For health equity to prevail, individuals must have access to essential health services, regardless of wealth, geographic location, gender, sexual identity, or ethnic group. Also crucial is strong political commitment to inform pro-equity health sector reform and ensure equal access.
To help foster political will, HP+ engages relevant stakeholders and supports the integration of equity goals within development strategies and policies. To ensure equity is sustained, we support countries to estimate the resources needed to reach vulnerable populations and monitor progress towards equitable health systems over time through quantitative data analytics.
HP+'s approach to assessing equity issues involves clearly understanding the equity problem, and includes identifying systematic barriers to access; quantifying inequalities; engaging stakeholders; integrating equity goals, targeting resources, and implementing policies; and monitoring equity issues over time. Specifically, we:
Develop pro-equity standards, working with countries to understand and reduce systematic barriers—such as stigma and discrimination—to accessing quality healthcare, in particular barriers that disproportionately affect vulnerable populations.
For seven years, HP+ has worked with government and partners across Mali’s health system. Results and accomplishments were highlighted Thursday, June 9 with an end-of-project event in Bamako. Over the last two years, HP+ in Mali focused on health financing, health system strengthening, and health equity. Representatives of Mali’s National Health Insurance Fund and Devolution and Decentralization Support Team emphasized the importance of the in-depth health financing analyses HP+ conducted to support Mali’s health system. Analyses have focused on provider payment systems, health finance flows, and efficiency and equity at all levels, and were completed in collaboration with key partners. Also noted at the event was HP+’s role in advancing advocacy for community health worker (CHW) rights and legal status. These efforts led to the recent adoption of a decree enshrining the formal status and rights of CHWs, marking a transformative step toward making essential community healthcare sustainable and accessible for all Malians. In closing her remarks at the ceremony, Director of Health at USAID/Mali Julia Henn emphasized, “Although HP+ is coming to a close, we are still with you and will continue to support the Malian population.”
Seven Years Catalyzing Universal Health Coverage Reforms in Nigeria
May 2022 —
On May 19, Nigeria marked seven years of work between the government, local stakeholders, and the Health Policy Plus (HP+) project with an in-person event, streamed live. The event focused on sharing knowledge and discussing how to sustain gains in locally led development, equity for health services, and improved access to care in family planning and reproductive health, maternal and child health, HIV, and tuberculosis across Nigeria. As Dr. Ngozi Azodoh, director of the Planning, Research and Statistics Department, of Nigeria’s Federal Ministry of Health (FMOH) told the gathering: “Like Oliver Twist, the FMOH wants more. [More] support from the HP+ team and the project director and an expansion of the scope of work in Nigeria … to help the Ministry of Health build a stronger health system and work towards meeting the country’s health goals.” Project director, Suneeta Sharma, attended the event and spoke to the more than 70 attendees present, including representatives of the FMOH, the National Agency for Control of AIDS, the National Health Insurance Scheme, the National Primary Health Care Development Board, the chairman of the Senate Committee on Primary Health Care and Communicable Diseases, implementing partners, civil society and private sector organizations, USAID Nigeria, and the media.
Regulation on Public-Private Partnerships for Health Approved in Indonesia
March 2022 —
Indonesia’s Minister of Health approved a regulation for public-private partnerships (PPPs) in the health sector in mid-February 2022. HP+ supported the ministry’s Center for Health Financing and Decentralization Policy in spearheading the development, adoption, and sensitization process for the regulation. PPPs are helpful in mobilizing the private sector to address gaps in health services within the public health sector. This regulation, which focuses on non-infrastructure needs within the health sector, will allow private companies and organizations to address government health priorities through various contracting and partnership mechanisms. This is expected to contribute to sustainable and equitable scale-up of those services. Read our report on Building the Foundation for Public-Private Partnerships for Indonesia’s Health Sector.
