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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.

General Reports

  • 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
  • The Millennium Development Goals (MDGs)—a set of eight, time-bound goals ranging from reducing poverty by half to providing universal primary education—present a major and important challenge to developing countries. The MDGs are set to be met by 2015, but current reports show that many countries are not “on track” to meet the goals by the deadline. If progress continues at the current rate, only the safe water and sanitation MDG will be met by all countries by 2015 (Vandemoortele, 2002). This report is about one strategy that will make the MDGs easier and more affordable for countries to meet. It shows how meeting unmet need for family planning can help countries achieve the MDGs by reducing the size of the target population groups for the MDGs and therefore lowering the costs of meeting the MDGs. A benefit-cost analysis was applied to 16 sub-Saharan African countries: Burkina Faso, Cameroon, Chad, Ethiopia, Ghana, Guinea, Kenya, Madagascar, Mali, Niger, Nigeria, Rwanda, Senegal, Tanzania, Uganda, and Zambia. Analyses were included for selected targets and indicators of five of the eight MDGs: • Achieve universal primary education • Reduce child mortality • Improve maternal health • Ensure environmental sustainability • Combat HIV/AIDS, malaria and other diseases Given past high rates of fertility, the number of women expected to enter the reproductive age group in the next 10 years will increase by some 35 percent resulting in a 33 percent increase in the annual number of pregnancies. A significant percentage of these pregnancies are either mistimed or unintended. For example, in five of the 16 countries that were studied more than half of the pregnancies were mistimed or unintended. One reason for this is the low use of family planning and the high rates of unmet need for family planning. In Rwanda, for example, 35 percent of women have an unmet need for family planning, suggesting a high level of latent demand and presenting a potential opportunity for increased provision of family planning services. For each country, two population scenarios were created: one when current unmet need for family planning is met and one when unmet need is not met. The costs of family planning and of meeting selected targets of each of the five MDGs were estimated under both scenarios for each country. Next, the difference in cost between the two scenarios was calculated over the 10-year period from 2005 to 2015. The additional cost of family planning was then compared with the savings that family planning will generate in each of the selected MDG sectors to calculate benefit-cost ratios for each sector and for the country overall. The analysis shows that the benefits (measured by savings in meeting MDG targets) from meeting unmet need outweigh the extra costs of meeting the unmet need in all countries. Overall, we found that benefit-cost ratios ranged from 2.03 in Ethiopia to 6.22 in Senegal. The greatest potential for cost savings in most countries is in education and maternal heath. Health benefits for children and mothers were also analyzed. The analysis shows that meeting unmet need can help avert maternal deaths during childbirth by reducing the number of pregnancies and induced abortions. For example in Tanzania, 18,688 mothers’ lives could be saved. Reducing unmet need for family planning can also reduce the number of infant and child deaths by reducing the percent of high-risk births. In Ethiopia and Nigeria, more than one million children’s lives would be saved. Thus, while increasing family planning use is not one of the MDGs, a strategy to increase contraceptive use by reducing the unmet need for family planning can play a valuable complementary role and help countries to move closer to achieving their MDGs by freeing up resources to meet these goals while at the same time saving lives.
    English
    MDGMaster 9 12 06 FINAL.pdf
  • Countries in the Asia-Pacific region have reached a crossroads in their HIV/AIDS response. The ability of countries in the region to maintain low national HIV prevalence levels will depend on their success in rapidly scaling up prevention, care, and treatment. The argument for responding quickly is compelling: the longer governments wait to adopt interventions, the higher the eventual cost in lives, productivity, and national as well as household medical expenses. The leadership and resources needed for rapid scale up requires strong political commitment and action from the countries’ highest leaders. “Act Now”—a joint publication of the Asia-Pacific Leadership Forum on HIV/AIDS and Development (APLF), UNAIDS, and the USAID-funded POLICY Project—encourages leaders from across the region to vigorously combat the epidemic before the situation worsens. Responses will have their greatest impact if countries act when national prevalence is still low.
