Welcome to the Publication Archives of USAID-funded Health Policy Projects.

Browse POLICY Project (1995-2006) Materials

↑ top

Files will load from www.policyproject.com.

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.

Core Packages-TOO Final Reports

  • The Allocate Model was designed to help countries overcome policy challenges by linking funding to program activities and linking program activities to outcome indicators. The models main objective is to help planners understand the relationship between funding levels and the effective implementation of safe motherhood, postabortion care, and family planning programs. The model aims to improve resource allocation for components of reproductive health (RH) programs by demonstrating its effects on a variety of national indicators. For example, what is the likely effect on maternal mortality rates if funding for family planning is reduced or increased? The Allocate Model facilitates the design of integrated national plans with attached budgets. The following models are used in the Allocate application. " DemProj. Forecasts the population structure for a country or a specific region by age and gender and by rural or urban residence based on specific fertility, mortality, and migration trends for up to 50 years in the future. This model serves as the base for most of the other models. " FamPlan. Estimates the number of users and acceptors and the cost of providing family planning (FP) services to (1) reduce unmet need for family planning, (2) achieve desired fertility, (3) attain a specified total fertility rate (TFR), (4) attain a specified contraceptive prevalence rate (CPR), and (5) achieve the maximum possible within a specific budget. FamPlan calculates indicators showing the number of users, commodities required, costs, unplanned pregnancies and births, and the number of abortions. " Safe Motherhood Model (SMM). Supports priority-setting exercises to demonstrate how improvements in program effort can help reduce maternal mortality rates. It allows improvements in different support and service areas and shows the impact of various patterns of effort. This model has a cost component that allows the user to cost out different interventions to help design national plans, strategies, and budgets. " Postabortion care (PAC) Model. Analyzes the effect of certain FP assumptions on maternal deaths; distributes maternal deaths according to planned births, unplanned births, and abortions; and demonstrates how the allocation of expenditures can increase postabortion treatments and reduce deaths. The POLICY Project provided technical assistance (TA) to Ukraine between February and July 2005, using the Allocate Model to help create a comprehensive National Reproductive Health Plan (NRHP) and to achieve greater efficiency in the use of available funds.
    Ukraine Allocate Core Report.doc
  • Ethiopias 1994 National Population Policy sets ambitious goals for 2015. However, most of the components of the policy have not been implemented and progress has been slow. In early 2004, the Ministry of Health (MOH), the U.S. Agency for International Development (USAID), the United Nations Population Fund (UNFPA), and other donors discussed the need to update the National Population Policy and create a Reproductive Health Strategic Framework. This activity was to be conducted jointly with major donors and stakeholders. The strategic framework was to address all areas of reproductive health, including family planning, safe motherhood, postabortion care, adolescent reproductive health, and possibly HIV/AIDS. At the same time, the government of Ethiopia was developing plans to achieve the Millennium Development Goals. The MOH was requested to indicate what actions and how much funding would be required to achieve the Millennium Development Goal (MDG) for safe motherhood. The Allocate Model was applied in Ethiopia to provide a thorough test of the model; to prepare an improved RH action plan with increased efficiency in the use of funding resources; and to foster dialogue among all stakeholders regarding RH priorities.
    Ethiopia Allocate case study.doc
  • The target of opportunity (TOO) in Bangladesh sought to strengthen women’s reproductive health using an innovative approach—repositioning family planning as a key component of safe motherhood programs. Family planning in the postpartum period not only allows couples to prevent unintended pregnancies, it enables women to plan and space births, which helps the mothers’ bodies recover before having another child. This limits the total number of pregnancies per woman and reduces the potential for higher-risk pregnancies. Promoting family planning in the postpartum is a critical strategy for Bangladesh because it has an estimated maternal mortality rate of 380—and, given the country’s population size, this places Bangladesh among the 10 countries with the highest number of maternal deaths in the world. Other priority action areas included promotion of safe motherhood practices for young couples, especially given early marriages in Bangladesh, and implementation of the Ministry of Health (MOH) draft National Maternal Health Strategy.
