Browse POLICY Project (1995-2006) Materials
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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.
The POLICY Project, funded by the US Agency for International Development (USAID), led a major effort to improve the policy environment for family planning/reproductive health (FP/RH), HIV, and maternal health in developing countries. Implemented in two phases (1995–2000 and 2000–2006), the project combined several USAID technical assistance areas—namely awareness raising, policy dialogue, and policy formulation—into a single program. POLICY’s mandate was to improve policies for an expanded range of reproductive health issues, including HIV and maternal health and to strengthen these policies by promoting multisectoral involvement in policy development processes. Together, POLICY I and II garnered $230 million in USAID core and field support, with the majority of funding received from USAID Missions. POLICY II, for example, established dozens of country offices and worked with four USAID regional programs. Overall, the project achieved nearly 1,100 strategic objective- and intermediate-level results in response to the project’s results-based framework. What this means is that, under POLICY II alone, the project: • Fostered the adoption of more than 140 policies and plans to guide FP/RH, HIV, and maternal health services; • Helped to form or build the capacity of more than 100 civil society networks, including reproductive health advocacy networks and networks of people living with HIV; • Brought groups such as faith-based organizations and businesses into the health policymaking process; • Awarded more than 250 small grants to support grassroots policy dialogue and advocacy efforts; • Conducted groundbreaking policy analyses to raise awareness of issues such as contraceptive security, resource needs, women’s inheritance rights, and HIV-related stigma; and • Assisted countries and partners allocate, mobilize, and/or leverage more than $200 million in additional funding for FP/RH, HIV, and maternal health. These results directly contributed not only to the project’s objective of creating an enabling policy environment, and helped meet the strategic goals of USAID’s Bureau for Global Health, USAID Missions, the President’s Emergency Plan for AIDS Relief, and host-country governments and partners. For the POLICY Project, how it achieved its objective was as important as what it accomplished. The project’s innovative model for implementing the work was both a facilitator and indicator of its overall success. Recognizing that sustainable policy processes must inevitably come from within a country, POLICY set out to establish a project model that put its principles—country focus, multisectoral engagement, capacity development, decentralization—into practice. POLICY transferred authority to local country directors and staff and equipped them with the necessary training, technical assistance from U.S.-based staff, and operational systems to effectively carry out their work. The project employed more than 600 field staff and worked closely with hundreds of local consultants and partners, thereby fostering “policy communities” in each country that will sustain policy work long after the project ends.
POLICY Project Final Report_FINAL.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.
MDGMaster 9 12 06 FINAL.pdf
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.
Advancing the RH of HIV Positive Women Policy Barriers Final 8 11 061.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.
FP-HIV Integration Costs and Savings Final.pdf
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
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.
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.
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.
Measure HIV Stigma.pdf
The Allocate Model was applied in Senegal from November 2005 to April 2006 to assist the government with developing their new national health strategic plan. As illustrated by the model’s application and findings described in this report, Senegal would benefit from an increased effort in meeting unmet need for contraception and an expanded and higher quality postabortion care (PAC) program. This would result in an improved allocation of resources from a reduction in the number of women requiring PAC services and, most importantly, a decrease in maternal mortality. This report discuss the status of maternal health in Senegal, the use of relevant model applications to help inform the development of strategic plans, the central findings from these applications, and recommendations and next steps regarding priority areas for follow-up activities and resource allocation.
Senegal Allocate Report Final 8 9 06.pdf
This report reviews the progress made to date under Egypt’s family planning (FP) program and estimates the benefits that have already been realized. It documents the effects of the FP program on Egypt’s demographic transition through a review of the country’s major demographic indicators. To estimate the benefits realized, a scenario of a less successful FP program was created and compared with the cumulative public sector savings achieved as a result of Egypt’s actual FP program for the period of 1980–2005. The health benefits for children and mothers were also analyzed.
