV) from more than 30 countries in every region of the world, with the vast majority of those involved living in developing countries and countries in transition. This handbook was created primarily for PLHIV who are already working on HIV/AIDS issues in their country and who have some prior knowledge of the Global Fund. It is anticipated that many in the target audience will already be involved in some aspect of work that is related to the Global Fund, perhaps through membership on a CCM, as members of networks represented on a CCM, or as sub-recipients of Global Fund grants. Some may not be directly involved at present, but may have an interest in learning more about the Global Fund and in advocating for inclusion of a network or organization on the CCM in a specific country or region.
    Russian
    CCM_Handbook_RUS.pdf

  • English
    f-models.pdf

  • French
    AdvocacyManual_Fr.pdf

  • French
    WW_WillToPay_Fr.pdf

  • English
    f-aidscomp.pdf

  • English
    toolkit.cfm

  • Government agencies are the largest employers in many countries, but too little attention has been given to strengthening HIV/AIDS prevention, care, and treatment programs for government employees and their families. This book offers practical guidance on creating or expanding HIV/AIDS workplace programs for civil services.
    English
    WW_PubSectGuide.pdf

  • This collection of stories highlights HIV-related advocacy work in communities around the world. This manual begins a process of documenting HIV/AIDS policy advocacy stories as a means of preserving them and making them available to others as more and more people become involved in HIV/AIDS advocacy issues. In all, 16 advocacy organizations are profiled in "Moments in Time." Although the stories focus on HIV/AIDS, the advocacy models are applicable to other settings and other issues. In fact, the developments in HIV/AIDS advocacy over the past 20 years can be helpful to other advocacy issues, just as other advocacy issues have been instrumental in the development of HIV/AIDS advocacy.
    French
    MomentsFR.pdf

  • Results from a 2003 survey of six regions in Russia using the Maternal and Neonatal Program Effort Index. Includes discussion of the MNPI, results by region, and priority action areas.
    English
    MNPI_RUS_6Reg.pdf

  • UNAIDS, USAID and the POLICY Project have developed the AIDS Program Effort Index (API) to measure program effort in the response to the HIV/AIDS epidemic. The index is designed to provide a profile that describes national effort and the international contribution to that effort. The API was applied to 40 countries in 2000. The results show that program effort is relatively high in the areas of legal and regulatory environment, policy formulation and organizational structure. Political support was somewhat lower but increased the most from 1998. Monitoring and evaluation and prevention programs scored in the middle range, about 50 out of 100 possible points. The lowest rated components were resources and care. The API also measured the availability of key prevention and care services. Overall, essential services are available to about half of the people living in urban areas but to only about one-quarter of the entire population. International efforts to assist country programs received relatively high rating in all categories except care. The results presented here will be supplemented later this year with a new component on human rights and a score that compares countries on program effort.
    English
    APIreport.pdf

  • UNAIDS, USAID and the POLICY Project have developed the AIDS Program Effort Index (API) to measure program effort in the response to the HIV/AIDS epidemic. The index is designed to provide a profile that describes national effort and the international contribution to that effort. The API was applied to 40 countries in 2000. The results show that program effort is relatively high in the areas of legal and regulatory environment, policy formulation and organizational structure. Political support was somewhat lower but increased the most from 1998. Monitoring and evaluation and prevention programs scored in the middle range, about 50 out of 100 possible points. The lowest rated components were resources and care. The API also measured the availability of key prevention and care services. Overall, essential services are available to about half of the people living in urban areas but to only about one-quarter of the entire population. International efforts to assist country programs received relatively high rating in all categories except care. The results presented here will be supplemented later this year with a new component on human rights and a score that compares countries on program effort.
    Russian
    APIreportrus.pdf

  • UNAIDS, USAID and the POLICY Project have developed the AIDS Program Effort Index (API) to measure program effort in the response to the HIV/AIDS epidemic. The index is designed to provide a profile that describes national effort and the international contribution to that effort. The API was applied to 40 countries in 2000. The results show that program effort is relatively high in the areas of legal and regulatory environment, policy formulation and organizational structure. Political support was somewhat lower but increased the most from 1998. Monitoring and evaluation and prevention programs scored in the middle range, about 50 out of 100 possible points. The lowest rated components were resources and care. The API also measured the availability of key prevention and care services. Overall, essential services are available to about half of the people living in urban areas but to only about one-quarter of the entire population. International efforts to assist country programs received relatively high rating in all categories except care. The results presented here will be supplemented later this year with a new component on human rights and a score that compares countries on program effort.
    Spanish
    APIreportsp.pdf