    BangladeshTOO 12-19-06 FINAL.pdf
  • From January 20022004, the POLICY Project and key stakeholders undertook an intensive, systematic policy analysis process that resulted in identifying two priority regulatory actions critical for reducing barriers to family planning and reproductive health (FP/RH); both actions were ultimately agreed to by Guatemalas Minister of Health, Dr. Julio Molina-Avilés. In January 2004, during his last weeks in office, Molina-Avilés signed a ministerial order that explicitly included the National Reproductive Health Program (NRHP) among the ministrys official health programs, effectively providing the policy and organizational foundation required to assure continuity of government-sponsored FP/RH service delivery under future administrations. He also supported modification of an existing government order that would define the NRHPs structure and functions and incorporated this and other stakeholder proposals for policy reform into the transition plan prepared for the incoming administration. The actions marked the end of a four-year period of support of FP/RH in Guatemala, as some members of the newly-elected incoming government vowed to reverse gains in FP/RH programs. Their task will be more difficult now because of the ministers actions and the broad political and popular support these actions received. This report traces the policy analysis process undertaken by stakeholders and POLICY by describing the context, methodology, sequence of events, major policy challenges, and the stakeholders involved in its successful outcome.
    Guatemala CP final report.doc
  • The POLICY Project funded a core package to assess the feasibility of integrating FP/MCH and STI/HIV services in two areas of Jamaica: the parish of Portland and the St. Ann's Bay Health District. Activities included: (1) mapping existing healthcare clinics and staff in Portland and St. Ann's Bay; (2) identifying potential integration interventions; (3) identifying operational policy barriers to integration; (4) conducting a feasibility study to determine whether the interventions could be implemented; (5) estimating the associated implementation costs; and (6) conducting a cost-effectiveness study regarding various alternatives for diagnosing and treating STIs. The core packages main results included the identification of priority interventions to facilitate integration and the development of a cost-effectiveness model for STI diagnosis and treatment. This report documents the POLICY Projects research activities and findings, including the context and organization of health services; activities undertaken to determine the feasibility and cost-effectiveness of integration interventions; key research findings; and the key results, challenges, lessons learned, and potential impact of the research conducted under this core package.
    Jamaica CP final report.doc
  • The POLICY Project implemented a core package of research and technical assistance to assist the government of Kenya in understanding the costs associated with the provision of family planning (FP) services over the period from 2003-2005. In implementing the financing part of the package, special attention was paid to addressing the needs of the poor, with free or highly subsidized services being delivered to such groups. This subsidy aspect of the package was introduced at the stage of developing guidelines for the implementation of user fees, waivers, and exemptions. Implementation of user fees was designed to generate revenue to maintain availability of FP services and strengthen the quality of those services while expanding access to the poor and underserved. Activities included analysis of current fee charging practices; analysis of operational policies affecting FP fees, waivers, and exemptions; market segmentation analysis; review of willingness and ability to pay; and development of draft pricing guidelines for FP services. POLICY core package activities led to a critical change of position on the merits of cost sharing by the Ministry of Health. The draft pricing guidelines will enable the government to enact an effective, evidence-based approach to implementing user fees, waivers, and exemptions for FP services. These results will ultimately lead to improved access to high-quality FP services for all social groups, including the the poor and currently underserved populations. This report documents the POLICY Project's core package in Kenya, taking into consideration the family planning and economic context in which the FP services are provided; key stakeholders; activities and products; key research findings; and lessons learned. The FP financing experience in Kenya has potential for replication in other countries.
    Kenya CP final report.doc
  • In August 2002, the first phase of POLICY Project's Core Package on the Reduction of Stigma and Discrimination Related to HIV/AIDS in Mexico (Proyecto Mo Kexteya) was launched in response to a request from the Mexican National Center for the Prevention and Control of HIV/AIDS (CENSIDA) to help develop indicators for a baseline measure of stigma and discrimination in Mexico and to identify innovative approaches to reducing this stigma. Completed in January 2004, the phase-a diagnostic phase-was designed to lay the groundwork for reducing HIV/AIDS-related stigma and discrimination by addressing it in a holistic manner through careful analysis and by developing replicable interventions. This report examines the four components of the diagnostic phase and outlines the process of developing an action plan to mobilize partners, build a policy dialogue, and undertake interventions to reduce stigma and discrimination. It also highlights some of the main results.