Egypt 25 yr retro Final.pdf
The POLICY Project facilitated a technical workshop, titled Epidemiologic Projections, Demographic Impact & Resource Allocation in Namibia, from February 27–March 2, 2006. Fifteen participants attended, including representatives from the public sector (the Ministry of Health and Social Services, the Ministry of Education, and the Central Bureau of Statistics); nongovernmental organizations (the Social Marketing Association of Namibia); academia (the University of Namibia); and development partners (the Centers for Disease Control and Prevention and the Global Fund to Fight AIDS, Tuberculosis and Malaria). The multisectoral group included public sector planners and other technical experts in demography, epidemiology, and economics. A large policy forum was conducted immediately following the workshop (March 3, 2006) and brought together 47 participants from a wide range of Namibian and international institutions. The workshop findings were presented and discussed, including how they could be used as an advocacy tool for resource generation and reallocation. The overall goal of the workshop was to present tools and strategies to assist the decisionmaking process for national-level resource allocation for HIV/AIDS. The main tool discussed was the Goals Model, an interactive computer-based tool that links budget allocation decisions to their impact on HIV/AIDS program goals. By stressing an evidence-based, multisectoral participatory process, POLICY hoped to build capacity in resource allocation advocacy and modeling skills, deepen local understanding of the strengths and weaknesses of the current HIV surveillance system in Namibia, and project the future course of the epidemic.
Namibia Windhoek final report Edited FINAL 5 22 06.pdf
This case study focuses on Cambodia, where a group of advocates recognized that involving men was an important aspect of improving the country's reproductive health status. Members of MEDiCAM, a large network of health nongovernmental organizations in Cambodia, formed the Reproductive Health Promotion Working Group (RHPWG), with technical assistance from the POLICY Project. Working as a bridge between implementers and policymakers, the RHPWG identified male involvement in reproductive health as its top advocacy priority. Through concerted advocacy efforts, the group succeeded in garnering policymaker support and worked with relevant ministries and other stakeholders to establish standard guidelines for male involvement programs. The draft guidelines were structured to align with the major components of the country's forthcoming Strategic Plan for Reproductive Health in Cambodia (2006-2010), which now refers explicitly to male involvement in several places. Cambodia's experience is a good model for other countries seeking to strengthen male involvement initiatives through advocacy, policy development, and implementation.
Cambodia MI casestudy final 1 24 06.doc
This booklet examines the impact of rapid population growth on development and illustrates how a successful population management program would provide significant economic and social benefits to Ghana, thereby improving the quality of life for all Ghanaians. The booklet is based on analysis conducted using the Resource for Awareness of Population Impacts on Development (RAPID) model.
A study of the print media in Cambodia in 2003 found that HIV/AIDS reporting was often sensationalistic or voyeuristic, displaying little respect for the dignity of people living with HIV/AIDS who were usually depicted as victims or objects of sympathy. This resource has been developed as a result of recognition that there was no media guide to meet the growing demands of reporters covering the increasingly complex HIV/AIDS issues.
Parent-Youth Relationships: Implications for Youth Reproductive Health Policies and Programs
Integrating Voluntary Counseling and Testing into a Reproductive Health Program for Young People
The IFPS Project sought to design, test, and expand innovative approaches for improving quality of and access to family planning and reproductive and child health services, particularly for women, rural populations, and other underserved groups. This document reviews lessons learned from this project to help policymakers and program planners improve RCH services in India or other countries.
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.
VCT into PAC FINAL4.pdf
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
Each year, nearly 530,000 women and girls die due to pregnancy- and childbirth-related causes and another 8 to 20 million suffer serious injuries and disabilities (WHO, 2003; UNFPA, 2005). The majority of maternal deaths occur immediately after or within one day of delivery, often due to severe hemorrhaging, obstructed labor, infection/sepsis, and eclampsia/hypertension. While proper care and nutrition throughout pregnancy (including regular antenatal checkups) are essential for reducing and identifying risks, researchers, health professionals, and policymakers are increasingly recognizing that skilled delivery assistance, access to emergency obstetric care, and prevention and treatment of postpartum hemorrhage are the most important strategies for preventing maternal and neonatal deaths and disabilities. It is skilled assistance at the critical time of delivery that can make the difference between life and death for thousands of women and their babies around the world.