  • UNAIDS, USAID and the POLICY Project have developed the AIDS Program Effort Index (API) to measure program effort in the response to the HIV/AIDS epidemic. The index is designed to provide a profile that describes national effort and the international contribution to that effort. The API was applied to 40 countries in 2000. The results show that program effort is relatively high in the areas of legal and regulatory environment, policy formulation and organizational structure. Political support was somewhat lower but increased the most from 1998. Monitoring and evaluation and prevention programs scored in the middle range, about 50 out of 100 possible points. The lowest rated components were resources and care. The API also measured the availability of key prevention and care services. Overall, essential services are available to about half of the people living in urban areas but to only about one-quarter of the entire population. International efforts to assist country programs received relatively high rating in all categories except care. The results presented here will be supplemented later this year with a new component on human rights and a score that compares countries on program effort.
    French
    APIreportfr.pdf

  • This collection of stories highlights HIV-related advocacy work in communities around the world. This manual begins a process of documenting HIV/AIDS policy advocacy stories as a means of preserving them and making them available to others as more and more people become involved in HIV/AIDS advocacy issues. In all, 16 advocacy organizations are profiled in "Moments in Time." Although the stories focus on HIV/AIDS, the advocacy models are applicable to other settings and other issues. In fact, the developments in HIV/AIDS advocacy over the past 20 years can be helpful to other advocacy issues, just as other advocacy issues have been instrumental in the development of HIV/AIDS advocacy.
    English
    MomentsFULL.pdf

  • The 1994 ICPD in Cairo shifted family planning program attention from a focus on achieving demographic targets to meeting individual needs of women for family planning and reproductive health services. Several governments in developing countries are responding by placing increased emphasis on program quality, meeting the expressed needs of clients, and placing less emphasis on achieving quantitative indicators of program performance. This report summarizes some of the changes in performance monitoring taking place in selected countries. There is considerable variability in how countries are making this transition. While Indonesia has been one of the most successful developing countries to meet its demographic objectives, it has recently made great strides in shifting the focus of its family planning program from a target-driven program to one based on the concept of understanding and fulfilling the needs and preferences of the family. Work is now underway to operationalize the policy at the field level, incorporate the approach in national and local planning, and devise strategies for collecting information that will allow assessment of its success. • In the Philippines, focus is placed on improving maternal and child health and meeting the reproductive intentions of women. Work is proceeding to improve the national MIS, make better use of existing data from a variety of sources to produce an annual status report for the Philippine Family Planning Program, as well as to strengthen monitoring systems at the local level. There is currently a lot of variability in capabilities by local government unit (LGU). While pilot approaches are being tested in a few LGUs, it is unclear to what extent these will be endorsed by either the Department of Health or other LGUs. • In Zimbabwe, greater attention is being paid to reproductive health in service provision, particularly STD treatment and prevention. A new report form is being tested to ascertain more clearly the quality of care provided and patterns of method switching. The next five-year plan, to be developed during 1996, is expected to formalize the new reproductive health strategy. • Increased emphasis is being placed on reproductive health in Mexico, although it's too early to know how the performance monitoring system will evolve to address these new concerns. While experience is beginning to accumulate, shifting from advocacy for a reproductive health approach to program implementation at national, subnational, and local levels will require much new work to obtain timely, accurate information for planning, implementation, and monitoring of reproductive health programs.
    English
    wps-01.pdf

  • Following the Platform of Action set forth at the 1994 ICPD in Cairo, nearly all countries place at least some policy emphasis on preventing and treating reproductive health problems. However, the necessary resources, both domestic and international, continue to be scarce. Nowhere in the developing world do reproductive health programs reach all the persons who would benefit. This means that policymakers and program managers must set priorities. This policy brief describes how to set priorities, various models and techniques available to set priorities and how priority setting works in practice.
    Spanish
    PI2Spanish.pdf

  • Following the Platform of Action set forth at the 1994 ICPD in Cairo, nearly all countries place at least some policy emphasis on preventing and treating reproductive health problems. However, the necessary resources, both domestic and international, continue to be scarce. Nowhere in the developing world do reproductive health programs reach all the persons who would benefit. This means that policymakers and program managers must set priorities. This policy brief describes how to set priorities, various models and techniques available to set priorities and how priority setting works in practice.
    French
    PI2French.pdf

  • Following the Platform of Action set forth at the 1994 ICPD in Cairo, nearly all countries place at least some policy emphasis on preventing and treating reproductive health problems. However, the necessary resources, both domestic and international, continue to be scarce. Nowhere in the developing world do reproductive health programs reach all the persons who would benefit. This means that policymakers and program managers must set priorities. This policy brief describes various models and techniques available to set priorities and how priority setting works in practice.
    English
    PI2English.pdf