    English
    ANE_ActNow.pdf
  • The POLICY Project conducted assessments of adolescent and youth reproductive health in 13 countries in the Asia and Near East (ANE) region that represent diverse population sizes and geographical, cultural, and socioeconomic settings. The countries included Egypt, Jordan, Morocco, and Yemen in the Near East; Bangladesh, India, Nepal, Pakistan, and Sri Lanka in South Asia; and Cambodia, Indonesia, the Philippines, and Vietnam in Southeast Asia. In 2000, there were 354 million young people ages 15–24 in these 13 countries combined. The purpose of the assessments was to highlight the reproductive health status of adolescents and youth in each country within the context of the lives of young males and females.
    English
    arh.cfm
  • While the need to address the reproductive health (RH) of HIV-positive women has been acknowledged in recent calls to action and articulated in advocacy efforts, less attention has been paid to identifying the specific policy changes required for its promotion. POLICY Project assessments and advocacy efforts in seven countries from Africa, Asia, and Eastern Europe have revealed key policy barriers and changes needed to support positive women’s reproductive health. The assessments indicate that policy changes need to focus on central areas such as (1) support for positive women’s informed RH decisions to have or not have children—free of coercion and discrimination; and (2) access to high-quality RH information, counseling, and care tailored for positive women. Assessment findings also highlight the supportive policy changes needed across RH and HIV programs and the gender policies and laws needed in the public sector and among communities, faith-based organizations, and businesses. This paper examines policy changes at multiple levels—from laws to national policies and plans to the often overlooked range of operational policies—and provides concrete examples of how these changes can address the two aforementioned central areas. The paper particularly contributes to identifying needed policy changes to support HIV-positive women’s health at the operational policy level, including, for example, formulation of clinical protocols, provider training, healthcare financing, and guidelines for operationalizing the Greater Involvement for People with Living with HIV/AIDS (GIPA) principle.
    English
    Advancing the RH of HIV Positive Women Policy Barriers Final 8 11 061.pdf
  • Four background papers prepared for the Plenary Session on HIV/AIDS of the AGOA Forum address issues related to the HIV/AIDS crisis.
    English
    AGOA_Overview.PDF
  • This paper describes the AGOA objectives and explains how HIV/AIDS may affect our ability to achieve those objectives.
    English
    AGOA_1.PDF
  • There is a growing literature that discusses the impact of HIV/AIDS on prospects for development (Barnett and Whiteside, 2002, provides an excellent overview). Less attention has been paid to the impact of development on the spread of HIV/AIDS. The process of development often leads to rural–urban migration, increased trade and transport, and the attenuation of family relations due to physical separation. These processes pose challenges in the fight against HIV/AIDS. On balance, economic growth and development support the fight against AIDS, yet the process of development must be managed effectively to assure that economic development and the fight against AIDS work together to benefit sub-Saharan Africa. Workplace programs are cost-effective. AGOA factories provide ideal environments for implementation of HIV/AIDS prevention, care, and treatment programs that are mutually beneficial for the companies and societies.
    English
    AGOA2003_1.pdf
  • AGOA representatives met late in 2001, again in 2002, and now for a third time in December 2003. Background papers from previous meetings suggested a number of actions that AGOA member countries could consider to enhance the effectiveness of responses to the threat of HIV/AIDS. This paper summarizes a few issues and actions, linking the actions specifically to (1) finance and planning ministries, (2) trade, labor, and commerce ministries, (3) the business sector, and (4) donors and assistance agencies. The delegates could discuss which key actions they would like to monitor and possibly report on at the next AGOA forum. They are welcome to recommend fresh approaches to maximize the benefits that can derive from a results-oriented, cooperative effort in the fight against HIV/AIDS.
    English
    AGOA2003_2.pdf
  • This paper describes the challenges ministries of finance and planning face in responding to the HIV/AIDS epidemic.