HP+ Experts Present at Global Digital Health Forum
December 2021 —
HP+ experts showcased digital health solutions that promote sustainability, equity, and private sector engagement at the Global Digital Health Forum, held December 6–8, 2021, under the theme of Improving Health Through Digital Transformation. For HP+ Mozambique, Marcel Saraiva presented efforts to transition a digital planning and budgeting module to the government as part of a panel on “Cultivating Successful Transition of Digital Systems to Government for Long-term Sustainability,” which was moderated by HP+’s Allison Connolly. Presenting HP+ Indonesia’s work, Adhiatma Akosah was part of a session on “Making Healthcare Fairer and More Equitable,” in which he highlighted the unique challenges faced by a local technology company delivering maternal and newborn digital care tools in the COVID-19 context. Lastly, HP+’s Bryant Lee presented on “Using Blended Finance to Mobilize Private Capital for Digital Health Enterprises” to share recommendations and opportunities to leverage new financing for affordable health in lower- and middle-income countries
Expanding Equity Measurements of Family Planning Beyond Wealth Status and Contraceptive Use
October 2021 —
A review published in the October edition of the Bulletin of the World Health Organization by the partnership on High Impact Practices in Family Planning, with HP+ Senior Technical Advisor for Family Planning Sara Stratton as the lead author, looked at how equity is measured in family planning programs. The review of eight studies revealed variations in how equity is defined, with most addressing economic barriers to contraceptive use. Drawing on the findings, the authors propose a more comprehensive approach for examining and addressing inequities in family planning. The article recommends expanding how inequities are characterized and how they are measured and evaluated to go beyond wealth as the sole driver of inequity and contraceptive use as the primary outcome.
Tanzania launches its fifth Five-Year Health Sector Strategic Plan
July 2021 —
Tanzania recently launched its fifth five-year health plan, a TSh 47 trillion roadmap for saving more than 200,000 lives and reducing HIV incidence by 50 percent. The Five-Year Health Sector Strategic Plan (HSSP V) also lays out strategies for averting more than 400,000 disability-adjusted life years and reducing infant, neonatal, and maternal mortality. To estimate the cost of the strategy, equivalent to US$20.3 billion, HP+ used the OneHealth tool. HP+ also estimated the resources available for the health sector from all sources. The mission of the plan, which covers 2021 to 2026, is to provide sustainable health services with standards that are acceptable to all citizens without financial constraints, based on geographical and gender equity. In her address during the June 24 launch, Honorable Minister for Health, Community Development, Gender, Elderly and Children, Dr. Dorothy Gwajima said the plan will expand reach of primary health services and address the prevention and treatment of both communicable and non-communicable diseases.
COVID-19 Vaccines: Needs, Lessons Learned and Recommendations for Effective Rollout
April 2021 —
As part of the global effort to equitably supply vaccines to countries in need, HP+ convened academic and program implementation experts to share best practices, lessons learned, and tools to support rollout in low-resource countries. Under an accelerated effort, developing countries will be supported by the COVAX mechanism to immunize 20 percent of the population in 2021. The target group, scale, and intensity of this immunization campaign is significantly different than those handled by health ministries and immunization programs in the past. Joining the discussion to explore this were Ramon Soto of HP+’s COVID-19 response team in Honduras, Dr. Laila Woc-Colburn from Emory University’s School of Medicine, Dr. Edwin Asturias from the University of Colorado Denver, and Danielle Darrow de Mora of FHI 360. Key issues emerging from the discussion include strategies to deliver vaccines to hard-to-reach populations including migrants and indigenous populations and the need to include communities in rollout planning (microplanning). Panelists proposed effective strategies on the prevention, identification, and management of rare adverse events.
Vaccine Equity a Crucial Issue as Countries Battle Pandemic
April 2021 —
In a recent blog post, HP+ deputy director Sara Bowsky argues that community healthcare workers and advocates for the marginalized need a seat at the table where governance decisions are being made. The call comes as the COVID-19 vaccination rollout has exposed inequities in access in both the United States and developing countries. She weighs the advantages and disadvantages of local and national responses to the pandemic. “But what’s needed is a balanced, adaptable approach—one that draws on the power and actions of communities in conjunction with federal and state agencies, and the collaboration needed to reinforce such a response,” she writes.
Knowledge Success Blog Features New Tool to Advance Family Planning Health Equity
March 2021 —
HP+ has produced a tool that expands the definition of conventional inequities in family planning to include such concepts as quality of care and access to information and services. In a blog post published by Knowledge Success earlier this month, HP+ shared the Family Planning Equity Tool, which goes beyond the traditional metrics of family planning inequality such as contraceptive uptake. Application of the tool in Uganda suggests that unmarried and less-educated women may be underrepresented in traditional measurements of family planning inequality.
New FP Equity Model
December 2020 —
Quality family planning information and services have not yet reached those with the greatest need. To support progress toward equitable healthcare, HP+ developed an approach for diagnosing inequity in family planning programs. This approach identifies inequities: 1) for a diverse range of disadvantaged subgroups; 2) for various programmatic components of family planning; and 3) at national and subnational levels. Replicable across countries, this approach enables users to easily transform demographic and health survey data to better understand the profile of inequity. This information can be used to develop evidence for policy, financing, and programmatic decisions at national and subnational levels. The new methodology and replication guide describes the approach and provides step-by-step instructions for running the open source code independently. Results from the application of the approach to Uganda can be found in the brief and in this webinar.
