Welcome to the USAID-funded Health Policy Plus (HP+) project website.
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On September 30, 2021, HP+ oriented stakeholders from international and local reproductive health nongovernmental organizations, multilateral and bilateral partners, and the Democratic Republic of the Congo’s ministries of health and planning on the application of the Family Planning-Sustainable Development Goals (FP-SDGs) model, which is currently underway. The model allows users to simulate the effects of family planning on a variety of health and non-health SDG indicators. It is anticipated that data resulting from use of the model will inform advocacy messages in support of a new five-year family planning strategy and ongoing family planning programs. As part of this application of the model, HP+ is developing an additional module to be completed by the end of the year connecting population to deforestation. The module is expected to simulate the impact of various policy scenarios on population as well as other factors that contribute to deforestation, such as gender, economic development, forest management, and governance.
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.
Youth in Madagascar have provided valuable input during a review of Madagascar’s 2016–2020 Costed Implementation Plan (CIP) for Family Planning and provided insight to be considered for the next CIP. The participatory and multisectoral CIP review, for which HP+ provided technical support, included the perspectives of youth stakeholders as members of the family planning committee. Their insight was particularly valuable as Madagascar’s CIP addresses the unique needs of young people in a country where nearly 60 percent of the population are under the age of 25. The CIP review revealed that the modern contraceptive prevalence rate among young people increased by 4 percentage points from the CIP’s introduction in 2016 to its end in 2020. Furthermore, recommendations from a May 2021 virtual consultation, led by the Youth Advocacy Association as part of the CIP gap analysis, will be factored into the next CIP (2021–2025). Their proposals include improving contraceptive supply chains, continuing to strengthen implementation of the 2018 law on reproductive health and family planning, bolstering government commitment to family planning, and improving service offerings that meet the specific needs of young people. They requested specific strategies targeting youth and recommended greater engagement of youth networks, nongovernmental organizations, and associations in family planning demand creation.
From 2017 to 2020, HP+ Cambodia delivered technical assistance and capacity development to advance universal health coverage and the sustainability of key Cambodian health programs. This included supporting the National Social Protection Council Secretariat to implement and monitor the National Social Protection Policy Framework 2016–2025, the government’s long-term roadmap to increase support for vulnerable populations and expand health insurance. The newly published Manual for the Social Protection Monitoring and Evaluation Mechanism, developed over three years of support from HP+, is a monitoring tool to ensure consistency, transparency, and accountability in the framework’s implementation. Approved by the National Social Protection Council in September 2020, the tool is now publicly available in English and Khmer on the GS-NPSC website. Cambodia’s Minister of Economy and Finance acknowledges USAID and HP+ support within the manual, stating, “As the chairman of the National Social Protection Council, I would like to deeply thank and acknowledge the contributions of the technical teams and all stakeholders, especially the Health Policy Plus (HP+) project supported by the United States Agency for International Development (USAID), as well as other development partners including UNICEF, for their active cooperation and valuable inputs to make this M&E mechanism happen.”
A “how-to” guide on an innovative, community-driven advocacy approach that can be used to facilitate local-level implementation of national policies and strategies has been published by HP+. HP+ used this multisectoral approach to strengthen implementation of Malawi’s national youth-friendly health services strategy, developing and piloting the approach in Mangochi District. The guide is intended to enable policymakers, government institutions, implementing partners, and others to replicate, refine, and tailor the approach used by HP+ to strengthen community-level implementation of national policies and strategies. While the HP+ pilot focused on youth-friendly health services and the guide’s contents are presented in those terms, the approach can easily be applied to support local-level implementation of other national strategies.
In Malawi, HP+ launched an intergenerational mentoring activity to support emerging young leaders to engage village, district, and national stakeholders to deliver on the sexual and reproductive health and rights promises laid out in national policies. Connecting emerging young leaders with more experienced mentors in a structured advocacy mentoring program provides a unique opportunity to support young people to affect the institutions with which they work. In line with positive youth development methodologies, the purpose of such a mentoring program is to (1) provide one-on-one support to build the agency of young people to participate in decision-making processes and (2) cultivate their knowledge, leadership skills, and abilities to meaningfully participate and advocate for their priorities. This guide provides best practices in mentoring learned from the experience in Malawi.
Madagascar’s Ministry of Public Health has published a final review of its 2016-2020 Costed Implementation Plan (CIP) in a new report available through HP+. The CIP is a five-year roadmap that identifies evidence-based strategies and approaches for improving family planning programs and estimates the costs of implementing those strategies. The final review report examines and details the CIP achievements using Organisation for Economic Co-operation and Development (OECD) criteria of effectiveness, efficiency, coherence, relevance, impact, and sustainability. The effort was part of the project’s commitment to help strengthen Malagasy capacity to develop, implement, and monitor health sector policies and strategies to improve equity and sustainability of health services. Information from the review report, which also includes perspectives of family planning stakeholders in-country and a literature review, will be used by Madagascar stakeholders as they develop the country’s next CIP and to improve the nation’s family planning program. HP+ had previously supported the government of Madagascar’s efforts to develop and implement the national costed implementation plan (CIP) for family planning (2016-2020).
Following a request by the USAID Kenya Mission, HP+ conducted a high-level budget advocacy training for all USAID implementing partners (IPs) during the latest USAID Chief of Parties’ meeting. The training was aimed at sharing HP+ knowledge and expertise on identifying key opportunities and bottlenecks along the medium-term expenditure framework (MTEF) process to effectively influence budgetary allocations for priority health programs. It is expected that this engagement will enable collaboration between HP+ and IPs support resource mobilization efforts across national and county governments through the MTEF budget process, thereby facilitating efficient allocation and mobilization of domestic resources to sustainably finance key health programs.
Turkana county health leaders pledged to reinstate budget lines for HIV (Ksh 500,000), as well as restore subprogram budget lines for reproductive, maternal, neonatal, child and adolescent health care (RMNCAH) (Ksh 6.4 million) interventions. As HP+ supported the Turkana County Department of Health to hold consultative discussions with the County Treasury, it presented data to illustrate how the county historically underfunded these programs and over-relied on donor support. It advocated for the county to not only finance these critical interventions, but also realign the county budget to a program-based budget approach and ensure they receive the money budgeted to them. These funds, once implemented, will support community-based interventions such as psychosocial support and adherence counseling, as well as nutrition, immunization, and reproductive health services. By improving service delivery and institutionalizing the funds for these interventions, the county aims to improve health outcomes across HIV and RMNCAH. Moving forward, HP+ will continue training county teams to monitor fund absorption and generate evidence to advocate for subsequent increased budget allocations. In doing so, it will strengthen the county’s capacity to efficiently allocate and execute its budgets as well as generate and use evidence to advocate for and promote sustainable financing of the key disease programs.
With HP+ support, the Lagos State Health Scheme in Nigeria has successfully integrated HIV services into the scheme’s benefit package with effective testing, referral, and reporting systems in place. Since June 2021, about 52 percent of the 213 empanelled health facilities enrolled in the scheme have begun to provide HIV services, with 2,850 tests conducted and positive cases linked to care. HP+ supported the Lagos State Health Management Agency to develop appropriate referral and monitoring frameworks, to train empanelled facilities on quality HIV service provision and reporting, and to disburse capitation payment to providers. HIV services through the insurance scheme will reduce out-of-pocket payment for HIV services by persons living with HIV, who spend an average of US$528 on such care every year. The insurance coverage also will expand access to quality HIV services and increase the number of HIV-positive persons who know their status and are promptly linked to treatment, thus contributing to HIV epidemiological control.
Madagascar’s Ministry of Public Health has finalized its final review of the 2016-2020 Costed Implementation Plan for Family Planning. HP+ provided updated gap analysis results and costed implementation plan (CIP) dashboard data, as well as a CIP execution checklist (part of the CIP Resource Kit). The final review report was validated in April by Madagascar’s Family Planning Committee, technical and financial partners, representatives from regional and district health directorates, civil society organizations, and youth networks. Key successes identified in the review include an increase in the modern contraceptive prevalence rate from 33 percent in 2012 to 41 percent in 2020, representing an estimated 959,000 more contraceptive users. Further, the political environment was improved through passage of the law regulating reproductive health and family planning, ensuring access to reproductive health and family planning services to vulnerable populations, youth, and individuals with disabilities without discrimination. HP+ contributed significant technical and financial support to the development of this law. The Madagascar Ministry of Public Health Family Health Directorate demonstrated strong country ownership and staff capacity throughout the final review process, including through its assessment and validation of all tools and materials used during the review.
A radio station based in Kenya’s southeastern coast recently hosted a live family planning discussion between a Muslim leader and a local Kilifi County government official. HP+ helped arrange for the interviews and discussed key talking points with the presenters. The discussion on Lulu FM between Muslim leader Ustadh Rashid and Kilifi County reproductive health coordinator Ken Miriti highlighted collaborative efforts between the county government and religious leaders to promote uniform messaging for family planning among interfaith communities in Kilifi. Kilifi County has among the lowest modern contraceptive uptake rates in Kenya and religion and cultural issues were identified in the county’s costed implementation plan as key contributing factors. Faith leaders in the area use different avenues to address existing myths and misconceptions about family planning through the lens of religious norms and beliefs. HP+ has fostered joint accountability between the county government and faith leaders from Christian and Muslim communities to implement family planning interventions. Throughout the COVID-19 pandemic, HP+ has supported this strong network of interfaith leaders from Christian and Muslim communities in Kilifi County to be more involved with family planning. HP+ will continue to support the Department of Health to engage with more leaders from established faith networks, to sensitize them on family planning, and enlist them as family planning champions in their communities.