  • In the effort to develop dynamic national family planning service systems, USAID has supported a sustained set of initiatives to strengthen private sector service delivery. Many of these, like the SOMARC, Enterprise, PROFIT, and Initiatives projects, have focused primarily on the operational side of program expansion (e.g., training private providers, helping clinic managers develop business and financial plans, improving management efficiency, and marketing products and services). This paper looks at how activities in the policy domain often determine the success or failure of efforts to develop private sector services. This paper examines lessons learned in USAID's OPTIONS and POLICY projects, both of which have worked extensively in developing countries to foster private sector involvement in family planning and reproductive health care. It presents lessons learned during implementation of these activities and emphasizes ways to strengthen the policy climate and plan for service expansion. Following a general discussion of lessons learned, the paper includes examples from 11 countries that describe efforts to remove impediments to private sector participation and effective health care financing. The issues range from taxation of imported commodities in the Philippines to divestiture of contraceptive brands in Jamaica to market segmentation in Egypt. In sum, the country examples illustrate the steps governments can take to ensure adequate financing of their programs, use their resources efficiently, and tap the extensive resources of the private sector. Summary of Lessons Learned: • Governments should ensure that sufficient resources are available for services from both public and private sector sources. • Government subsidies should be targeted to appropriate clientele. • Efforts to increase private sector participation in family planning service delivery should begin with the public sector. • Many public sector clients can afford to pay for needed services either in part or in full. • Legal and regulatory barriers can impede the involvement/performance of the private sector. • Governments have a fundamental role in regulating the quality of private sector health services; however, many governments lack experience in regulating the private sector. • The private sector is often able and willing to work with the public sector as a partner. • Donors and cooperating agencies need to communicate and collaborate to ensure synergy of efforts in the field.
    English
    wps-02.pdf

  • Global demand for family planning services continues to increase rapidly. By 2015, the number of women using modern contraceptives is expected to nearly double (Ross and Bulatao, 2001). This dramatic growth is due in part to an increase in the number of women of reproductive age. It also stems from the fact that national family planning programs are doing a better job of both reaching out to women in need of family planning products and removing barriers to family planning services. Demand for condoms is rising even faster as a “dual-use” product, protecting against unwanted pregnancies as well as against sexually transmitted infections (STI), including HIV. New challenges for family planning programs have arisen from their success. In many family planning programs operated by the public sector, resources are falling short of growth in demand for services. At the same time, individuals with unmet need for family planning services are increasingly concentrated among hard-to-reach groups. Moreover, as low-cost public services come to dominate the family planning market, they compete with and crowd out the private sector. This brief explores one potential solution—targeting—to meet these challenges, alleviating barriers to the expansion and use of family planning services.
    Spanish
    PF3_Sp.pdf

  • Global demand for family planning services continues to increase rapidly. By 2015, the number of women using modern contraceptives is expected to nearly double (Ross and Bulatao, 2001). This dramatic growth is due in part to an increase in the number of women of reproductive age. It also stems from the fact that national family planning programs are doing a better job of both reaching out to women in need of family planning products and removing barriers to family planning services. Demand for condoms is rising even faster as a “dual-use” product, protecting against unwanted pregnancies as well as against sexually transmitted infections (STI), including HIV. New challenges for family planning programs have arisen from their success. In many family planning programs operated by the public sector, resources are falling short of growth in demand for services. At the same time, individuals with unmet need for family planning services are increasingly concentrated among hard-to-reach groups. Moreover, as low-cost public services come to dominate the family planning market, they compete with and crowd out the private sector. This brief explores one potential solution—targeting—to meet these challenges, alleviating barriers to the expansion and use of family planning services.
    French
    PF3_Fr.pdf