Cambodia’s National Social Protection Council Executive Committee Approves Monitoring and Evaluation System Developed with HP+ Support
October 2020 —
On September 14, 2020, Cambodia’s National Social Protection Executive Committee approved the adoption of a new monitoring and evaluation (M&E) system, developed with HP+ support, to enable systematic oversight of social protection results and financing to manage its portfolio, improve accountability and transparency, and inform future investment priorities. HP+ supported the development of the system by creating a logical framework and identifying indicators; drafting an operational manual and legal framework; and providing customized trainings and ongoing coaching to build capacity of a new team with no previous M&E experience. Implementation of the system will support Cambodia’s policy goals of preventing and reducing poverty, vulnerability, and inequality.
Webinar Introduces New Approach for Diagnosing Inequities in Family Planning Programming
June 2020 —
An HP+ webinar on May 28—Diagnosing Inequities in Family Planning Programs: A Case Study from Uganda—introduced a new, replicable approach for diagnosing inequities across family planning programming outputs and outcomes at both national and subnational levels. Presenters showcased results from its application to Uganda, focusing on the sub-regions, disadvantaged sub-groups, and family planning components for which inequities are most pervasive, and demonstrated its applicability to other countries. Use of the model is intended to increase the quality of family planning information and services for women.
Nigeria’s Abia State Government Releases Funds for Technology Infrastructure to Support Health Insurance Rollout
March 2020 —
Nigeria’s Abia State government has formally approved the release of US$137,000 as take-off grant to be used for procuring technology infrastructure—a critical need that has delayed the rollout of the state insurance scheme since its official launch in September 2019. HP+ has supported Abia State Health Insurance Agency (ABSHIA) in multi-layered advocacy efforts that resulted in the release of the take-off grant. The release of the grant will enable an effective rollout of the ABSHIS toward providing health insurance for about 200,000 residents—a major leap forward in improving access to affordable and equitable quality healthcare in the state.
Champions secure strengthened RH law, right family planning access for all
January 2018 —
Burkina Faso's reproductive health law has been strengthened with the Minister of Health's approval of new regulatory language that emphasizes the rights of users, including new text that states, "People of reproductive age or adolescents can freely use family planning without any barrier or constraints related to sex, religion, [or] marital status." The reproductive health law, originally passed in 2005 with support from USAID-funded health policy projects in collaboration with the National Assembly, had previously lacked enforceability. The new language, developed in collaboration with HP+, the West Africa Health Organization Network of Champions, and AgirPF, extends rights to reproductive health and family planning to all persons of childbearing age, including adolescents.
Mauritania Reproductive Health Law Advances – Language Guarantees Reproductive Health as Universal Right
November 2016 —
Mauritania’s Council of Ministers, on October 6, 2016, approved the text of a new Reproductive Health Law, which explicitly states that the right to reproductive health care is a universal right guaranteed to all throughout the course of their lives and prohibits forms of violence against women, including female genital mutilation. The law, submitted by the Minister of Health, brings Mauritania’s national policies into alignment with those of other countries of the Ouagadougou Partnership pursuing commitments on family planning outlined in FP2020 goals. This comes as a result of nearly a decade of unceasing effort by USAID and its policy advocacy partners, including UNFPA, Health Policy Plus and its predecessor projects, which helped draft an early version of the law for FP2020 advocacy efforts across West Africa. The bill will be presented to Parliament for passage in the coming months.
Lessons from LAC: Expanding family planning through universal health coverage
November 2016 —
In recent decades many Latin America and Caribbean (LAC) countries have lowered fertility rates and increased contraceptive prevalence. This progress is due in part to broad social reforms, including the adoption of universal health coverage (UHC) policies. To extract lessons for countries—both within LAC and beyond—who are in the early stages of implementing UHC programs, USAID through the Health Policy Plus project examined the interplay between UHC and family planning (FP) in nine countries. They found that, while LAC’s progress in moving toward UHC and expanding FP access has been positive, systematic inequalities persist. Most social health insurance schemes cover FP, but method choice is not always guaranteed and there are disparities in access and coverage between ethnic, geographical, and wealth groups. The briefs are available for download from the HP+ website.