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Browse POLICY Project (1995-2006) Materials

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  • This briefing book is intended to provide information about the HIV/AIDS epidemic in Zimbabwe. This material is also available as a slide or interactive computer presentation. The information provided includes: what we know about HIV/AIDS in Zimbabwe today, the number of people who might develop AIDS in the future, the social and economic impacts of AIDS, and what needs to be done to prevent the spread of AIDS.
  • 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.
  • 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.
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  • The 1994 ICPD intensified the worldwide focus on reproductive health policies and programs. Officials in many countries have worked to adopt the recommendations in the ICPD Programme of Action and to shift their population policies and programs from an emphasis on achieving demographic targets for reduced population growth to a focus on improving the reproductive health of their population. This paper presents information from case studies carried out in Bangladesh, India, Nepal, Jordan, Ghana, Senegal, Jamaica, and Peru to assess each nation's process and progress in moving toward a reproductive health focus. The case studies show that within their unique social, cultural, and programmatic contexts, the eight countries have made significant progress in placing reproductive health on the national health agenda. All countries have adopted the ICPD definition of reproductive health either entirely or in part. Policy dialogue has occurred at the highest levels in all countries. The countries have also achieved considerable progress in broadening participation in reproductive health policymaking. Bangladesh, Senegal, and Ghana have been particularly effective in involving NGOs and civil society organizations in policy and program development. In some of the other countries, however, the level of participation and political support for reproductive health may not be sufficient to advance easily to the next crucial stage of implementation. The case studies indicate almost uniformly that countries are grappling with the issues of setting priorities, financing, and implementing reproductive health interventions. Bangladesh has made the greatest progress in these areas while India, Nepal, Ghana, Senegal, Jamaica, and Peru are beginning to take steps toward implementation of reproductive health activities. Jordan continues to focus primarily on family planning. Several challenges face these countries as they continue to implement reproductive heath programs. These challenges include improving knowledge and support of reproductive health programs among stakeholders; planning for integration and decentralized services; strengthening human resources; improving quality of care; addressing legal, regulatory, and social issues; clarifying the role of donors; and maintaining a long-term perspective regarding the implementation of the ICPD agenda. Despite many encouraging signs, limited progress has been achieved in actually implementing the Programme of Action; this finding is neither surprising nor unexpected. It took more than a generation to achieve the widespread adoption and implementation of family planning programs worldwide, and that task is far from complete. The key to continuing progress lies in setting priorities, developing budgets, phasing-in improvements, and crafting strategies for implementation of reproductive health interventions.
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