    English
    AGOA_2.PDF
  • The accompanying tables provide background data on health spending in AGOA countries; background data on successful applications for grants from the Global Fund to Fights AIDS, Tuberculosis and Malaria and grants received by AGOA countries under the World Bank Multisectoral AIDS Program (MAP) for Africa; and background data on HIV/AIDS prevalence. These data may help orient and clarify discussion of progress and objectives.
    English
    AGOA2003_3.pdf
  • This paper addresses challenges faced by ministries of trade and commerce in addressing the HIV/AIDS crisis, particularly in the areas of intellectual rights, trade practices, tourism, the world of work, and international competitiveness.
    English
    AGOA_3.PDF
  • This paper discusses ways in which the private business sector is responding to the issue of HIV/AIDS.
    English
    AGOA_4.PDF
  • This study tests the hypothesis suggested by many smaller studies that young people prefer to use private providers to access contraceptive methods. It examines the patterns in young women’s levels of sexual activity, use of modern methods of contraception, and sources of modern contraception by age group and union status, using Demographic and Health Survey (DHS) data. In addition, while controlling for other important explanatory variables, the study seeks to answer the question of whether young women are more likely to choose private sector providers than older women. Results indicate that young women ages 15–24 have higher levels of sexual experience in Africa than in the Latin American, Caribbean, or Asian countries included in this analysis. Overall proportions of young women currently using modern contraceptive methods in Africa, however, are quite low when compared with countries included in the analysis from the Latin American, Caribbean, and Asian regions. Data examining whether young women are more likely than older women to choose private sector providers—while controlling for important explanatory variables—reveal mixed results. In Africa, data for most countries indicate that young women are significantly more likely to choose private and commercial sector providers. In two of the four countries examined in Asia, young women were significantly more likely to choose the private sector. Only in the Latin American and Caribbean (LAC) countries were young women generally less likely to choose private and commercial sector providers than older women.
    English
    contraception_sources.pdf
  • The purpose of this paper is to examine the costs and savings associated with making FP services available at HIV/AIDS treatment centers. The paper will summarize study findings that discuss how providing contraception to HIV-negative and HIV-positive women can help to prevent new infections among women and reduce the risk of a child becoming HIV positive due to an unintended pregnancy or of subsequently becoming an orphan because the child's mother or father dies of AIDS-related causes. The paper will also present estimates of the costs and savings of including family planning in existing HIV-related care and treatment services in the original 14 Emergency Plan focus countries.
    English
    FP-HIV Integration Costs and Savings Final.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
  • Progress toward achieving the goals of the Declaration of Commitment on HIV/AIDS and the Millennium Development Goals requires significant expandsion of HIV/AIDS programs to foster a supportive environment, to prevent new infections, to care for those already infected, and to mitigate the social and economic consequences of the epidemic. One measure of progress is the percentage of people living in low- and middle-income countries who have access to key prevention and care services. This report presents the results of an assessment of the coverage of several key health services in 2003. It updates and adds information to a similar report on coverage in 2001. This report includes results from 73 countries, including most low- and middle-income countries with more than 10,000 people living with HIV/AIDS in 2003. The information presented here relies on service statistics and expert assessment. These data focus on the quantity of services provided and do not address the quality of those services. The results should be interpreted with caution but are useful in indicating the progress made in the last two years toward future goals. The results of this analysis suggest that most people in low- and middle-income countries do not have access to many key prevention services. Utilization is very low for voluntary counseling and testing (VCT) with an estimated 6.1 million visits per year or 0.2 percent of adults 15–49. Approximately 10 million pregnant women are offered services to prevent mother-to-child transmission of HIV (PMTCT), about 8 percent of all pregnant women in these countries. About 70,000 women receive AZT or nevirapine to prevent HIV transmission to the newborn child, only 3 percent of all HIV-positive pregnant women.