With HP+ support, the Nigerian National Agency for the Control of AIDS (NACA) developed and disseminated a Domestic Resource Mobilization and Sustainability Strategy, which can mobilize up to US$662 million for Nigeria’s HIV program by 2025. HP+ worked with NACA through a multisectoral and collaborative process to assess the health financing landscape for HIV in Nigeria and develop feasible strategies to raise tangible resources for the HIV program. Implementation of the strategy across all states will reduce Nigeria’s dependence on donors, increase access to quality HIV services, improve HIV outcomes, and ensure the sustainability of the HIV response.
Kenya’s Council of Governments, a consultative forum of all 47 county governors, recently adopted an HP+ recommendation to put in place county health planning units (CHPU) that will support health planning and budgeting. HP+ played an instrumental role in designing the CHPU model with the National Treasury and Council of Governments and promoted it with county health leaders. Once established, these units will help county governments streamline budget planning and implementation, generate evidence on health budget performance, track health financing indicators, and advocate for further increases in budget allocations for health. This will help counties meet the complex set of requirements and timelines outlined by Kenya’s Public Finance Management Act of 2012 that counties have struggled with, often resulting in poor prioritization of needs, loss of allocated funds, and missed opportunities to sustain increased budget allocations for HIV, family planning and reproductive health, and malaria. HP+ will provide technical assistance to USAID’s focus counties to establish the CHPUs with the goal of strengthening local capacity and promoting domestic resource mobilization.
As a result of data collected and analyzed by HEP+, the Guatemalan Ministry of Health (MSPAS) authorized the COVID-19 vaccination for everyone 18 years and over in specific rural areas, as opposed to following vaccination administration by age groups. MSPAS also adopted a community engagement plan to better promote vaccination in rural communities. HEP+ conducted evaluations of two rural communities in Quiché and explained to the government the challenges of reaching the most remote communities while following the current national vaccination plan. HEP+ also collaborated with community leaders and municipal authorities to develop a strategy to promote vaccination in the rural community of Ixcán in Quiché. Since this engagement, Ixcán has experienced an increase in the number of people vaccinated and the percentage of the population fully vaccinated exceeds the department average of 10.3%. HEP+ is using the same approach of community evaluation, vaccination plan modification, and community engagement with the local health area directorates in the departments of Ixil, San Marcos, and Alta Verapaz, and aims to continue implementing the strategy at the national level.
The government of Kenya and the Global Fund to Fight AIDS, Tuberculosis and Malaria recently kicked off a three-year, US$440-million project to combat these diseases over the next three years. The Global Fund grant, executed in July, will enable Kenya to implement activities in HIV, tuberculosis, and malaria, as well as cross-cutting areas such as integrated service delivery and quality improvement, human resources for health, financial management systems, and health sector governance and planning. HP+ developed and implemented methodologies to cost the proposed interventions and identify counties that meet the co-financing requirement. HP+ also conducted the HIV funding landscape analyses and developed the malaria program’s plans for sustainability, transitioning, and health financing. With the Global Fund grant, Kenya will bring more HIV-positive clients into antiretroviral treatment with a goal of reaching 90 percent coverage by June 2025 and expand distribution of insecticide-treated nets, benefitting 21.6 million people. It will increase intermittent preventive treatment of malaria in pregnancy, and enhance community-based systems for service delivery, among other interventions. The government of Kenya and partners AMREF Health and Kenya Red Cross will implement grant activities and pursue a transition to sustainable financing.
Representatives from four district hospitals in Malawi where new nursing standards are being piloted came together this month to share experiences, challenges, and lessons learned. HP+ and the Nurses and Midwifery Council of Malawi (NMCM) developed new technical standards for nursing and midwifery practices for child and adult health, oncology care, and breastfeeding. The lack of specific standards for these key areas of practice has been an obstacle for nurses and midwives in delivering high-quality care and has prevented professional councils such as NMCM from assessing and assuring quality of care in service delivery. HP+ trained staff from NMCM and the Ministry of Health’s Quality Management Directorate as quality improvement coaches in rolling out the adult health standards in the four pilot sites. HP+ coached this team as members implemented the standards using a QI approach and facilitated the learning and review meeting. All four sites improved their compliance with the standards against the baseline assessment, despite having had only five months to adopt the concept, implement the standards, and undergo assessment. The pilot helped to identify gaps in the draft standards, which will now be revised, finalized, validated by the professional committee, and scaled up.
Through a local civil society organization (CSO) partner, HEP+ successfully delivered 12 trainings to leaders from partner civil society organizations in Guatemala. Representatives from National Alliance of Indigenous Women’s Organizations for Reproductive Health (ALIANMISAR), the National Network of Men, and Young Artists for Social Justice (JAxJS) received trainings on project and financial management, fundraising, proposal development, marketing, and conducting social audits. The 12 sessions were attended by 1,863 participants from the various networks, and the average increase in knowledge as demonstrated by pre- and post-tests was 34 percent. HEP+’s collaborative partner was the Consultora Multi-Profesional S.A., which also provided mentorship opportunities for 70 network leaders with the aim of developing their skills through practical exercises in each of the training topic areas. Following these trainings, civil society groups are more empowered to sustain their gains in skills and knowledge and to hold authorities to account. For example, after the trainings, three civil society networks of Totonicapán organized a meeting with their Health Area Directorate in June to learn about the 2020-2021 budget execution of the Crecer Sano program, which aims to combat chronic malnutrition. The civil society groups of Totonicapán will be conducting new budget analyses with the information gathered during the meeting and will develop strategies to make better use of the program's financial resources.
HP+ recently helped planners in Tanzania ensure that local family planning services systems reflect national-level guidance. HP+ provided technical support to update the National Package of Essential Family Planning Interventions for Comprehensive Council Plans and ensure that both it and the National Family Planning Costed Implementation Plan (NFPCIP) 2019-2023, are incorporated into revised guidelines for the local level decisionmakers and used as the key reference documents for subnational budgeting and planning for family planning. Integrating these family planning guidelines within council level plans—which previously contained no FP planning guidance—is expected to increase domestic resource mobilization for family planning and further support efforts to encourage sustainable family planning budget allocation and disbursement among local government areas. It is also anticipated to increase the effectiveness and speed of NFPCIP 2019-2023 implementation at all levels and increase uptake of modern contraceptives.
Frontline healthcare workers at Guatemala’s Ministry of Public Health and Social Assistance (MSPAS) recently completed an HEP+-created series of training sessions on COVID-19 care. “Improving the Quality and Hospital Care of Patients with COVID-19” covered epidemiology and management of COVID-19, COVID-19 therapy and therapeutic options, intubation, mechanical ventilation, nosocomial infections, anesthesia and management of delirium, ventilator weaning, and other topics. Thirty-nine doctors and 42 respiratory therapists and nursing staff completed the 26 hours of theoretical and practical training in June. A second training series in July and August covered mental health for health workers, the use of antibiotics in the patient with COVID-19, post-COVID-19 syndrome, and fungal infections in a COVID-19 patient. Health workers who have completed the course will train the staff under their charge on the same material. Thus far, a total number of 1,421 attendees have attended these additional sessions in July and August. HEP+ will provide technical assistance to update the infection prevention and control manuals in the coming weeks.
Guatemala and Malawi recently launched two university courses on policy modeling, data utilization, and demography and development created with HP+ support. Public Health and Demography, Reproductive Health and Nutrition at the School of Medicine of the Universidad San Carlos de Guatemala is an initiative of the Technical and Academic Commission led by USAC faculty in the School of Medicine, of which HEP+ has been a part since February 2021. HEP+ led the course's development by coordinating workshops and course approval and developed the course documentation and modules. Classes include Introduction to Public Health, Public Policy Framework, Demography and Development, and Reproductive Health and Development. In Malawi, HP+ developed the Policy Modeling curriculum at the University of Malawi’s Chancellor College alongside professors in the college’s Department of Population Studies, contributing models for policy planning such as Spectrum, DemDiv, and ImpactNow. The course, which was developed in 2019 and approved in 2021, will be mandatory for fourth-year demography students. In both courses, students will gain knowledge and skills in analyzing and communicating complex data for decision making, set policy goals, and use model results for policy analysis, implementation, and planning. These activities will prepare students to be effective public health policy influencers and practitioners.
Traditional Guatemalan midwives—comadronas—recently received property from San Juan Ostuncalco for the creation of their own clinic. HEP+ supported the Observatory on Reproductive Health (OSAR)—Guatemala’s reproductive health watchdog—in the development of a proposal to the San Juan Ostuncalco Municipal Council for clinic space to provide medical services and store equipment. After the June handover of the property, clinic construction can begin. The clinic will be attended by 93 comadronas and remain open 24 hours a day. It is expected to serve 40 percent of the young children and pregnant women in San Juan Ostuncalco.
Eight facilities that HP+ trained on the Baby Friendly Hospital Initiative (BFHI) from 2019-20 received accreditation as baby-friendly during the national launch of World Breastfeeding Week on July 30 in Lilongwe. Malawi Minister of Health and Population Khumbize Kandodo Chiponda recognized the facilities and encouraged health workers and service providers to continue to support women to breastfeed exclusively from birth until at least six months. In each facility, HP+ trained 80 percent of the clinical and support staff on the World Health Organization’s Baby-Friendly Hospital Initiative course. Community promoters are also trained to provide ongoing support to women to continue breastfeeding after they return home with their babies. HP+ provided ongoing coaching and mentorship as the facility staff prepared to undergo their external accreditation assessments by the Ministry of Health. HP+ has trained 12 facilities in Malawi on the BFHI program since 2018; all have now received accreditation.