Safe Motherhood Brief 1 HQP.pdf
The term “safe motherhood” refers to efforts to prevent maternal and infant death and disability through improved access to healthcare and other supportive services (White Ribbon Alliance, 2005). Sadly, women in the developing world experience a 1 in 61 lifetime risk of dying from pregnancy- or childbirth-related complications (World Health Organization, 2003). This is compared to a 1 in 2,800 lifetime risk for their counterparts in developed countries. Common causes of maternal and neonatal mortality and morbidity are excessive bleeding, obstructed labor, infections, and hypertensive disorders. They can occur suddenly, often with little warning. However, negative outcomes can be greatly reduced with proper nutrition throughout the pregnancy, skilled assistance at delivery, and access to regular antenatal checkups, emergency obstetric care, and postpartum care. Effective operational policies are essential for ensuring access to maternal health services, especially for underserved and hard-to-reach populations. Operational policies are the rules, regulations, codes, guidelines, and administrative norms that governments and organizations use to translate laws, policies, and resources into programs and services on the ground (Cross et al., 2001). These policies and guidelines affect all aspects of service quality and accessibility. Examples of operational barriers include unreliable supplies of medicines, unnecessary restrictions on the types of services that can be performed by various healthcare providers, high user fees for services, and inconsistent resource allocation and staffing plans that neglect rural health facilities.
Safe Motherhood Brief 2 HQP.pdf
In countries with high fertility rates and poor access to maternal healthcare services, each pregnancy can put a woman’s life at risk. Women in the developing world experience a 1 in 61 lifetime risk of dying from pregnancy- or childbirth-related complications. This is compared to a 1 in 2,800 lifetime risk for their counterparts in developed countries. Lifetime risk of maternal death considers the “probability of becoming pregnant and the probability of dying as a result of pregnancy cumulated across a woman’s reproductive years” (WHO, 2003, p. 1). Factors that increase the likelihood of complications during pregnancy and delivery include (1) too many pregnancies, (2) too short an interval between pregnancies, (3) having a pregnancy too early in life, or (4) having a pregnancy too late in life. These risk factors can negatively affect a woman’s long-term health by depleting her nutritional and overall health status— contributing to anemia, fatigue, increased blood pressure, and decreased immunity to diseases such as malaria and reproductive tract infections. These factors can also increase the risk of birth injury, miscarriage, or stillbirth. It stands to reason, then, that maternal and neonatal deaths can be prevented by (1) limiting the number of pregnancies each woman experiences during her lifetime and (2) improving access to reproductive and maternal healthcare—particularly antenatal care, skilled attendance at delivery, emergency obstetric care, postpartum care, and postabortion care. Family planning allows for healthy spacing and timing of pregnancies and limits the number of unintended pregnancies, both of which are essential components of comprehensive safe motherhood strategies (see Figure 1). Through integration of family planning and safe motherhood programs, women can limit their overall fertility and reduce the number of times they are at risk for maternal death; space births, thereby allowing their bodies to recover from previous pregnancies; and time their pregnancies. Improving access to and integrating family planning and safe motherhood programs provides additional societal benefits, including: healthier women who are better able to contribute economically to their families and communities; a reduction in neonatal deaths, deaths among children under 5, and children orphaned by maternal mortality; a reduced burden on public health and social welfare systems; and a reduction in abortions.
Safe Motherhood Brief 3 HQP.pdf
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
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.
RHCS Paper Final.pdf
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
The POLICY Project prepared this paper as part of a study of the status of family planning in four countries hit hard by HIV/AIDS: Ethiopia, Kenya, Zambia, and Cambodia.