    English
    CoverageSurveyReport.pdf
  • This report includes results from 69 countries, including most low- and middle-income countries with more than 10,000 people living with HIV in 2005. The information presented here relies on national service statistics and expert assessment. These data focus on the quantity of services provided and do not address the quality of those services. In many countries, national consensus workshops were held to validate the data. Estimates of the population in need of each service have been derived from demographic and epidemiological statistics and may not correspond to national estimates of need, but are used here to present coverage estimates that are comparable across countries and regions. For countries that did not participate in the survey, we have used regional averages to estimate the number of people served. The results should be interpreted with caution, but are useful in indicating the progress made in the last two years toward future goals. For all regions combined, prevention services are provided to about 33% of sex workers, 9% of men who have sex with men, 34% of prisoners, and 16% of children living on the street. Twenty-six countries reported having prevention programs for injecting drug users, most from Eastern Europe and Asia. The most common type of program was information and education on risk reduction, which is provided for about one million injecting drug users. Needle and syringe exchange programs reach less than half as many (400,000) and drug substitution programs reach only about 32,000. Estimates of the number of injecting drug users are highly uncertain, but coverage of harm reduction programs is still low in most lowand middle-income countries. In short, significant progress has been made in most areas since 2001, but the only programs that provide access to most people who need services are AIDS education in the schools and condoms. Some regions have achieved universal access for some services, such as ART in Latin America. In most other areas, greater effort will be required to expand services to meet the goal of universal access.
    English
    HIVCoverage20051.pdf
  • Excel file with the country annex tables to accompany the document, "Coverage of selected services for HIV/AIDS prevention, care, and treatment in low- and middle-income countries in 2005."
    English
    FINAL HIV Coverage Survey 2005 - Country Annex Tables.xls
  • 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 publication provides a concise overview of the current situation; analyzes the future course and impact of HIV/AIDS in the region; outlines recommendations for responding to the epidemic; and highlights promising programs that are already underway. Importantly, the report is designed as a user-friendly tool to help both government policymakers and civil society advocates encourage policy dialogue and commitment to address HIV/AIDS throughout the region. Focusing on the HIV/AIDS situation in Cambodia, the People's Democratic Republic of Laos, Thailand, and Viet Nam, the report also draws attention to six issues that are of particular concern in the region: 1) Women and HIV/AIDS, 2) Children Affected by HIV/AIDS, 3) Health Care Delivery and Costs, 4) Implications for Development, 5) Cross-border Issues, and 6) HIV/AIDS and Tuberculosis. Promoting an enabling policy environment, responding to the entire continuum of care (including prevention, care, and mitigation), and empowering vulnerable groups are among the strategies that are noted as central to an effective HIV/AIDS response in the Mekong Region.
    English
    HIV_Mekong.pdf
  • This paper provides an overview of the rationale for integrating family planning into HIV programs, as well as lists of resources that can be used for policy development and policy implementation to integrate FP into HIV policies and programs. It is a companion document to the CD-ROM of the same name, which contains the actual resources listed. The paper is divided into seven sections: 1. International conventions (FP and HIV-related service integration) 2. National HIV policies and FP 3. VCT policies and FP 4. PMTCT policies and FP 5. ART policies and FP 6. Operational policies 7. Additional resources
    English
    ImplementingPoliciesandPrograms.pdf
  • This paper will offer evidence of the positive effect of adding a follow-up PAC visit, during which women can fully benefit from voluntary HIV counseling and testing and receive additional support for FP use. Evidence will be presented in terms of the benefits to women receiving PAC services, progress toward development goals, and potential cost savings.
    English
    VCT into PAC FINAL4.pdf
  • Throughout the world, a number of countries are facing withdrawal of funding and technical assistance for their family planning programs. This trend, known throughout the family planning community as “phaseout” or “graduation,” is occurring for various reasons. In many countries, phaseout is linked to the success of the family planning program and the ability of the country program to become self-reliant. As donors, missions, and governments make decisions to phaseout family planning support and create strategies for transitioning to an independent program, there is a need to reflect on experiences from past phaseouts. This case study of Mexico provides an in-depth look at a national family planning program before, during, and after phaseout and documents the lessons learned from that process.