The Burkina Faso national government, local officials, and community leaders recently agreed to a plan to coordinate family planning activities in two eastern communes. The signed partnership agreement, facilitated by HP+, enabled an annual allocation of FCFA 2 million (approximately US$3,600) for community leaders in Fada/Dori and Kaya communes to continue conducting awareness-raising activities on local radio, in health facilities, and during cross-generation dialogue. Parties to the agreement are the Ministry of Health, the East Region municipality of Fada, health districts, and the local community leaders’ union (Union des Religieux et Coutumiers du Burkina pour la Santé et le Développement or URCB/SD). The agreement is just one effort in Burkina Faso to promote family planning as a way to lower birth rates and infant mortality. Through the Sahel project, HP+ collaborated with URCB/SD to map community influencers and potential family planning spokespersons in three regions. A total of 720 local leaders were identified and trained in family planning promotion. Afterward, they held sessions on community radio and organized awareness sessions in health and social promotion centers. The messages were developed by the leaders and linked family planning advocacy to holy texts and cultural values. In each region, the leaders held an intergenerational dialogue on sexual and reproductive health with more than 30 participants including other traditional leaders, religious leaders, women, youth, teachers, and parents. Finally, leaders held advocacy meetings with local elected officials and health officials, where they shared community feedback from their family planning awareness-raising experiences and discussed ways to sustain the interventions, which were appreciated by their constituencies.
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.
Building digital solutions for health was the focus of a recent online policy forum convened by the Health and Education Policy Plus project (HEP+) in Guatemala. HEP+, with the Ministry of Health and Social Assistance (MSPAS) and the Office of Human Rights (PDH), delved into the importance of increasing information-sharing through digital platforms. The July 27 forum featured opening remarks by Yma Alfaro of USAID and Herminia Reyes, HEP+ Guatemala’s country director, which led into descriptions of three data dashboards that monitor health and education indicators. The panel discussion that followed focused on the experience of MSPAS and PDH in working with the HEP+ technical team and how HEP+ support helped bring solutions to the population. Claudia Maselli of PDH emphasized that “the support of USAID, HEP+, and Palladium has been hugely beneficial to the institution. This partnership and leadership [with HEP+ have] enabled us to build these tools that monitor and publish the results of our work. The technical assistance has been very valuable for our entire team.” The online policy forum was held in Spanish with live English interpretation.
The Kenya government officially adopted in July the 2020—2030 Kenya Health Financing Strategy, which provides direction on how the nation will mobilize resources to finance health services to improve access for all. HP+ supported the Ministry of Health this year in revising a draft of the strategy to accommodate new government policies and reflect new research evidence on healthcare financing since the previous version was developed in 2015/16. The strategy outlines how the country aims to achieve universal health coverage and increase access to services for all through strengthened health systems. When fully implemented, the strategy will help Kenya deliver quality care for all and increase the proportion of the total population covered under mandatory prepayment schemes to 85 percent. The strategy also calls for the government to increase its spending on health to 13 percent of total government spending. A national launch of the strategy is planned in the coming months followed by rollout of the interventions, including development of legal and structural instruments and other supportive systems for implementation of the KHFS. HP+ will provide technical assistance to the MOH to organize the launch, design communication and advocacy activities, and support stakeholder engagement on proposed health financing reforms.
Success stories are emerging from efforts to train Malawi youth in business management and entrepreneurship through HP+ and Palladium’s Feed the Future Agricultural Diversification project. The project is focused in Mangochi District, where several youth clubs have dramatically increased their profits. The Wake UP youth club doubled its revenue after the training, from MWK 400,000 ($ 497), at which level it had stagnated for the past four years, to MWK 800,000 ($994) in 2020. Mlambe Youth Club increased its investment in land for its green maize production from 2019 to 2020 and grew its revenue. The club now makes an average annual gross profit of more than MWK 1 million ($1,242). Through the youth clubs’ Village Savings and Loan programs, individuals have been borrowing start-up funds and launching their own successful businesses, such as selling tomatoes or fish. In addition to investing in expanding their businesses, the clubs also are putting their profits toward constructing youth corners, physical structures where youth can access family planning services and commodities. Other clubs are supporting needy students with school fees and bicycles and motorbikes to help youth from remote areas access youth friendly health services.
The School of Medicine of the Universidad San Carlos de Guatemala recently established a course titled "Public Health and Demography, Reproductive Health and Nutrition," with Health Policy Plus deputy director and family planning expert Jay Gribble delivering the launch keynote address. At the June 11 event, Gribble stressed the importance of focusing on the need for multisectoral approaches, systems interventions, and integrated methodologies to promote local development. In a blog post building on the speech—The Data Imperative in Guatemala's COVID-19 Recovery—Gribble and Robin Brazier, assistant country activity manager for Health and Education Policy Plus (HEP+) in Guatemala, shared their perspectives on the critical role data can play in improving public health and local development, particularly in the context of a global pandemic. In the post, they discuss how, as the COVID-19 pandemic continues in Guatemala, a focus on improved data collection and systems, data use, and data triangulation across sectors is imperative for decisionmakers to best address the pandemic’s impact across other health areas.
Sessions on presenting evidence and ideas on public financial management, the health impacts of COVID-19, and health insurance financing were among those delivered by HP+ researchers at this year’s International Health Economics Association (iHEA) online congress. Representatives from HP+ Kenya, Malawi, and Nigeria hosted an organized session on the need for a strong public financial management system and the challenges faced by many countries in delivering better spending in their journeys toward universal health coverage. HP+’s Rebecca Ross collaborated with the London School of Hygiene and Tropical Medicine to convene an organized session, presenting results from a mixed method study on the impact of Indonesia’s national health insurance scheme on the competitive landscape of public and private healthcare providers. View HP+’s sessions.
HP+ Kenya is successfully reshaping its approaches to keep project activities running in the face of COVID-19 restrictions and, in the process, strengthening capacity and implementing sustainable processes that appear likely to outlive the current pandemic. HP+ has been adapting to the restrictions on movement imposed by the COVID-19 pandemic by training local county teams in data collection and analysis as well as planning and budgeting using virtual trainings. For example, HP+ trained a Kajiado County government representative on data collection of the geocodes required to map antiretroviral treatment sites and private pharmacies. Instead of recruiting independent research teams and sending them to the field, this alternative minimizes movement of people and strengthens capacity of local county staff.
Family planning is a key part of Liberia’s first private sector engagement strategy, advanced during a recent workshop in Monrovia supported by USAID and HP+. “The Ministry of Health has recognized the need to engage effectively with the private sector if we are to succeed in our mission,” Assistant Minister George Jacobs told the assembled Ministry of Health staff and representatives from professional associations, federation and regulatory bodies, nonprofit organizations, and the private health sector. The strategy for 2021–23 calls for private facilities offering family planning services to have regularly trained providers, consistent with the ministry’s family planning costed implementation plan. Government approval of the strategy is expected by fall 2021. Following that, the Ministry of Health will begin implementation with a multisectoral technical working group led by the ministry’s newly designated focal point for private for private sector engagement. The group will bring together public and private sector actors, begin rollout of the strategy at county level, and undertake a master training for key ministry focal persons.
HIV services for men and boys are getting a boost in Malawi through the efforts of teen clubs and a church-based support group. With the support of HP+, the Evangelical Association of Malawi is reaching out to teens in Phalombe and Nkhotakota districts with psychosocial counseling, nutritional support, assistance with treatment adherence, and viral load monitoring. Since July 2020, the Faith and Communities Initiative effort has reached 662 men and boys and 82 teen members with nutritional support. The teen clubs have promoted access to early viral load testing among boys living with HIV at Kapiri Health Centre, where 148 members have accessed viral load monitoring services.
In June, HEP+ completed a series of training sessions for frontline health care workers at Guatemala’s Ministry of Health (MSPAS). HEP+ designed the content for and delivered the course, “Improving the Quality and Hospital Care of Patients with COVID-19.” The series covered topics such as epidemiology and management of COVID-19, COVID-19 therapy and therapeutic options, intubation, mechanical ventilation, nosocomial infections, anesthesia and management of delirium, and ventilator weaning. Eighty-one healthcare providers (39 doctors and 42 respiratory therapists and nursing staff) completed the 26 hours of theoretical and practical training. To continue the knowledge transfer within hospitals, those health workers who have completed the course will train the staff under their charge on the topics about which they have learned. HEP+ will provide technical assistance to update the infection prevention and control manuals in the coming weeks. A second training series is being conducted in July and August 2021, which will cover mental health for health workers, rational use of antibiotics in the patient with COVID-19, post-COVID-19 syndrome, and fungal infections in a COVID-19 patient.
Malawi religious leaders are using dance to reach men and boys with messages of hope on HIV testing, treatment, and adherence. In May, the Quadria Muslim Association of Malawi (QMAM), with support from the U.S. President’s Emergency Plan for AIDS Relief and HP+, organized a dance event at Traditional Authority Chamba that attracted 2,500 people and distributed 197 HIV self-test kits. The traditional dances, called Zikiri dances, are performed as a competition by young men in praise of Allah. As part of their grant activities, QMAM integrated HIV messages of hope into their praise songs to help create demand for HIV services.