  • The 1994 ICPD expanded the population agenda far beyond family planning. Reproductive health, and the preventive and curative services that could assure it in developing countries, became a key objective accepted by the more than 180 signatory governments. Left unclear were the cost of this expansion and the source of funds to finance it. To fill that cost-estimation gap, the authors reviewed 160 publications issued between 1970 and June 1997, most of them about the time of the Cairo conference. The studies highlighted in this paper offer some quantitative data on the costs of reproductive health services identified as part of the Cairo agenda. In this review, cost data are reported for eight categories of reproductive health interventions: family planning, safe motherhood programs, maternal/infant nutrition and immunizations, obstetric care, abortion/postabortion care, STI/HIV/AIDS, reproductive cancers, and miscellaneous gynecology. The review of family planning cost data is treated differently from other reproductive health interventions. For the seven non-family-planning reproductive health elements, there were about 75 examples (29 studies) of unit cost data. We found only 17 instances of cost-effectiveness estimates (i.e., quantitative relations established between costs and health outcomes) in 15 studies. Furthermore, there were only six studies that referred to inter-disease measures of health outcomes, such as disability-adjusted life-years (DALYs), producing 16 cost-effectiveness estimates. This literature review identifies the gaps in cost information regarding potential reproductive health interventions within the individual reproductive health elements; within geographic regions; and by costing methods. First, about one-half of the expected reproductive health (mostly clinical) services have been costed in at least one setting. Second, only four countries—Bolivia, Ecuador, Mexico, and Zimbabwe—have cost information for more than two services. Third, there is considerable variability in the costing methods applied. Some of the reviewed studies do not clearly report the method used and the assumptions made in calculating the cost results. Nor do they provide all the necessary data to make recalculation of the results possible. Even given valid and replicable measurement, the cost-estimates as presented are generally not comparable because of the lack of a common denominator. This review recommends that "filling the gaps" should be based on local information needs, and that issues of quality, access, and integrated service delivery require closer attention. In addition, the ongoing debate about existing measures of health outcomes suggests that alternative methods for comparing health interventions merit attention. Finally, collecting the cost information available in developing countries (i.e., not in the international literature) would be useful both to local decision makers and others involved in setting priorities and allocating resources for health services.
    English
    wps-03.pdf

  • As countries try to allocate limited public sector funds for family planning effectively and efficiently, there is increasing interest in understanding and measuring clients' ability to pay for services. If public funds are not sufficient to serve the entire population, they should be targeted to users who are less able to pay. Ideally, women with some ability to pay for health care services should use the private sector, at least for less costly contraceptive methods. This paper presents a methodology for describing the extent to which government subsidies are efficiently applied, that is, to users who could not otherwise afford their contraceptive methods. It examines national family planning markets that include both government and commercial providers and in which government resources are not sufficient to provide universal family planning coverage. Using Demographic and Health Surveys (DHS) data from 11 countries, the analysis shows that the commercial sector market share is higher for less expensive contraceptive methods and that women who make use of private sector maternal and child health care services are more likely to use commercial outlets for contraception. Distortions in this general pattern emerge in countries that over-subsidize certain contraceptive methods, particularly oral contraceptives, to the detriment of the commercial sector. Findings from this analysis can provide insights for further exploration of potential problems such as untargeted government subsidies for less expensive methods or lack of access for clinical methods.
    English
    wps-04.pdf

  • The improved nutritional status of women, particularly during their childbearing years, is an important element of reproductive health. Efforts to improve women's nutrition and health include increasing food intake at all stages of the life cycle, eliminating micronutrient deficiencies, preventing and treating parasitic infections, reducing women's workload, and reducing unwanted fertility. This paper outlines the critical role of maternal nutrition and, in particular, micronutrients to reproductive health. The micronutrient status of women in developing countries affects their health during pregnancy and lactation, the outcomes of their pregnancies, and the health of their infants. For women who are vitamin and nutrient deficient, improving micronutrient intake can be an important means of reducing maternal morbidity and mortality. Micronutrient malnutrition is primarily the result of inadequate dietary intake. Dietary surveys in developing countries have consistently shown that multiple micronutrient deficiencies, rather than single deficiencies, are common, and that low dietary intakes and poor bioavailability of micronutrients account for the high prevalence of these multiple deficiencies. Recent evidence concerning increased micronutrient supplementation suggests the following findings: • Enhancing vitamin A intake reduces maternal mortality. • Increasing calcium and magnesium intake can reduce the risk of death from eclampsia. • Ensuring adequate intake of iron, zinc, iodine, calcium, magnesium, and folic acid during pregnancy can improve pregnancy outcome. • Increasing the intake of folic acid before pregnancy can reduce birth defects. • Providing zinc, calcium, and magnesium supplements during pregnancy can improve birthweight and reduce prematurity, especially among high-risk women. • Improving the maternal intake of many nutrients directly enhances the quality of breast milk. In addition, micronutrients play an essential role in the function of the immune system, and deficiencies in them influence the rate, duration, and severity of infections. Infection rates during pregnancy or lactation, including reproductive tract infections, increase because of deficiencies in iron, vitamin A, and zinc. Also, low serum vitamin A levels in pregnant women have been associated with increased transmission of HIV to infants and with increased transition from HIV to AIDS and increased mortality from AIDS among infants. The consequences of malnutrition affect the ability of women to sustain work and care for their families. Solutions to prevent or eliminate micronutrient malnutrition include nutrient supplementation of women of childbearing age before and after pregnancy through repeated reproductive cycles. Combined supplements are usually more effective in improving micronutrient status than single supplements, since women are usually deficient in more than one micronutrient. In addition, universal or targeted food fortification, which has proved cost-effective, can be an important strategy in preventing micronutrient malnutrition.
    English
    wps-05.pdf