    English
    Mexico_Phaseout_of_FP_Donor_Suppot_Report.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
  • To learn more about how countries have been addressing RH-and family planning (FP) in particular-commodities and where significant advocacy efforts have occurred, the POLICY Project, the International Planned Parenthood Federation (IPPF), and United Nations Population Fund (UNFPA) undertook a global survey of local and international, nongovernmental organizations (NGOs) and public officials. The survey’s goal was to gather information on countries' processes and activities aimed at meeting current and future contraceptive commodity needs. This report focuses principally on the results of the survey; however, it also includes complementary findings from additional research on recent and current CS activities.
    English
    RHCS Paper Final.pdf
  • Policy change is influenced by several factors, including the issue, context, process, and actors. This paper presents case studies of networks in 11 countries assisted by the POLICY Project to demonstrate how reproductive health advocacy networks were influential actors that played a role in fostering significant policy changes over the past decade. In 1995, with the launch of the POLICY Project, the U.S. Agency for International Development (USAID) sought to put the principles of meaningful participation and civil society engagement in family planning/reproductive health (FP/RH) policymaking—as articulated during the 1994 International Conference on Population and Development—into practice. The objective of POLICY was to create an enabling environment for the formulation and implementation of policies and plans that promote and sustain access to high-quality FP/RH, HIV, and maternal health services. USAID and POLICY recognized that civil society-led networks and coalitions could play a significant role in encouraging political commitment for FP/RH, facilitating broader stakeholder participation in policy processes, and ensuring improved quality of and equitable access to services. Reproductive health advocacy networks, therefore, became a critical mechanism for POLICY in its efforts to promote participation of civil society groups and other partners in the health policy arena.
    English
    Networking Paper POLCY EOP report_FINAL.pdf
  • This document presents a summary of the global OVC situation and identifies policy-level gaps in national responses to the growing crisis. Importantly, the report proposes a country-level OVC "policy package" and offers recommendations to guide future policy dialogue and action. Adopting laws that protect the rights of all children, encouraging multisectoral collaboration, placing a special emphasis on educational opportunities, and establishing systems to identify the most vulnerable children are all crucial aspects of a comprehensive OVC policy response.
    English
    OVC_Policies.pdf
  • This document presents a summary of the global OVC situation and identifies policy-level gaps in national responses to the growing crisis. Importantly, the report proposes a country-level OVC "policy package" and offers recommendations to guide future policy dialogue and action. Adopting laws that protect the rights of all children, encouraging multisectoral collaboration, placing a special emphasis on educational opportunities, and establishing systems to identify the most vulnerable children are all crucial aspects of a comprehensive OVC policy response.
    French
    OVC_PoliciesFr.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
  • Approximately 15 million children worldwide have been orphaned by AIDS. In addition, there are almost 1,800 new HIV infections per day in children under 15ýmostly due to mother-to-child transmission (UNICEF, 2005). Preventing children from becoming orphans should be a priority goal adopted by governments, nongovernmental organizations (NGOs), and donors. Effective strategies to achieve this goal include preventing unintended or mistimed pregnancies, keeping HIV-positive parents healthy, decreasing maternal mortality, and preventing new HIV transmission. Interventions should focus on increasing access to family planning services, testing and counseling services, antiretroviral therapy (ART), and comprehensive healthcare services for women.
    English
    OVC Programming Paper 2006_FINAL.pdf
  • Los módulos contenidos aquí proporciona una lista de intervenciones en salud reproductiva e investigación de soporteque documentan la eficacia de las mismas. Esta guía será de utilidad para quienes desarrollen lineamientos para las mejores prácticas. Aquí se presenta una síntesis de las investigaciones publicadas en trabajos de revisión de pares con datos claros y transparentes sobre la efectividad de distintas intervenciones en salud reproductiva, iniciativas políticas y de programas que pueden ser implementados con el fin de mejorar la planificación familiar/salud reproductiva y reducir las ITS/VIH/SIDA en países en desarrollo, en vez de dosificar niveles de medicamentos específicos. La información biomédica ha sido incluida toda vez que ésta haya sido relevante para las consideraciones programáticas.