Uganda has adapted an HP+-produced COVID-19 guide in support of the 75 percent of cases in the country that can benefit from home care. The document can guide health workers, village health teams, caregivers, patients, and family members on how to effectively implement home-based care activities and manage the disease. The adaptation was spearheaded by the USAID Uganda Health Systems Strengthening Activity and the USAID Social and Behavior Change Activity with the Uganda Ministry of Health.
The government of Nigeria has advanced its efforts to identify sustainable financing mechanisms for the control of HIV with the publication in June of a national strategy document, National Domestic Resource Mobilization and Sustainability Strategy for HIV, 2021–2025. The document was developed with support from the Health Policy Plus (HP+) project with inputs from HIV stakeholders at both the federal and state level. Nigeria seeks to raise up to US$662 million for the 2021–2025 period with a focus on state and national domestic sources. The strategy is a call to urgent action to mobilize domestic funds to sustain treatment for patients in care, and to identify and treat the additional 20 percent of people living with HIV who have not yet commenced treatment. Between 2005 and 2018, a total of US$6.2 billion was spent on the HIV response in Nigeria, with more than 81 percent from international donors.
Guatemala has streamlined the approval process for water and sanitation projects for 19,000 people in 22 communities, reducing the time needed for approval of water project from six months to one to two weeks. HEP+ provided technical assistance to the Ministry of Health and Welfare’s Integral Health Care Directorate, supporting the development of the streamlining proposal and its presentation to the ministry. The approved proposal also includes the creation of a National Water and Sanitation Office at the directorate, which will supervise the work carried out by other water and sanitation offices in the country.
In a historic accomplishment, Malawi youth clubs supported by HP+ have banded together to form the first youth-led and youth-centered cooperative in Mangochi District. The cooperative will continue the individual businesses established by the clubs—beekeeping and the sale of honey—and the businesses’ support of local family planning initiatives. Such initiatives include revamping youth corners, buying bicycles and motorbikes to ferry youth to and from facilities, and supporting youth-friendly health services/family planning coordinators to conduct limited outreach. Members also hope to establish a facility separate from the hospital space where they now hold their regular meetings. The Thema Honey Youth Producers and Marketing Cooperative Society is one of only 12 in the district. To establish the cooperative, the individual clubs completed a required training facilitated by a multisectoral government team from central, district, and community levels and with financial and technical assistance provided by HP+. After the training, members applied to the Ministry of Trade and Industry for certification. Once certified, the cooperative will be eligible to access better markets for their honey as well as other government initiatives and opportunities.
After receiving an entrepreneurial training delivered jointly by HP+ and Feed the Future’s Agriculture Diversification Activity, participants from Nankumba Traditional Authority in the Mangochi district of Malawi used the curriculum and their own resources to orient other youth clubs on the topic. This raises the total number of youth clubs conducting social enterprises (such as bee keeping, maize farming, and goat farming) from the initial 15 clubs, two years ago when the training was first provided, to 29. Since a proportion of the profits from these businesses are invested in youth-friendly health services (YFHS), an increase in the number of clubs translates to an increase in YFHS investments. The vision of these clubs is to construct a youth resource center in their community through collective contributions, beyond the other investments currently being made. The youth resource center will serve as a separate space where FP information and some services can be provided, as the YFHS facility where youth currently access services is located within the local hospital and is quite small.
Achieving improved health outcomes through multisectoral actions was the focus of an online policy forum convened by Health Policy Plus on June 22, 2021. The session—A Multisectoral Endeavor Called Health: Working Across Sectors for Quality and Sustainability—delved into the importance of designing cross-sectoral interventions and building strong collaborations, such as networks that focus on common goals and bring success to all their members. Clive Mutunga of USAID opened the discussion and provided insights on how multisectoral approaches strengthen health policy and sustainability. Building on his remarks, lead authors from the HP+ blog series “A Multisectoral Endeavor Called Health” shared some lessons learned around youth, nutrition, public and private sector collaboration, and governance. In a panel discussion led by Jay Gribble, deputy director for HP+, panelists addressed challenges faced when coordinating across silos, the importance of understanding context, the need to have good communications, and the role of stakeholder engagement. Speakers addressed audience questions around adapting strategies for sustainability in response to the COVID-19 pandemic and how to work with global organizations to support countries in undertaking multisectoral action.
Community health stakeholders have developed a roadmap for digitization of community health information in Burkina Faso to improve data management and health service delivery at the community level. The roadmap, which describes digitization interventions in all of the country’s 13 regions, grew out of a workshop supported by HP+ and organized by the Ministry of Health. The workshop aligned technical and financial partners involved in the digitization of community health data and was chaired by Burkina Faso Health Minister Prof. Charlemagne Ouedraogo. Also participating were USAID and partners Digital Square, the U.S. Centers for Disease Control and Prevention, Living Goods, the Bill & Melinda Gates Foundation, the World Bank, UNICEF, Terre des Hommes, the Malaria Consortium, Abba’s International Healing Center, and the Red Cross. The alignment workshop explored the use of CommCare, a platform for building and deploying data applications in low-resource settings. Following the workshop, USAID announced it will contribute $1 million to the digitization effort, to include a coordination role for HP+. A task force will be established to oversee and coordinate implementation of the roadmap.
HP+ recently trained Honduran microbiologists on technology that delivers faster and better targeted testing for the COVID-19 virus. The new technology, called TaqPath, incorporates a reagent that cuts the time required for diagnostics from two hours to one, increasing the number of samples that can be processed per lab per day from 500 to 800. In addition, it will allow Honduran scientists to sequence samples that they previously sent to Brazil for further analysis. USAID provided the materials and reagents for the training and processing of 100,000 samples. The May training involved more than 60 microbiologists from four laboratories in Honduras. A training of laboratory supervisors was followed by a seminar series on the use of TaqPath and molecular biology co-delivered by HP+ and manufacturer Thermo Fisher. Learn more about HP+ activities in Honduras.
With special guests from the Center for Global Development, USAID Kenya and Mozambique, the Kenya School of Government, and the Mombasa Department of Health, HP+ convened an online discussion,The State of the Art in Health Financing Reform, on strengthening public financial management (PFM) in health at sub-national level as an enabling environment to advance meaningful progress towards universal heal coverage (UHC) and ensuring sustainable and adequate domestic public financing for the health sector. This discussion, featuring program-based budgeting innovations at the county level in Kenya and Mozambique and emphasis on innovative information systems and digital solutions in Mozambique, stressing the importance of capacity strengthening at local levels as an important component in strengthening efficiency, transparency, and accountability of health resources, as well as improving access to quality health care services. Sanjeev Gupta of the Center for Global Development set the scene for the discussion stressing the need to both increased funding and improved spending. Andrew Rori, the Deputy Director of Learning and Development at the Kenya School of Government, and an HP+ Kenya partner discussed the importance of building the capacity of county-level health officials at all stages of the budget cycle. Dhimn Nzoya of USAID Kenya and Adriano Nhabanga of USAID Mozambique shared USAID’s goals to catalyze domestic resource mobilization and capacity strengthening for long-term sustainability.
The Malawi Ministry of Health recently completed a detailed review of health programs and data in all five health zones. District health management teams and national and departmental representatives used these data to discuss progress on implementing the Health Sector Strategic Plan II. MoH Chief of Health Services Dr. Queen Dube praised the quality of the review: “We have noted major improvements in the quality of the analysis in the presentations; we now need to focus on the implementation of the action plans that have been developed.” The U.S. President’s Malaria Initiative and HP+ have been providing central-level health information systems support as well as ongoing training, tools and templates, and mentorship on routine data analysis to district data management focal persons and program coordinators. For additional background, view our brief.
Indonesia’s public and private sectors have come together to endorse a policy that will provide a legal framework, institutional arrangements, and reporting requirements to catalyze health public-private partnerships. Representatives from both sectors endorsed the Public-Private Partnership Policy for Health Services in early May, following a series of HP+-supported workshops on the topic. The policy is now considered final, and the Ministry of Health is charged with its administration and implementation. In a preliminary example of how the partnerships can play out, a new partnership was created to address early-childhood immunization. It involves a vaccine manufacturer, a health technology provider, a consumer goods company, and district-level government. The new policy is expected to open up similar opportunities for partnerships between public and private actors to expand access to healthcare. For additional background, listen to our webinar covering this topic.
With the support of HEP+, the Nutrition Institute of Central America and Panama (INCAP) has made significant progress in collecting baseline data for Guatemala’s Great National Crusade for Nutrition (GCNN), which aims to reduce malnutrition in the country. As of May 25, INCAP had visited 536 homes in Chimaltenango, Sacatepéquez, and the department of Guatemala as a part of an effort to identify municipalities most in need. Once baseline data collection is complete, the information will be used to monitor and evaluate the GCNN’s efforts, help the Guatemalan government better identify local health needs, and inform nutrition intervention delivery. In addition to preventing chronic malnutrition and anemia, the national strategy aims to reduce maternal and infant mortality and morbidity, promote food security and nutrition, strengthen food services, and prevent and infectious diseases. HEP+ support of the GCNN initiative includes creating systems for technical and operational analyses, a budget based on programmatic categories, and a strategy to define the resources and activities needed to strengthen the GCNN.