  • The need to meet the family planning needs of men and women, coupled with dwindling donor resources, is forcing family planning programs worldwide to confront increasingly difficult financial challenges. One option for expanding the resource base for family planning and reproductive health services in developing countries is to promote the growth of the commercial family planning sector. Using DHS data for 45 countries, this paper demonstrates that (1) the commercial sector plays an important role in national family planning markets, even in countries where contraceptive prevalence is low; and (2) the commercial family planning sector does not always develop coincidentally as prevalence grows or as programs mature. If the commercial sector does not necessarily gain market share as prevalence grows, what factors account for differences in commercial market shares across countries? This paper examines three sets of factors to explain variations in commercial market share across countries: • Microeconomic or household factors. Characteristics of individuals, such as ability to pay or knowledge of contraception, may make them more likely to use the commercial sector. • Macroeconomic or business climate factors. Characteristics of a country and its economy may lead to a larger commercial market share for contraceptive services and commodities. • Programmatic factors. Characteristics of a family planning program, such as government support and method mix, may lead to a larger commercial market share. The commercial market share for family planning is related to many factors, which can be grouped in two categories: external factors, over which there is no control, such as per capita income and the level of urbanization, but which can be exploited or understood as a program constraint; and programmatic factors, which are under the direct or indirect control of the program, such as public sector pricing or program effort. The cross-national analysis shows that broad-based purchasing power, improved knowledge of reproductive health, critical densities of population, and appropriate public policy are each associated with relatively strong commercial sectors. This paper recommends that public health policymakers take steps to integrate the commercial sector into their programs by developing economic and policy environments supportive of its expansion. In many countries, family planning has been provided as if it were a public good. Large public programs were designed to expand service delivery in public sector facilities, while limited attention was paid to growth of the commercial sector, likely assuming commercial sector share would grow as a consequence of growth in general public interest in family planning. This study identifies factors for which key policy support may be able to generate increased use of the commercial sector for family planning.
    English
    wps-06.pdf

  • The purpose of this paper is to familiarize policymakers with market segmentation analysis and its role in supporting more efficient and effective resource use. Specifically, the paper summarizes how market segmentation analysis helped initiate public/private dialogue to guide resource allocation decisions in four countries: Turkey, India, Morocco, and Brazil. In Morocco and Turkey, market segmentation analysis results were central to public/private reproductive health finance discussions and guided public sector decisions to concentrate resources more heavily on the most vulnerable and needy population groups. In Brazil and India, market segmentation analysis findings helped guide reproductive health finance discussions between donors and the private sector that led ultimately to private sector expansion.
    English
    wps-07.pdf

  • The transition to low fertility in much of the developing world is incomplete. To leave it half-finished or to slow its pace would have enormous demographic, programmatic, and foreign assistance implications. Despite considerable progress over the last 35 years, much remains to be done to complete the demographic transition. The world’s population has not stopped growing, and it is growing fastest in the poorest countries. To achieve sustainable development, strong measures by governments and donor organizations to promote fertility decline in developing countries—and to give individuals and couples the means to do so—need to continue for the foreseeable future. This paper reviews the status of the demographic transition worldwide, discusses factors associated with fertility decline, and highlights challenges associated with completing the transition in developing countries. It is intended to help policymakers both here and abroad to better understand the need for continued efforts to reduce fertility and population growth rates, even in the wake of the HIV/AIDS epidemic. A reduction in population growth to sustainable levels is not something that will just occur on its own. Completing the demographic transition requires addressing a number of challenges—and first and foremost is maintaining strong support for family planning programs from governments and donor organizations. Sustaining the demographic transition also requires focused attention on other proximate, or direct, determinants of fertility, such as increasing the age at marriage and reducing abortion. In addition, donors and governments have an important role to play in providing continued support for policies that indirectly affect fertility, such as promoting girls’ education and safe motherhood.
    English
    op-8.pdf

  • During its five-year term (1995-2000), the POLICY Project improved the policy environment for FP/RH programs and advanced ICPD objectives worldwide. Working in 36 countries and with USAID three regional organizations, POLICY collaborated with scores of institutional partners, including NGOs, research institutions, government agencies, consulting firms, media companies, and universities. By the end of the project, POLICY employed 152 overseas staff and consultants, who provided continuous in-country technical support to project activities. At the same time, there were approximately 80 U.S.-based staff members working on POLICY.
    English
    FRPOLICY.pdf