Working Paper 17- FP HIV Integration Synthesis.doc
El objeto de este breve informe es ayudar a los gobiernos nacionales y subnacionales y directores de programas para que trabajen en forma conjunta para alcanzar sus objetivos de la DAIA. Aún cuando la autoridad y la responsabilidad se transfieran a niveles inferiores de gobierno, una iniciativa de la DAIA efectiva requerirá el liderazgo, compromiso y coordinación del gobierno central. Este breve informe incluye cinco temas que se deberian tratar al intentar de lograr la disponibilidad asegurada de insumos anticonceptivos en niveles inferiores de gobierno: (1) política; (2) planificación estratégica; (3) finanzas; (4) logística, adquisición y administración de recursos humanos; y (5) participación comunitaria. En cada tema, el informe propone estrategias para la capitalización de oportunidades al trabajar en un entorno descentralizado al mismo tiempo que se enfrentan los desafíos relacionados. Asimismo, se incluyen ejemplos de los países que han progresado con respecto a la disponibilidad asegurada de insumos anticonceptivos en entornos descentralizados.
Ce résumé est un guide ayant pour but d’aider les gouvernements nationaux et sous-nationaux2 et les responsables des programmes à travailler ensemble pour atteindre les buts de la SC de leur pays.Même lorsque les pouvoirs et les responsabilités sont délégués au niveau local, une initiative réussie de SC n’en demande pas moins la direction, l’engagement et la coordination du gouvernement central. Ce communiqué est organisé en cinq domaines d’activités essentielles dans cette quête vers la sécurité contraceptive aux niveaux inférieurs du gouvernement: 1) politiques, 2)planification stratégique, 3) financement, 4) logistique, achat et gestion des ressources humaines, et 5) participation communautaire. Pour chaque domaine, le communiqué propose des stratégies pour tirer profit des possibilités dont s’accompagne la décentralisation tout en cherchant à surmonter les obstacles et relever les défis qui se présentent. Des exemples sont également présentés de pays qui ont réussi à progresser vers la sécurité contraceptive dans un milieu décentralisé.
This brief is intended to help national and subnational governments and program managers to work together to achieve their countries' CS goals. Even when authority and responsibility are transferred to lower levels of government, a successful CS initiative still requires the central government's leadership, commitment, and coordination. This brief is organized into five areas that focus on issues to be addressed while aiming to achieve contraceptive security at lower levels of government: (1) policy; (2) strategic planning; (3) finance; (4) logistics, procurement, and management of human resources; and (5) community participation. In each area, the brief proposes strategies for capitalizing on the opportunities for working in a decentralized setting while addressing the associated challenges.
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.
Networking Paper POLCY EOP report_FINAL.pdf
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
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.
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.
OVC Programming Paper 2006_FINAL.pdf
Seizing the Moment: An Advocacy Kit for GBV Policy Change is a practical toolkit directed to NGO leaders, researchers, advocates, and others who work on the issue of gender-based violence (GBV) around the world. While numerous resources are available to those who work on GBV as a social issue, the POLICY Project saw the need for a specific product that helps advocates use data to build support for increasing resources for GBV programming. The Advocacy Kit was prepared by the POLICY Project under USAID Contract No. HRN-00-00-00006-00. POLICY Project is implemented by the Futures Group in collaboration with the Centre for Development and Population Activities (CEDPA) and Research Triangle Institute (RTI). Components of the Advocacy Kit include: · Responding to GBV: A Focus on Policy Change – A 33-slide PowerPoint presentation is provided on CD-ROM that builds a case for an improved policy response to GBV. The presentation seeks to raise awareness about the societal costs of GBV and propose solutions to address the issue. It defines GBV and related myths and realities, unpacks GBV as a public health and development issue, and explores the specific costs of the phenomenon on society. The presentation serves as a template and provides sample policy recommendations to address GBV. The presenter is encouraged to adapt the PowerPoint to his/her own country setting, using local GBV data where available. · Responding to GBV: A Focus on Policy Change – A Companion Guide The companion guide is included to support the advocate as s/he prepares to deliver the PowerPoint presentation. A first section about setting the stage looks at potential audiences, advocacy entry points, and presentation tips. The second section provides detailed guidance to the presenter about how to adapt the presentation’s content to a specific country setting using available data sources. Finally, the companion guide includes a set of speaker’s notes—a suggested narrative script that the presenter can rely on, if s/he so chooses. · Understanding the Issue: An Annotated Bibliography on GBV This 28-page bibliography was prepared in January 2006 to reflect the most current publications and materials concerned with gender-based violence—most of which are available on the World Wide Web. Documents include basic information about the prevalence and nature of GBV, training tools, reviews of promising interventions to address GBV, and how-to guides for service providers to improve the health sector response to GBV.