HP+ Indonesia hosted a webinar on June 4, Advancing Indonesia's Equitable Health Policy through Strategic Capacity Strengthening Partnerships, to highlight a nearly a six-year collaboration with the government of Indonesia to support its ambitious health reform agenda and improve the policy, financing, and regulatory environment to promote positive outcomes in primary healthcare, maternal and child health, and HIV. The discussion, with special guest speakers from the Ministry of Health’s Institute for Health Research and Development, the Center for Health Financing and Insurance, and the Ministry of National Development Planning explored advances made in creating fiscal space for health, data analysis, and private sector engagement with an emphasis on capacity strengthening and addressing challenges of decentralization. Pamela Foster and Jack Langenbrunner from USAID’s Indonesia Mission joined the discussion on the collaboration and the need to sustain health sector gains in a post-COVID-19 era.
Community health workers provide essential healthcare at local levels, but their status and funding are uneven, often sitting outside official health systems. Momentum is building and the case is being made to formalize and fund these essential health service providers as part of national and subnational health systems throughout many low- and middle-resource countries. HP+ teams in Mali and the West Africa Regional office developed videos to support advocacy for formalization and greater investment for this important cadre of health worker. Interviews for The Place and Role of Community Health Workers in Achieving Universal Health Coverage took place during a high-level meeting of health officials hosted by HP+ West Africa in Lome, Togo in 2019, with participation from the World Health Organization, the West African Health Organization, the United Nations Population Fund, and USAID West Africa. In addition, Togolese community health workers provided testimonials on their work in the community. Mali’s video, The Importance of Investing in Essential Care Provided by Community Health Workers, was developed to support stakeholders to advocate for greater support and funding from the Malian government.
Prominent civil society organizations in Guatemala have come together to raise the profile of family planning and its role in men’s lives. Guatemala’s Network of Indigenous Women for Reproductive Health, the Young Artists for Social Justice of San Marcos, and the Network of Men for Health, Education, and Nutrition held an online conversation May 15 on “Family Planning and New Masculinities” to commemorate the International Day of Families. HEP+ supports gatherings such as this by facilitating partnerships between participating organizations. This discussion among network representatives promoted the importance and benefits of family planning, as well as the important role men have in family planning. This conversation is part of a broader HEP+ effort to build community understanding of and support for sexual and reproductive rights and to emphasize men’s responsibility in supporting their families.
Tanzania has taken some steps to broaden financing for family planning. During a two-day workshop convened last month by HP+, Tanzanian stakeholders discussed options for sustainable financing for family planning services, focusing on segmentation of the family planning consumer market and integration of family planning into the county’s national health insurance scheme. HP+ will model several policy scenarios for financing the scale-up of family planning services to reach the modern contraceptive prevalence rate outlined in the Tanzania National Costed Implementation Plan. The modeling will quantify costs to the government and to women under scenarios in which family planning is offered for free to all users, is incorporated into the health insurance benefits package, and is expanded through commercial products. The findings will be used to advocate for a sustainable option to finance family planning scale-up, with the intent of increasing domestic resource mobilization for family planning, increasing private sector engagement in the delivery of family planning services, and improving access to family planning for the underserved and vulnerable in Tanzania.
Malawi is developing guidelines on how to sustain youth-friendly health services (YFHS) as evidence shows that the COVID-19 pandemic has drastically decreased the use of such care. The use of YFHS declined by approximately one-third in April/May of 2020 compared to the same period in 2019, according to two 2020 assessments on COVID-19 and YFHS. In response, HP+ Malawi is working with government and other stakeholders to develop National Guidelines for Sustaining Provision of Youth-Friendly Health Services amidst the COVID-19 Pandemic. The guidelines, which are being developed by a multisectoral group of stakeholders, are intended for both governmental and nongovernmental entities that offer health information and services to young people. They are a framework to hold implementers accountable for offering services during the pandemic as well as a way to empower communities and youth themselves to better understand their right to access health services despite COVID-19-related restrictions or access barriers. The government of Malawi is further discussing how to expand the scope of the guidelines to address public health emergencies beyond COVID-19.
Several local media outlets in Malawi have reported on evidence-based HIV programming implemented by faith-based organizations. HP+ is providing these organizations funding from the U.S. President’s Emergency Plan on AIDS Relief as well as technical and organizational development assistance. The project conducts outreach, provides counseling, and carries out advocacy around HIV, with a focus on reaching men and boys with messages of hope and information about HIV. The religious organizations are shifting social norms by reducing stigma and increasing acceptance of discussing HIV in faith settings. They are providing HIV self-test kits and linking individuals to health facilities to support them to know their status and, if positive, to start and stay on treatment. Media coverage of the role of faith communities in HIV programming in Malawi will increase awareness of the important role the faith community plays in the HIV response. This coverage is expected to increase local confidence in the ability of faith leaders to contribute to the HIV response, bolstering strong collaboration between faith communities and the health system.
HEP+ Guatemala held a virtual conference on May 6 for more than 480 healthcare and hospital workers about therapeutic options to treat COVID-19. It was the first in a series of 27 training sessions to develop capacities among frontline healthcare workers to improve quality of care for COVID-19 patients in Guatemala. Conference keynote speaker Dr. William Checkley, associate professor of medicine at Johns Hopkins University, shared resources to improve clinical practice in the care of COVID-19 patients. The session also featured remarks from Dr. Francisco Coma, vice-minister of hospitals for Guatemala’s Ministry of Public Health and Social Assistance; Dr. Yma Alfaro of USAID/Guatemala; and Herminia Reyes, country director for HEP+ Guatemala. The session improved understanding of current, evidence-based options available to treat patients diagnosed with COVID-19 and promoted the exchange of experiences, challenges, and improvements in patient care.
The Kyrgyz Republic this month requested bids for US$57,000 in HIV services, increasing its HIV social contracting commitment by 35 percent over the previous tender in 2019. The Republican AIDS Center within the Kyrgyz government will secure grants with nongovernmental organizations for services to expand access to HIV treatment and retention in care, directly addressing the Joint United Nations Program on HIV/AIDS’ 95-95-95 goals. HP+ conducted a critical needs assessment in support of the project, collecting and analyzing NGO proposals and supplied technical assistance on the design of the new program. The Kyrgyz Republic Ministry of Health launched the initiative in December and HP+ will provide ongoing mentoring and technical assistance to the Republican AIDS Center in support of the program. Engaging local organizations to provide this critical work—and financing it—demonstrates the Kyrgyz Republic’s progress toward a sustainable and responsive HIV program.
HP+ and Feed the Future conducted a gender-focused leadership training for 15 youth leaders under age 30 from youth-led organizations in Malawi. The training used the Gender Action Learning System methodology, which empowers communities to articulate needs, envision change, and identify gender-equitable initiatives. Suited to communities with limited literacy and numeracy skills, it communicates abstract concepts such as gender sensitivity and isolates the roots of social norms. HP+ adapted the methodology to include positive youth development domains and policy. Participants demonstrate leadership growth by replicating the training and spearheading the development agenda of their organizations, communities, and districts. Participants are expected to implement what they learned in their communities. There are already results from the training. One youth leader secured an internship with the training partner and another facilitated a similar training in her community less than two weeks later. HP+, Feed the Future, and MERAMO Consulting will continue to monitor and offer technical support to the youth leaders as they cascade the methodology within their communities.
With HP+ technical support, Madagascar’s Ministry of Public Health recently validated the Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition Investment Case for the Global Financing Facility. The investment case outlines priorities for interventions and regions in addressing the country’s RMNCAH-N objectives and health system improvements. HP+ was the lead technical partner, in collaboration with UNICEF, the United Nations Population Fund, the World Bank, and the World Health Organization, supporting the ministry in the development of the investment case. The process offered the opportunity to improve the alignment of donor financing with government priorities and objectives. It also focused on targeting limited government resources on high-impact practices and healthcare access for the country’s most vulnerable populations. HP+ will continue to provide technical assistance to build the ministry’s capacity to monitor the implementation of the investment case at national, regional, and district levels. The investment case aims to reduce the total fertility rate—the average number of births a woman has over a typical lifetime—from 4.6 to 4.2 and aims to reduce the adolescent fertility rate from 151 to less than 130 births per 1,000 women. The five-year plan would reach 17 out of 22 prioritized regions, covering 19.1 million people (78 percent of the population) and avert more than 9,000 neonatal deaths, approximately 3,000 maternal deaths, and nearly 40,000 deaths of children under five years of age.
HEP+ is actively supporting the Guatemalan Ministry of Health and Social Assistance in rolling out the country’s second phase of its vaccination plan. HEP+ is coordinating efforts among government agencies, private sector representatives, and other implementing partners to set up in-person registration stands at accessible points and help deploy vaccination posts based on population density. HEP+’s activities have resulted in the installation of 547 vaccination centers and 49 registration stations for people without an internet connection. HEP+ also supported the ministry with the IT support necessary to launch its COVID-19 Vaccine Website, where Guatemalans can register online for COVID-19 vaccinations. With these activities, Guatemala expects to speed up the second vaccination phase, forestall crowds at vaccination sites, and increase the number of vaccinated people in the country. As of May 10, more than 131,000 people 70 years of age and older had registered on the website. Guatemala hopes to vaccinate 620,000 people over the age of 70 as part of phase two of its vaccination plan.
At a meeting of the Lake Region Economic Bloc (LREB) last week, representatives proposed progressively increasing malaria control county budget allocations to procure at least 10% of their malaria commodities and supplies. This reflects a key HP+ health financing recommendation for malaria control in the eight bloc counties that are a focus of the President’s Malaria Initiative. In Busia, Bungoma, Vihiga, Homa Bay, Kakamega, Kisumu, Migori, and Siaya counties, HP+ analysis showed that underfunding for malaria control has persisted even as overall county health budgets have increased. HP+ data further showed that over the years in these eight counties, there has been low absorption—actual spending—of malaria control funds coupled with heavy reliance on donor funding for key malaria commodities. The evidence on funding will be used to inform county priority-setting in these counties, which are located in an endemic malaria zone and participate in the LREB.