  • This document contains a listing of results at the SO and IR levels achieved over the life of the POLICY I Project. Table 1A shows a tally of results by country and region. Each individual check denotes achievement of a result in that country. The column totals in the table represent the number of countries in which a result at that level occurred. Overall, POLICY achieved 88 SO level results in 33 countries and 149 IR level results in 36 countries. The detailed text of results by country follows Table 1A.
    English
    FRPOL_Annex.pdf

  • Progress report on core package implementation.
    English
    CorePkg_July02.doc

  • The countries of West Africa have some of the highest levels of unmet need for family planning in the world. During the six-year period (1995–2000) following the 1994 International Conference on Population and Development, there were an estimated 12 million unintended pregnancies in the 18 West Africa Regional Program (WARP) countries. Yet family planning programs are currently low on most national agendas and there is no concerted effort to address the expressed need for family planning. To reduce the health and development consequences of unintended fertility in West Africa, policymakers and planners need to study the characteristics of women with a demonstrated unmet need for family planning and use that information to improve policies and programs. This series of briefing papers is designed to contribute to that effort by offering some perspectives on the nature and dimensions of unmet need based on the findings of Demographic and Health Surveys (DHS) in 11 West African countries: Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, and Togo. This brief focuses on Benin.
    English
    BEN_UnmetNeedFP.pdf

  • The countries of West Africa have some of the highest levels of unmet need for family planning in the world. During the six-year period (1995–2000) following the 1994 International Conference on Population and Development, there were an estimated 12 million unintended pregnancies in the 18 West Africa Regional Program (WARP) countries. Yet family planning programs are currently low on most national agendas and there is no concerted effort to address the expressed need for family planning. To reduce the health and development consequences of unintended fertility in West Africa, policymakers and planners need to study the characteristics of women with a demonstrated unmet need for family planning and use that information to improve policies and programs. This series of briefing papers is designed to contribute to that effort by offering some perspectives on the nature and dimensions of unmet need based on the findings of Demographic and Health Surveys (DHS) in 11 West African countries: Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, and Togo. This brief focuses on Burkina Faso.
    English
    BUR_UnmetNeedFP.pdf

  • The countries of West Africa have some of the highest levels of unmet need for family planning in the world. During the six-year period (1995–2000) following the 1994 International Conference on Population and Development, there were an estimated 12 million unintended pregnancies in the 18 West Africa Regional Program (WARP) countries. Yet family planning programs are currently low on most national agendas and there is no concerted effort to address the expressed need for family planning. To reduce the health and development consequences of unintended fertility in West Africa, policymakers and planners need to study the characteristics of women with a demonstrated unmet need for family planning and use that information to improve policies and programs. This series of briefing papers is designed to contribute to that effort by offering some perspectives on the nature and dimensions of unmet need based on the findings of Demographic and Health Surveys (DHS) in 11 West African countries: Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, and Togo. This brief focuses on Cote d'Ivoire.
    English
    CDI_UnmetNeedFP.pdf

  • The countries of West Africa have some of the highest levels of unmet need for family planning in the world. During the six-year period (1995ý2000) following the 1994 International Conference on Population and Development, there were an estimated 12 million unintended pregnancies in the 18 West Africa Regional Program (WARP) countries. Yet family planning programs are currently low on most national agendas and there is no concerted effort to address the expressed need for family planning. To reduce the health and development consequences of unintended fertility in West Africa, policymakers and planners need to study the characteristics of women with a demonstrated unmet need for family planning and use that information to improve policies and programs. This series of briefing papers is designed to contribute to that effort by offering some perspectives on the nature and dimensions of unmet need based on the findings of Demographic and Health Surveys (DHS) in 11 West African countries: Benin, Burkina Faso, Cameroon, Cýte dýIvoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, and Togo. This brief focuses on Benin.
    English
    unmetneed_ghana.pdf

  • This report reflects on the achievements and lessons learned from the POLICY II Project (20002006). POLICYs HIV activities are supported by the Presidents Emergency Plan for AIDS Relief through the United States Agency for International Development (USAID). POLICYs HIV activities have been implemented through 27 country offices and four regional programs bringing the projects presence to over 30 countries around the world. POLICYs efforts have led to the adoption of 33 policies, plans, and strategies at national and regional levels; strengthened networks of people living with HIV in 11 countries and for the Asia and Pacific region; and more than 150 faith- and community-based groups mobilized through small grants to build local capacity to carry out HIV activities. This report higlights the achievements of the project in five key technical areas: policy formulation, leadership and advocacy, resources and data for decisionmaking, reducing vulnerablity, and multisectoral engagement.
    English
    HIVEOP.pdf.pdf

  • This paper summarizes findings from over 130 studies of private services provided to improve child health.
    English
    Final_-_WHO_2.pdf