    Mexico CP Final Report 1 11 06.doc
  • In 2003, the POLICY Project implemented a core package in Nepal, which was designed to create a model for increasing the meaningful participation of injecting drug users (IDUs) in the HIV/AIDS policymaking environment. Activities centered on bringing together recovering IDUs to form a network, thereby developing their leadership capacity and knowledge of HIV prevention in order to advocate for HIV treatment, support, and care. This report describes how the project took on a life of its own and helped transform a loosely organized network into an established nongovernmental organization (NGO). The following list exemplifies the breadth of the project's achievements: 1) Nepal's first IDU network was created, which united IDUs and increased their leadership capacity. 2)549 IDUs participated in training sessions throughout the country. 3)IDUs advocated with donors and policymakers for care, treatment, and support, including free drug rehabilitation services, for people living with HIV/AIDS (PLHAs). 4)IDUs developed strategic relationships among themselves and with policymakers, donors, and HIV service and drug rehabilitation organizations. 5)The network successfully used the media to raise awareness of stigma and discrimination against IDUs and PLHAs.
    Nepal CP final.doc
  • This paper documents the achievements of the Edo State YAARH core package, which was implemented over the period from August 2001 through March 2004. Section II presents the context, policy issues, and stakeholders affecting the successful implementation of YAARH policies and programs in Edo State. Sections III and IV focus on the interventions and results achieved under the package, and Section V discusses the legacy of the project. In summary, this paper documents a pilot effort to facilitate a participatory networking, strategic planning, capacity building and advocacy process, resulting in a strengthened role for civil society in policy processes; the development, adoption, and funding of an evidence-based state-level YAARH strategy; and an improved enabling environment for the implementation of national YAARH policies and strategies at the state level.
  • The POLICY Project (POLICY) provided a focused technical assistance package between September 2002 and June 2004 in Peru to help identify and eliminate operational barriers that stand in the way of access to safe delivery care for low-income women, particularly in areas with high maternal mortality. Our research and analysis identified barriers to delivery care. Key stakeholders at both the regional and national levels assessed the most significant barriers as follows: the severe lack of financial resources and absence of appropriate personnel at health establishments; multifaceted problems with the implementation of the Integrated Health Insurance (SIS) resulting in poor quality services that clients must pay for; and lack of respect for local cultural practices and customs at health facilities that serve as a disincentive for women seeking institutional care for their deliveries.
  • This report summarizes the analysis, actions, and lessons learned from the core-funded activity, Policy Reform to Meet Access-to-Treatment Goals. The POLICY Project, in partnership with the International Community of Women Living with HIV/AIDS (ICW) in Swaziland and South Africa, implemented the project from October 2004 to December 2005. The report describes the results of the project’s rapid assessment of HIV-positive women’s access to care, treatment, and support (ACTS) in Swaziland. The purpose of the assessment was to gain a clear understanding of the specific issues affecting HIV-positive women and how the policy environment supports advocacy opportunities for policy and programmatic change. Subsequent to the rapid assessment, POLICY supported ICW-led validation and capacity-building workshops to translate analysis into prioritized advocacy issues and action plans.
    ACTS Final Report 5 18 06.pdf
  • Contraceptive security, defined as a condition when all women and men who need and want contraceptives can obtain them (Sine and Sharma, 2002), is a new concept in Romania. Nonetheless, in August 2000, the government approved—for the first time ever—policies that included a budget line item for contraceptives and the provision of free commodities to vulnerable population sectors. The August 2000 policies were broad, and implementation problems soon emerged. In response, the USAID-funded POLICY Project (POLICY) provided a focused package of technical assistance (TA) that lasted from March 2001 to December 2002 to help the government of Romania (GOR) to target those most in need and improve family planning equity. POLICY assistance contributed to four GOR policy decisions that occurred between 2001 and 2003: 1. Increased Ministry of Health and Family (MOHF) resources for free contraceptives in 2001 and 2002 2. Generic contraceptive formularies covered by social health insurance (2002) 3. Norms for government funding of nongovernmental organizations (NGOs) involved in public health programs, including providing free contraceptives to the poor (approved in 2003) 4. Self-certification of poverty status as documentary proof for access to free contraceptives (2003)
  • In 2002, the POLICY Project embarked on an HIV/AIDS stigma research project in a country that has a substantial HIV/AIDS epidemic. The POLICY Project developed HIV/AIDS indicators and guidelines for stigma mitigation through a participatory, consultative process. The project carried out a qualitative research study in three sectors that play a leadership role in South Africa: the faith-based sector, national government departments, and the media. The research was conducted in communities across South Africa, and of the focus group participants, 85 percent were black, 55 percent were women, and 43 percent were people living with HIV/AIDS. HIV/AIDS indicators were developed to assist HIV/AIDS program managers to monitor and evaluate the effectiveness of their stigma mitigation efforts. Comprehensive guidelines were also developed to guide and strengthen HIV/AIDS programs to ensure that HIV/AIDS stigma mitigation programs are mainstreamed, resulting in a comprehensive and effective response to the HIV/AIDS epidemic in South Africa. Further funding has been secured through USAID/South Africa to continue the project and ensure that the findings, tools, and documents from this research will be used, tested, and improved and that they inform training interventions in the next phase of the project.