HP+ is supporting FP2030, the next iteration of the FP2020 global effort to enable 120 million more women and girls to use contraceptives. Participating in the new family planning commitment-making process, HP+ health financing experts will provide feedback on country commitments and act as a one-on-one resource for country focal points. A number of reports and briefs developed under HP+ are included in FP2030’s Incorporating Domestic Financing in Commitments brief as part of the FP2030 Commitments Resource Kit developed for countries to use as they develop their family planning financing commitments. The kit includes HP+ documents on legal, regulatory, and financing considerations of universal health coverage, health insurance, catalytic investments for family planning, and the Family Planning Financing Roadmap.
With financial and technical support from USAID, the Pan American Health Organization, and HP+, 3 new molecular laboratories were constructed in Cortes, Copan, and Atlantida. With these additional laboratories, the turnaround time for COVID-19 test results has been reduced from almost one month to 48 hours (previously, COVID-19 diagnostics were available only at the national laboratory in Tegucigalpa). By increasing the geographic distribution of laboratory capability, the Ministry of Health is now able increase the availability of testing and sample processing for communities across the country, improving COVID-19 response efforts at the local level. To support the opening of the laboratories, HP+ created standard operating procedures and strengthened the capacity of lab staff, including microbiologists and lab technicians, through technical training and certification in microbiology and sample processing.
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.
In its efforts to improve its family planning programs, Guatemala is moving ahead with addressing guidelines outlined in the country’s National Family Planning Strategy. With technical and financial support from HEP+, the Department of Guatemala last month formally established a Subcommittee on Contraceptive Security. Subcommittee members will develop their 2021-2022 work plan by August of this year and plan to address the guidelines outlined in the National Family Planning Strategy. Goals include strengthening family planning services, implementing comprehensive sex education in schools, and guaranteeing the supply of contraceptive methods in all health services. The Department of Guatemala is the largest of the county’s 22 geographic divisions and membership in the subcommittee includes representatives from the region's four health area directorates, which cover 20 percent of the country's total population. The subcommittee also will have representation from key nongovernmental organizations: the Asociación Pro Bienestar de la Familia de Guatemala, the Guatemalan Social Security Institute, the Organization for Women's Health & Development, the Reproductive Health Watchdog, and the Presidential Secretariat for Women. The establishment of the subcommittee is part of HEP+’s larger efforts to support the National Contraceptive Security Commission and the Ministry of Health and Social Assistance’s National Reproductive Health Program.
In March, HP+ convened and led a workshop that kicks off a six-month leadership development process in Malawi using the new model for building the capacity of health stewardship. The 23 participants are drawn from four districts and comprise district youth officers, family planning coordinators, youth development officers, youth-friendly health services coordinators, district nursing and midwifery officers. The curriculum combines in-person and virtual learning events with a virtual peer support group, a leadership assessment, one-on-one coaching and mentoring, and individual stewardship development plans that link leadership development daily professional responsibilities. Participants will be undergoing a leadership assessment in the coming weeks and begin preparing for a second learning event in June. This activity’s anticipated impact is a cohort of key actors in each of the select four districts with strengthened leadership and stewardship capacities to better address key challenges within the health system, with particular emphasis on family planning and youth-friendly health services.
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.
Mali has taken a step forward toward ensuring the sustainability of its community health worker program. The country’s inter-ministerial council in March reviewed a draft decree that would formalize CHWs’ status, rights, and responsibilities, and would obligate the government to finance the CHW program. Securing government support for CHWs—particularly the decree’s formal commitment recognizing the CHWs as a health worker cadre—will boost the sustainability of the program, which has historically relied almost entirely on external funding. HP+ Mali has consistently supported advocacy efforts in favor of government recognition of CHWs as a formal cadre, including supporting numerous workshops during which a draft decree was produced, helping draft the roadmap to adoption, and helping to mobilize the Ministry of Health, as well as its subdivisions and partners, to sponsor the decree. If approved by the inter-ministerial council, the decree will move to the council of ministers, over which Mali’s president presides, for adoption. Finally, the decree will pass to the National Assembly for voting. No timetable is set for these steps. Read more about Mali’s CHW efforts.
In a recent report, HP+ examined the policy environment for male engagement in family planning in Nepal, focusing on men and boys 15–24 years of age. The report presents findings on how policies engage men and boys in family planning, how implementation of those policies influences male engagement, and priority policy actions to strengthen a supportive environment for engaging men and boys in family planning programs and services. Recommendations include a call for more evidence around what works for engaging young men and boys in family planning in Nepal, strengthening family planning policies to explicitly engage men and boys in family planning, and increased capacity to develop and implement male engagement policies across all levels of the health system.
Policy implementation requires information, insight, and effective decision making, but if policymakers are unable to digest and act on new information we have fallen short. The community health worker programs in Mali used data visualization to illustrate how community health workers serve rural communities in Mali and how such scarce human resources might be better used. It’s crucial to better understand how these systems do and could work, says HP+ researcher Patrick Pascal Saint-Firmin. “Nearly 60 percent of sub-Saharan Africa’s population lives in rural areas and relies extensively on community health workers; however, the long-term financial sustainability of these programs is in question,” he says. In a Health Worker Week blog, Saint-Firmin reflects on HP+'s work to inform efforts around Mali’s community health worker program and argues that analysis isn’t enough. As data practitioners, how we make the case using data visualization matters.
HP+ has completed a financial gap analysis to accompany the Mali Costed Implementation Plan for Family Planning (2019–2023). The analysis was prepared to help Mali’s Sub-directorate of Reproductive Health better implement its costed implementation plan, understand the extent to which activities and strategic areas have been allotted funding, and advocate for future funding to drive achievement of Mali's family planning objectives and larger development goals. The costed implementation plan, completed in July 2019, is a five-year roadmap designed to help the Malian government achieve its family planning goals.
HP+ has developed a guide on how to incorporate the priorities of Malawi’s national costed implementation plan for family planning into local district-level plans. The guide calls for a three-step approach to helping councils increase their awareness of national objectives and develop district-level plans based on the Costed Implementation Plan (CIP) for Family Planning (2016–2020). HP+ collaborated with the Ministry of Health’s Reproductive Health Directorate to facilitate implementation in several districts by establishing multisectoral task forces to facilitate the integration of priority plan activities into district implementation plans. One district, Machinga, allocated its own resources to implement family planning activities for two years in a row, while other district task forces directed available donor resources to family planning activities. The guide is intended to enable others to replicate and refine this approach beyond the life of the project. While the guide was developed for Malawi's health context, it could be adapted and used in other decentralized settings.
HP+ is exploring three new areas for implementing blended finance in family planning as the first step in developing financing models for USAID consideration. In December HP+ virtually convened 27 experts—USAID representatives, implementing partners in family planning, development finance experts, and impact investors—to explore how stakeholders can use blended finance to help expand modern contraceptive use. Three areas for opportunity came into focus: (1) market introduction/shaping and market access, (2) innovation in distribution channels and point-of-sale, and (3) new direct-to-consumer technologies. Blended finance is the strategic use of public and donor resources to mobilize private capital to achieve development outcomes, including addressing health. Such arrangements have been used to address climate change, access to clean water, and other economic development issues.
Civil society organizations in West Africa are reporting progress in reducing stigma toward persons living with HIV and increasing access to HIV care after receiving organizational support and training from HP+. During fiscal years 2020 and 2021, HP+ supported the development of data collection tools and trained data collectors to use the tools to ensure PEPFAR-funded facilities provided a supportive environment for quality and barrier-free HIV services in 17 facilities in Burkina Faso and 25 in Togo. In initial feedback received so far, the trained organizations have seen a reduction in reports of stigma and an increase in access, specifically fewer instances of informal fees and earlier access to antiretroviral therapy. HP+ will continue to support the organizations in their efforts to secure funding and expand their monitoring objectives to better quantify the impact of HP+’s technical assistance.
A participant at a recent HEP+ organized forum on female empowerment said that opposition from her own family is one of the obstacles women face in contributing to Guatemala’s civil society organizations. “[My family] told me that women only had to dedicate ourselves to having children, but I said no, that we also have to take advantage of the time we have and empower more women and support them,” said Amanda Baltazar, leader in a network in San Marcos. Amanda’s remarks were made at a virtual forum on March 12, one of two supported by HEP+ as part of International Women’s Day activities organized by REDMISAR, the JAxJS Network, and the Network of Men for Health, Education, and Nutrition of San Marcos. Participants in the discussion, "The Power of Women in Society,” described some of the challenges and opportunities that have motivated them to grow personally and professionally. The second forum, "Empowered Women," was organized by the Metropolitan JAxJS Network. Guest speakers shared their personal and professional challenges and explained how they have overcome them.
How best to improve maternal health access and quality in resource-constrained settings was the focus of an online policy forum convened by HP+ on March 23. The session—Quality v. Coverage: Is There a Trade-off in Financing Maternal Health?—highlighted the continued high level of maternal mortality despite increases in facility-based births. It explored the push and pull that policymakers must face when planning and allocating resources aimed at increasing access and quality. Led by Elena Ateva, HP+’s maternal health lead, the discussion featured Alison Morgan of the Global Financing Facility, Nana Twum-Danso of the Rockefeller Foundation, and Aparajita Gogoi of the White Ribbon Alliance/India. In addition, HP+’s Dorit Stein shared recommendations from a research study on strategic health purchasing reforms for maternal and neonatal health services and Aparajita Gogoi shared results from the What Women Want campaign and accompanying dashboard of women’s responses
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.