    Spanish
    WhatWorksSpan.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
  • 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
  • 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.
    English
    GAQsynthesis.pdf
  • USAID and its cooperating agencies are studying procurement issues and options for countries that no longer receive USAID and/or international donor support for contraceptive commodities, including Brazil, Chile, Colombia, Costa Rica, and Mexico. This report summarizes the key findings from Costa Rica. This review of Costa Rica's contraceptive procurement practices suggests that the country program has been successful in maintaining a consistent supply of contraceptives from a variety of sectors. The Costa Rican government received its final contraceptive commodity support from international donors more than 12 years ago. In 1992—just before USAID's withdrawal from Costa Rica—contraceptive prevalence was already high at 75 percent. The latest reproductive health survey conducted (1999) showed another increase in prevalence to 80 percent—almost six years after USAID's withdrawal. This report highlights the key factors that were important in procuring sufficient contraceptive commodities to meet the needs of Costa Rican men and women.
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    382_1_Procurement_Options_Costa_Rica.pdf
  • USAID and its cooperating agencies are studying procurement issues and options for countries that no longer receive USAID and/or international donor support for contraceptive commodities, including Brazil, Chile, Colombia, Costa Rica, and Mexico. This report summarizes the key findings from Mexico. The review of Mexico's contraceptive procurement practices suggests that almost seven years after the phaseout of USAID support, public health institutions—particularly the Ministry of Health—are still facing some challenges in ensuring the availability of high-quality, affordable contraceptive supplies.
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    383_1_Procurement_Options_Mexico_FINAL.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.
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    WW_ServiceDelivery.pdf
  • A fresh reason for attending to fertility dynamics has emerged—the “demographic dividend.” As fertility rates fall during the demographic transition, if countries act wisely before and during the transition, a special window opens up for faster economic growth and human development.
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    Demo_Div.pdf
  • Worldwide, about 500,000 women and girls die of complications related to pregnancy and childbirth each year; and over 99 percent of these deaths occur in developing countries. The tragedy – and opportunity – is that most maternal deaths could be prevented with cost-effective health care services. Facing a range of competing priorities and limited resources, policymakers and program planners are in need of concise information on programs that are both effective and feasible. The POLICY Project is pleased to have the opportunity to make a significant contribution to the maternal health field with the launch of a new resource that documents safe motherhood interventions that work. This publication – the first in a series entitled “What Works: A Policy and Program Guide to the Evidence on Family Planning, Safe Motherhood, and STI/HIV/AIDS Interventions” – presents a comprehensive review of the interventions (with supporting evidence) that have been shown to enhance maternal health in developing countries. Importantly, this document helps public health officials and decision makers answer the question “What should we do?” when trying to figure out how to improve maternal health. It is also a tool to help maternal health advocates demonstrate that safe motherhood programs save lives, benefit societies and communities, and are effective and feasible, even in resource-constrained settings. The Safe Motherhood Module brings together the best available evidence on a range of interventions and packages it in one convenient source, covering topics such as Labor and Delivery, Postnatal Care, Care During Pregnancy, Pre-pregnancy Care, and Policy and Program Issues. It also provides guidance on programs that have not been shown to work, programs that should be avoided, and programs for which more evidence is needed. Additional sections provide a summary of safe motherhood interventions and present resources for program designers. The Safe Motherhood Module has been reviewed by some of the world’s leading maternal health experts, including those from the United Nations Population Fund (UNFPA), World Health Organization (WHO), International Center for Research on Women (ICRW), JHPIEGO, Pan American Health Organization (PAHO), U.S. Agency for International Development (USAID), and others. Forthcoming modules in the series will focus on addressing STIs/HIV/AIDS and reducing unintended pregnancies.
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    SM_WhatWorksps2.pdf