  • With one of the highest HIV prevalence rates in the world, Swaziland faces substantial demand for care and support by those affected by HIV/AIDS. In particular, women bear the brunt of the epidemic, as historically their unequal social and legal status has made them more vulnerable to HIV and less able to access care and support. Against this backdrop, the USAID-funded POLICY Project initiated a core package project in May 2003. Named Sikanyekanye, meaning "we are together," the project sought to identify and address operational policy barriers to improving and promoting HIV-positive women's reproductive health within the context of programs that address reproductive health, HIV/AIDS, and sexually transmitted infections (STIs). Project activities focused on voluntary counseling and testing, prevention of mother-to-child transmission, and antenatal care. This report provides background information on the status of women, HIV/AIDS, and the policy environment in Swaziland. It includes a detailed description of the project approach, activities, and results, followed by implementation challenges. The report ends with an examination of the project's impact, concluding that the advocacy and policy change strategy used in the core package provides a multisectoral and multilevel framework for advancing HIV-positive women's reproductive health globally.
    Swaziland CP report final.pdf
  • From July 2004-December 2005, POLICY, in partnership with the International Community of Women Living with HIV/AIDS (ICW), implemented the core-funded target of opportunity (TOO), Meeting the Reproductive Health Needs of HIV-Positive Women: Using Evidence to Advocate for Change, in Swaziland and South Africa. This report presents a summary of the key findings from the project's rapid assessments on HIV-positive women's reproductive health (RH) needs and details the project’s lessons learned and implications for implementing possible future activities.
    TOO RH Swaziland and South Africa.pdf
  • This report includes two-page summaries that document the purpose, objectives, activities, and achievements of each TOO and also their related products, such as final activity reports and studies. In Uganda, POLICY conducted a study to assess the position of family planning in the context of HIV/AIDS policies and programs and the demand for and use of family planning by clients of HIV/AIDS services. The Haiti TOO focused on identifying policy and operational barriers to the provision of and access to voluntary counseling and testing services for adolescents. The ongoing TOO in Bangladesh is designing and implementing an innovative advocacy approach for maternal health. In South Africa and Swaziland, the TOO increased the capacity of HIV-positive women's networks to advocate for improved policies and guidelines to better address the family planning and reproductive health needs of HIV-positive women. The stigma and discrimination TOO is advancing the global debate on addressing stigma and discrimination as a central element in all HIV/AIDS programs.
    TOO.Activities and Achievements.12.15.05.doc
  • Uganda has had laudable success in reducing HIV prevalence in the country and is still focused on strengthening and scaling up prevention, treatment and care, and support efforts. Currently, over 1 million people are estimated to have received HIV counseling and testing, over 500,000 HIV-positive individuals are receiving palliative care and over 60,000 are receiving antiretroviral therapy (ART). Access to services has increased as service delivery sites have expanded into rural areas. With a prevalence rate that appears to have stalled at around 7 percent and new infections continuing to occur among those of reproductive age, the epidemic still requires policy and program attention.
    Uganda TOO Final 12 20 05.pdf
  • Through a targeted package of activities, POLICY assisted major stakeholders in analyzing the operational policy barriers to implementing the National Reproductive Health Program 2001-2005 (NRHP). POLICY also provided technical assistance from September 2001 to November 2003 to help the RH Policy Development Group identify and document operational policy barriers to efficient resource allocation and use in two typical Ukrainian cities (Kamianets-Podilsky and Svitlovodsk) and to help RH stakeholders in Kamianets-Podilsky set priorities and include them in an RH implementation plan. This paper documents the role of the POLICY Project in achieving policy changes and decisions regarding the NRHP.
    Ukraine CP final 11.05.doc