  • This volume, an updated and enlarged edition of the first edition, was conceived as a way to assist action programs by bringing together much of the comparative data that bear upon family planning and reproductive health. A matrix for 116 countries was constructed to embrace time trends for each of numerous data sets. The object was to provide both reference information through supporting tables, and basic analyses through textual presentation. The body of the text comments on the chief patterns and trends of each feature, usually by region. The topics chosen embrace a continuum from the demographic context to past and future contraceptive use, to service burdens, maternal and child health, HIV/AIDS, and, finally, to a selection of alternative action objectives. Large countries are given special attention in most sections.
    English
    Profiles116FP2ed.pdf

  • The success of family planning programs, continued growth in the number of women of reproductive age, and the growing response to curb the HIV/AIDS pandemic are increasing demand for contraceptives, including condoms, worldwide. Countries are faced with the challenge of ensuring that this demand can be sustainably met. Financing is not keeping pace, while the problem is also often one of disruptions and vulnerabilities in the systems that need to work well, and work together, to ensure that supplies are available to people. SPARHCS - The Strategic Pathway to Reproductive Health Commodity Security - is a tool to help countries develop and implement strategies to secure essential supplies for family planning and reproductive health programs. SPARHCS is meant to bring together a wide range of stakeholders to initiate at the country level concerted efforts toward the goal of reproductive health commodity security. It is not a roadmap, or a fixed process. SPARHCS can be customized to a country’s specific needs and resources. It can be used for contraceptives alone, for contraceptives and condoms for HIV/STI prevention, or for a still broader set of reproductive health supplies. (French)
    French
    SPARHCS_fre.pdf

  • The success of family planning programs, continued growth in the number of women of reproductive age, and the growing response to curb the HIV/AIDS pandemic are increasing demand for contraceptives, including condoms, worldwide. Countries are faced with the challenge of ensuring that this demand can be sustainably met. Financing is not keeping pace, while the problem is also often one of disruptions and vulnerabilities in the systems that need to work well, and work together, to ensure that supplies are available to people. SPARHCS - The Strategic Pathway to Reproductive Health Commodity Security - is a tool to help countries develop and implement strategies to secure essential supplies for family planning and reproductive health programs. SPARHCS is meant to bring together a wide range of stakeholders to initiate at the country level concerted efforts toward the goal of reproductive health commodity security. It is not a roadmap, or a fixed process. SPARHCS can be customized to a country’s specific needs and resources. It can be used for contraceptives alone, for contraceptives and condoms for HIV/STI prevention, or for a still broader set of reproductive health supplies.
    English
    SPARHCS.pdf

  • The success of family planning programs, continued growth in the number of women of reproductive age, and the growing response to curb the HIV/AIDS pandemic are increasing demand for contraceptives, including condoms, worldwide. Countries are faced with the challenge of ensuring that this demand can be sustainably met. Financing is not keeping pace, while the problem is also often one of disruptions and vulnerabilities in the systems that need to work well, and work together, to ensure that supplies are available to people. SPARHCS - The Strategic Pathway to Reproductive Health Commodity Security - is a tool to help countries develop and implement strategies to secure essential supplies for family planning and reproductive health programs. SPARHCS is meant to bring together a wide range of stakeholders to initiate at the country level concerted efforts toward the goal of reproductive health commodity security. It is not a roadmap, or a fixed process. SPARHCS can be customized to a country’s specific needs and resources. It can be used for contraceptives alone, for contraceptives and condoms for HIV/STI prevention, or for a still broader set of reproductive health supplies. (Spanish)
    Spanish
    SPARHCS_spa.pdf

  • This collection of stories highlights HIV-related advocacy work in communities around the world. This manual begins a process of documenting HIV/AIDS policy advocacy stories as a means of preserving them and making them available to others as more and more people become involved in HIV/AIDS advocacy issues. In all, 16 advocacy organizations are profiled in "Moments in Time." Although the stories focus on HIV/AIDS, the advocacy models are applicable to other settings and other issues. In fact, the developments in HIV/AIDS advocacy over the past 20 years can be helpful to other advocacy issues, just as other advocacy issues have been instrumental in the development of HIV/AIDS advocacy.
    Spanish
    MomentsSP.pdf

  • The following document was written by a team of leading economists and social scientists in response to the question, “What is the state of the art in the field of AIDS and economics”. This question was intentionally designed to provide authors with the ability to focus on the issues that they felt were most critical. As a result, each chapter represents a unique perspective on the question at hand.
    English
    SOTAecon.pdf