A recent peer-reviewed journal article by HP+ staff and consultants explains how Mali can reduce its spending on community health workers without sacrificing quality. The article in Global Health Science and Practice concludes that US$13.01 million expended in 2015 for a package of 23 services, including contraceptive injections and oral contraceptives, could have been reduced to US$8.36 million, if standard care protocols were followed. The article also notes that geographic targeting in rural areas is a particularly productive strategy for optimizing service delivery. The analysis appears at a time when 88 percent of funding for Mali’s community health workers is derived from donors and is thus vulnerable to declines in international funding. The publication is part of a 15-article supplement Communities as the Cornerstone of Primary Health Care: Learning, Policy, and Practice, which explores how countries are reinvigorating primary healthcare systems with communities across diverse settings. The supplement’s editorial notes HP+’s innovation in finding efficiencies and geographic targeting to reach underserved communities.
HP+ is working to advance implementation of a transformative reproductive health and family planning law in Madagascar by providing advocacy training to representatives of civil society organizations and government ministries. Twenty-eight participants from 17 civil society organizations and government ministries—including youth and women's organizations and three ministries (health, youth, and population)—attended an HP+-hosted advocacy training from February 24–26, 2021. Using the Advance Family Planning SMART approach, participants developed work plans, budgets, and SMART objectives. Examples of objectives include incorporating a budget line for state participation in contraceptive purchasing and conducting a situational analysis and consultation with persons with disabilities regarding access to reproductive health and family planning services. During the next 12 months, HP+ will continue to provide support and monitor the SMART objectives and advocacy plans developed and adopted during the training.
HP+ has helped the Kenya Ministry of Health retain its current allocations for national HIV, malaria, and reproductive health programs into the next fiscal year even in the face of economic constraints due to COVID-19. HP+ provided technical assistance to the Ministry of Health program teams to develop budget justification memos that supported the need to continue to fund these programs. The memos were used during the sector performance review and resource sharing process, helping to ensure that each program is able to continue supporting its respective critical disease area. In preserving budget allocations despite a tightened fiscal space, the health programs established their continued importance among the nation’s priorities, allowing Kenya to maintain stewardship and accountability for funding these programs. The FY 2021/22 funding for HIV, malaria, and reproductive, maternal, newborn, adolescent, and child health programs is US$12 million, $8 million, and $8.63 million, respectively.
Field, Kenya, Health
Domestic Resource Mobilization
HP+ has helped Nigeria increase the availability of HIV services offered to enrollees in its insurance scheme in Lagos State, home to 12 million people and the nation’s capital city. Between September 2020 and February 2021, the Lagos State Health Management Agency (LASHMA) brought 119 new HIV facilities into the Lagos State Health Scheme. With these HIV facilities now active in the state health insurance scheme, HP+ estimates that more than 3,836 enrollees living with HIV can now access HIV services through the scheme. HP+ worked with LASHMA to simplify requirements that facilities must meet to become contracted into the state scheme and helped LASHMA approve a four-month grace period for facilities to submit the necessary documentation. By the end of 2021, assuming LASHMA meets its current target of enrolling 3.5 million people, HP+ estimates that these facilities will serve around 49,000 people living with HIV. In the upcoming months, HP+ will train contracted facilities on how to provide HIV services to clients through the state scheme, how to procure test kits, and how to submit claims.
Community and faith leaders have come together in Kilifi County, Kenya, to craft uniform, consistent messaging in support of family planning. At a workshop in February convened by HP+, the leaders developed messages they will use to advance family planning in their communities through their respective forums. One message, for example, posed the question: Did you know that family planning is not against our faith? The goal of the campaign is to foster a better understanding of family planning and address misconceptions that impede its uptake. The hybrid physical/virtual workshop was an outgrowth of an action plan developed with HP+ support during a workshop in November 2019. The activity is intended to encourage demand for family planning services and to address Kilifi County’s all-method contraceptive prevalence rate of 38 percent, lower than Kenya’s national rate of 58 percent.
The Mali Ministry of Health has approved plans for reorganizing the country’s health infrastructure, including the creation of a National Center for Immunization. The plans, developed with technical assistance from HP+, are intended to accelerate implementation of Mali’s foundational reform documents, the Health and Social Development Plan and the Strategic Framework for Economic Recovery and Sustainable Development. The Ministry of Health plans describe the restructuring of the General Directorate of Health and Public Hygiene and provide authority for the National Center for Immunization to organize and operate the national immunization program. The next step is the passage of the revised policies by several committees and adoption by the Council of Ministers.
Guatemala's government last month launched a technical working group charged with streamlining public services related to education, health, citizen security, infrastructure, and the environment with an emphasis on the country’s inland regions. The group, the Decentralization Process Bureau (METPRODES) is the initiative of Guatemala President Alejandro Giammattei and Presidential Secretary for Executive Coordination (SCEP) Álvaro Díaz. The plan for decentralization will allow ministries to transfer functions and resources to the local level, improving quality of, and increasing access to, public services across communities. HEP+ has worked closely with the SCEP since 2016 to launch and implement the national strategy for decentralization and will continue to do so in support of METPRODES.
A Malawi youth is using skills acquired at a recent USAID-funded training to advocate for youth-friendly health services (YFHS) in his home district of Mwanza. He is one of 15 Malawi youth leaders HP+ trained in health budget advocacy with the goal of increasing young people’s engagement in health budget processes. After the training in November, the youth developed an advocacy action plan focused on increased budget allocations for YFHS and presented it to representatives of the Mwanza CSO Network in December. The CSO Network pledged its support, committing to engage a member of Parliament as a strategic partner to strengthen the advocacy community in Mwanza. HP+ will be monitoring the implementation of this action plan for the next nine months.
HEP+ Guatemala and one of its long-standing civil society partners are among the co-authors on a recent article on the importance of encouraging partnerships during challenging times such as the COVID-19 pandemic. The paper draws on a 12-country study series on multisectoral collaboration for health and sustainable development in the context of the health and rights of women, children, and adolescents to incorporate sectoral analysis into multisectoral research methods, develop a core set of research questions, and identify shared indicators of success and failure across sectors. The article, “Specific Considerations for “Research on the Effectiveness of Multisectoral Collaboration: Methods and Lessons from 12 Country Case Studies,” appeared in BMC Globalization and Health. Among its co-authors are Susana Palma from HEP+ and Silvia Xinico from HEP+ the partner National Alliance of Indigenous Women’s Organizations for Reproductive Health.
In the first collaboration of its kind, Mali’s workers’ unions and civil society came together recently to support Universal Health Coverage Day December 22. The event in the capital city of Bamako was supported by technical assistance from HP+. It brought together various stakeholders to demand government action on its universal health coverage (UHC) strategy. The Council of Ministers endorsed the universal health insurance plan and national fund for universal health insurance in 2018 as part of Mali’s UHC strategy, but implementation remains slow. To ignite implementation of the plan in 2021, HP+ partnered with the Civil Society Platform for UHC, a civil society group under the Global Financing Facility, to mobilize key stakeholders to push the government to adopt the necessary regulations to fully operationalize the insurance coverage. With support from HP+, the Civil Society Platform developed a UHC call to action and the workers’ unions agreed to sign. Full implementation of plan will contribute to improved health outcomes for Malians.
Mali has joined the Global Financing Facility (GFF), giving the country potential access to development funding from the World Bank and other donors worldwide, and helping to improve financing efficiencies for health. The country took the final step in unlocking access to GFF funding at a December workshop, when it completed its investment case for reproductive, maternal, newborn, child, and adolescent health (RMNCAH). At the same time, Mali finished development of a monitoring framework for its Health and Social Development Plan, which is tied to the RMNCAH investment case. Finalization of these key strategic documents is essential for the social health sectors and Mali’s intention to achieve the Sustainable Development Goals. The country’s GFF investment case seeks an improvement in health outcomes, including a reduction in maternal mortality from 325 to 146 per 100,000 births by 2023 and a reduction of the proportion of women 15-49 years who have experienced gender-based violence from 10.8 percent in 2018 to 2 percent in 2023. HP+ organized the December workshop with the Ministry of Health and other stakeholders to finalize the document and facilitated remote participation of some partners.
With the help of HEP+, the Guatemalan government is on track for a successful distribution of 400,000 doses of the COVID-19 vaccine from Astra Zeneca. After four months of HEP+ support, the Guatemalan government unveiled the National Vaccination Plan Against COVID-19 on February 9, will receive the vaccine in late February, and plans to begin distribution in the beginning of March. The vaccination process will cover several months and reach, in order, 1) health care workers, 2) those 70 and older, 3) people with pre-existing medical conditions, 4) other. HEP+ will continue to support the Ministry of Health for the full rollout.
HP+ has helped the Malawi Ministry of Health relieve an acute and long-standing shortage of data management personnel. Health and local government ministries recently absorbed 327 facility data management staff, strengthening data management and improving the quality and use of data to develop health service delivery across all levels of care. The shortage stemmed from a recruitment freeze arising from expenditure restrictions and resulted in limited use of data to inform health sector decision making and data quality concerns. HP+ is helping the government hire and recruit an additional 397 data staff by 2022, a move that will increase data management staff levels to more than 100 percent from the 2016 level of around 25 percent, before HP+ helped develop and operationalize a plan to address the shortage.