This report documents the significance and impact of the POLICY Projects core packages and targets of opportunity that address HIV/AIDS issues. The HIV portfolio includes two core packages implemented in Nepal and Swaziland, respectively; one target of opportunity located in South Africa and Swaziland; and one target of opportunity summarizing major findings and lessons learned from POLICYs work on stigma and discrimination, especially the work stemming from earlier core packages in Mexico and South Africa. These core packages and targets of opportunity reflect POLICYs technical leadership in developing approaches to repositioning communities most affected by HIV at the center of the global policy response. In particular, the projects focused on formulating models to support leadership and advocacy among those most affected by HIV, including HIV-positive women and injection drug users (IDUs), and on developing innovative approaches to reducing stigma and discrimination. Together, these approaches represent part of POLICYs effective response to HIV.
HIV AIDS CP final report.doc
This report documents the significance and impact of the POLICY Projects core packages and targets of opportunity that address FP/RH issues. This report documents the achievements of five RH core packages conducted in Guatemala, Kenya, Jamaica, and Peru and the design and application of the Allocate core package and three targets of opportunity in Bangladesh, Haiti, and Uganda. All of the core packages and targets of opportunity assessed current policies and addressed the components of those policies that hinder access to reproductive health services. Activities under the core packages and targets of opportunity aimed to assess operational policies and remove barriers to access; integrate family planning, HIV/AIDS/STI, and maternal health services; improve access to services among the poor, and implement new tools for and approaches to resource allocation and advocacy.
RH CP final report.doc
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.
Family planning remains one of the most cost-effective public health measures available in developing countries. Use of family planning is associated with lower rates of maternal and infant mortality and can influence economic growth. It is an essential component in the prevention of mother-to-child transmission (PMTCT) of HIV/AIDS and in adolescent reproductive healthcare programs, and it can play a role in improving gender equity. Expanding access to and improving the quality of family planning programs around the world is central to improving and maintaining the health of individuals and societies and helping them reach their full potential. The purpose of this toolkit is to assist advocates in the family planning/reproductive health fi eld in their efforts to promote policy dialogue on the health, social, and economic benefi ts of increasing access to family planning services. By tailoring the messages included in the toolkit, advocates can present culturally relevant arguments to promote family planning and birth spacing in their particular settings.
Family Planning Toolkit final.pdf
This report summarizes the POLICY Project in Nepal from 2002-2006. This report addresses the policy environment when the project began, major accomplishments, and remaining challenges to the enabling evironment for HIV and AIDS programming in Nepal.
Strengthening the HIV & AIDS Policy Environment in Nepal- Nepal Final Report.pdf
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
This report presents information regarding practicing midwives’ skill sets, scopes and protocols of practice, and referral systems to identify gaps in access and service delivery, legal and operational barriers to practice, and geographical disparities in coverage. These data provide important direction for policymakers to increase the ability of Ghanaian women to access comprehensive services and strengthen midwives’ ability to provide those services. Midwives are important providers of reproductive healthcare in Ghana. There are more than 3,379 midwives in Ghana compared with fewer than 2,000 physicians. While midwives practice throughout the country, physicians tend to be clustered in large cities. As a result, midwives provide the majority of antenatal, delivery, and newborn and postpartum care, including emergency obstetric care, especially in rural areas. Further, midwives provide family planning services, postabortion care, treatment of sexually transmitted infections (STIs), nutrition and breastfeeding counseling, and child health services. The purpose of the Midwife Mapping Project was to assess the accessibility to comprehensive reproductive healthcare, including routine and emergency obstetric care, as provided by midwives, as well as to learn about midwives’ experiences in service provision throughout Ghana. The study included three complementary research methodologies: • Policy environment analysis • Survey of practicing midwives and geospatial mapping • Focus group discussions (FGDs) with practicing and non-practicing midwives
Ghana Midwife Mapping final.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.