  • Recent international initiatives reflect, and are responding to, a worldwide movement for greater access and equity in HIV-related treatment. The new millennium has witnessed growing support from the global community to increase access to antiretroviral (ARV) treatment for those most in need. The global shift in support for treatment access, coupled with declining drug prices and the availability of generic drugs, has led many in the field to recognize that the barrier to treatment is no longer simply a matter of financial resources. This paper seeks to define treatment governance and address the roles that stigma and discrimination and the greater involvement of people with AIDS play in the policies and programs that are designed in response to the HIV/AIDS epidemic.
    English
    Treatment_Governance.pdf

  • English
    POLICY_FBO_and_HIV_Factsheet.pdf

  • Many people see an effective AIDS vaccine as the best solution to the HIV/AIDS pandemic. A considerable amount of funding and research effort is devoted to developing an effective vaccine. Ten years ago many scientists had hoped that a vaccine would be available by now. Most scientists are still optimistic that vaccines will be developed and many candidates are being tested. Programs to implement vaccination need to be developed in order to be ready when vaccines do become available. The nature of those programs will depend on the characteristics of each vaccine. How much does it cost? How effective is it? How long does protection last? The answers to these and other questions will help determine issues such as: Who should be vaccinated? Should regular re-vaccinations be scheduled? How much funding will be needed? Do vaccination campaigns need to be supported with safe sex messages? What will be the impact of the vaccine on the epidemic? This study uses two computer simulation models to investigate the effects of various vaccine characteristics and implementation strategies on the impact and costeffectiveness of vaccines in different contexts. A simulation model from the Imperial College is applied to data from rural Zimbabwe and the iwgAIDS model is applied to Kampala and Thailand. The models are used to investigate the effects of efficacy, duration, cost and type of protection on impact and cost-effectiveness. The models also illustrate the merits of targeting public subsidies to various population groups: all adults, teenagers, high- risk groups and reproductive age women. The impact of vaccines on the epidemic is compared with the impact of other prevention interventions, such as condom use and behavior change. Finally, the models are used to explore the extent to which behavioral reversals may erode the positive benefits of the vaccine. A highly effective, long- lasting, inexpensive vaccine would be ideal and could make a major contribution to controlling the HIV/AIDS pandemic. However, vaccines that do not attain this ideal can still be useful. A vaccine with 50 percent efficacy and 10 years duration supplied to 65 percent of all adults could reduce HIV incidence by 25 to 60 percent depending on the context and stage of the epidemic. Better efficacy and longer duration would provide even more impact. Programs focused on teenagers or high-risk populations have less overall impact but would provide significant benefits at much less cost than those reaching all adults. Behavioral reversals could erode much of the benefits of vaccination programs so it will be important to combine vaccination with continued messages about the importance of safe behaviors. The cost of the vaccines is not known at this time. At a cost of $10 or $20 per person vaccinated the cost per infection averted would be as low or lower than other prevention interventions. Higher costs for the vaccines and the need for many booster shots could reduce the cost-effectiveness significantly.
    English
    Vaccine_World_Bank_article.pdf

  • UNAIDS, USAID, and the POLICY Project developed the AIDS Program Effort Index (API) to measure program effort in the response to the HIV/AIDS epidemic. The index is designed to provide a current profile of national effort and a measure of change over time. The API was applied to 40 countries in 2000; a revised index was applied in 54 countries in early 2003. The results show that program effort is relatively high in the areas of political support, policies, and planning with average scores above 70 percent of the maximum effort. Prevention programs and the legal and regulatory environment are the next most highly rated components with scores between 60 and 70 percent. The human rights component received the lowest score. Respondents reported that legal structures are in place to protect human rights but that resources and enforcement efforts are lacking. Resource availability and mitigation effort also received low scores. By region, Eastern and Southern Africa has the highest overall scores. West and Central Africa and Asia also scored relatively high, with Latin America and the Caribbean and Eastern Europe somewhat lower. The average score for all countries increased slightly from 56 percent in 2000 to 59 percent in 2003. The largest increases were for political support, resources, and care and treatment. The API survey shows clearly that all countries have some organized effort to combat the HIV/AIDS epidemic. Most countries have good policies and organizational structures in place. The weakest areas are in the implementation of the policies and plans. Countries with the strongest effort, such as Brazil, Senegal, Thailand, and Uganda, all have strong political commitment and a national consensus that lead to significant effort to implement comprehensive programs.
    English
    API2003.pdf

  • This document was written at the request of the Service Delivery Improvement Division as part of its planning process for the next decade. It focuses primarily upon features that concern the provision of services, not upon all aspects of reproductive health programs. The first five sections present the factual background; the final two sections build on those to suggest future program strategies and options.
    English
    WW_ServiceDelivery.pdf

  • Spanish
    Answering_the_Call_SPANISH_FINAL.pdf