While some patients with SARS-CoV-2 infection require hospitalization, most can be cared for at home. HP+ developed a new visual guide, COVID-19 Home-Based Quality Care: A Practical Guide for Healthcare Workers, to help healthcare workers educate patients, their families, and other household members on how to care for patients at home and prevent transmission of the virus. The guide also provides healthcare workers with information on caring for special conditions and identifying the need for timely referral to a hospital. The guide is equally useful for personal use or when caring for a household member with COVID-19. The guide is available for download in Spanish and English from the HP+ website and via the UCSF Open Critical Care Portal.
Using skills gained in HP+-led training sessions, a Malawi sheik is among the 30 religious leaders active in their communities promoting HIV treatment and prevention. The two-day sessions in Dwangwa and Nkhotakota.in August 2020 focused on the promotion of HIV testing and counselling, HIV treatment services, and treatment adherence. Sheiks have been promoting these messages among their faith community, with a particular emphasis on reaching men and boys. Sheik Muhamad Abdul from Dwangwa’s main mosque has referred 30 men and boys for HIV testing and supported three people in restarting antiretroviral therapy (ART) after one year of discontinuing. The messages promote HIV testing, ART initiation and ART adherence. This work is being supported by PEPFAR’s Faith and Communities Initiative (FCI) and implemented by HP+ with six local faith organizations in Malawi.
HP+ worked with the FP2020 Secretariat to develop new guidance on establishing strong “mutual accountability” approaches. The new guidance provides a “how-to” for governments to meaningfully engage civil society throughout the commitment process and how government and civil society can hold each other accountable for meeting 2030 commitments to family planning. The FP2020 Secretariat is rolling out the new guidance, and it will be officially launched in the coming weeks. The accountability guidance builds on HP+’s extensive experience supporting accountability for FP2020 commitments. It promotes including civil society throughout the commitment process—commitment-making, implementation, and tracking—and includes examples derived from an HP+ global review of existing social accountability mechanisms. FP2020 will disseminate this guidance through its country focal persons and other venues. Both the guidance and examples are available online.
HEP+ is training local leaders and experts in Guatemala on how to plan for and deliver services related to COVID-19. The training is designed to help participants work with local authorities in planning for both COVD-19 care and prevention services. So far, 130 area chiefs, epidemiologists, statisticians, and heads of service provision from five health areas have taken the course. In addition to these three trainings, reaching leaders from Escuintla, Santa Rosa, Retalhuleu, Suchitepéquez and Sacatepéquez health areas, HP+ is planning an additional three sessions. At the conclusion of the in-person training, HP+ will index the material and make it available throughout the country, giving health experts quicker access to this information to better respond to the ongoing pandemic.
HP+ helped officials in Indonesia assess their available budget space for family planning and other health interventions. HP+ conducted an initial budgetary space analysis with the Ministry of Finance to validate macroeconomic, provincial, and district government spending as well as key financial projections. The techniques offered as part of the analysis can push policymakers and health planners to identify and tap into additional sources of funding by re-prioritizing health budgets, identifying efficiency gains, increasing health-specific resources, and managing health sector grants and assistance. The fiscal space analysis was followed by development of a manual and a class on the process in early December attended by 50 representatives from the National Development Planning Agency, the Ministry of Finance, and the Ministry of Health. The manual will be hosted on the University of Indonesia’s website, allowing access by all government representatives.
HP+ supported the Guatemala Ministry of Health (MSPAS) in improving the quality, efficiency, and management of public spending through the development a Spending Quality Tool. The tool helps to automate reporting on the use of the health budget. It creates automated dashboards that monitor advances by unit, center, or cost, and type of purchase, among other classifiers, and generates reports. The tool replaces a manual reporting system, helping the MSPAS present financial results faster and saving on personnel costs. Delivery of the tool represents the first stage of HP+’s work; in the upcoming months, HP+ will develop another programming and planning module with budget planning and procurement scheduling functions.
The Malawian Ministry of Health in January officially endorsed and adopted the updated Respectful Maternity Care (RMC) Charter: The Universal Rights of Women and Newborns, which sets an international standard for the rights and services women and newborns should receive when seeking care. The charter was updated in 2019 by USAID, HP+ partner White Ribbon Alliance, and other partners to ground the charter in widely accepted international and regional human rights instruments. To advocate for adoption of the charter, WRA Malawi coordinated with key nursing and midwifery institutions including, the Directorate of Nursing and Midwifery Services and the Kamuzu College of Nursing to present, provide feedback on, and approve the updated charter. The effort was buoyed by the What Women Want campaign, whose survey had found the top priority among women and girls was respectful and dignified care. WRA Malawi also introduced and advocated for adoption of the charter with key decisionmakers, such as the Safe Motherhood Technical Working Group and the Reproductive Health Directorate and hosted the official launch event where the MOH officially endorsed and adopted the charter. The MOH and nursing and midwifery training institutions will translate the document into Chichewa and update their curricula to be in alignment with it. WRA will support the Reproductive Health Directorate in distributing the charter to all health facilities in Malawi and will begin introducing the charter to women and health workers.
HP+ has helped coordinate the donation of 50 ventilators, facilitated by USAID, to the Guatemalan Ministry of Health. In early December, HP+ provided more than 100 medical and paramedical personnel from five Guatemalan hospitals in-person training in the use of ventilators. Equipped with improved treatment protocols and patient care options, healthcare workers will be able to immediately use the ventilators to treat COVID-19 patients. They will also be able to provide other necessary therapies for adults and children in need of ventilator support. In upcoming weeks, HP+ will provide training for two additional hospitals and will continue to provide technical assistance to ensure adequate use and handling of the equipment.
HP+ Kenya has helped the Kenya Ministry of Health develop budget proposals that align with its health sector priorities and craft advocacy materials in support of these proposals. The MOH requested an additional US$12 million for HIV commodities, an additional US$8 million to procure first line anti-malarial drugs and to settle tax obligations arising from donor-procured malaria commodities, and an additional US$8.6 million for family planning. HP+ Kenya supported national performance reviews of HIV, malaria, and reproductive, maternal, newborn, child, and adolescent health programs to develop sector working group reports that inform the MOH and Treasury budget allocations.
Senegal’s Ministry of Health and Social Action used HP+ supported resources to raise the visibility of and consensus around the need for domestic resources for family planning, helping lead to an increase in the government’s budget allocation to contraceptives. In 2019, HP+ worked with the MSAS and other family planning stakeholders to identify and evaluate opportunities to catalyze domestic resources for family planning, based on an HP+ framework. HP+ also led a budget advocacy training, supporting stakeholders to develop an action plan to influence the next budget cycle. In a recent news article, MSAS Cabinet Director Alphonse Ousmane Thiaw discusses a consultation on mobilizing domestic resources for family planning. He quotes a report supported by HP+ that suggested a focus on national and subnational government advocacy and strengthening support for family planning under Senegal’s Agency for Universal Health Coverage. Thiaw reaffirms the government’s commitment to financing family planning and announces an increased allocation for contraceptives in 2021. This allocation of CFA 500 million (US$926,000) aligns with the country’s FP2020 commitment, reverses the trend of decline in this allocation between 2016 (CFA 300 million) and 2019 and 2020 (CFA 117 million) and will support the annual contraceptive needs of approximately 160,000 family planning users.
A recently drafted law against gender-based violence was the focus of Mali’s “16 Days of Activism” on GBV in November. HP+ Mali provided technical and financial support in the Koulikoro Region to two key organizations—Coordination of Women's Associations and Organizations and Malian Association for the Well-being of Women and Children. Two separate events to advocate for the adoption of law against GBV produced pledges to abandon the practice of female genital mutilation and commitments from the governor of Koulikoro, the mayor of Kati, and local decision makers to support and advocate for the adoption of the law. Youth from the NGO TAGNE (an organization working for the abandonment of GBV) in Kati challenged decisionmakers through a performance of Poetry Slam, requesting they accelerate government actions to support abandonment of GBV in Mali. Koulikoro is the second of seven regions with 15 percent of women reporting having experienced acts of sexual violence at some point in their life.
HP+ has helped the government of Honduras develop and publish an extensive epidemiological report of the COVID-19 pandemic in the country. This report has provided useful information to not only government agencies but also outside parties such as journalists and clinicians. With the publication of this report, the Health Surveillance Unit in the Secretariat of Health is positioned to produce monthly epidemiological reports that capture new and emerging data, such as that from rapid diagnostic tests, while also continuing to improve the quality of reported epidemiological indicators in the country. The report provides key epidemiological data from March 10, 2020, when the first COVID-19 case was identified in Honduras, through November 14, 2020 (epidemiological weeks 11-46).
Nigeria officially launched the country’s National Blueprint for Integration of HIV into State Health Insurance Schemes on December 1, World AIDS Day. The blueprint—developed by the National Agency for the Control of AIDS, the National Health Insurance Scheme, and other HIV stakeholders with support from the USAID-funded Health Policy Plus project—guides Nigeria’s states on how to integrate HIV services into their state health insurance schemes. It represents a significant milestone toward sustainable HIV financing, a key universal health coverage reform in Nigeria. Implementing the document’s recommendations is expected to increase financial protection and access to care for HIV patients, and ultimately lead to improved HIV outcomes.
Family planning stakeholders can find recommendations for how best to participate and influence the development and implementation of Global Financing Facility-financed projects in the recently published Opportunities for Financing Family Planning Through the Global Financing Facility. The report by Health Policy Plus provides 19 recommendations tailored to the stages of GFF funding: before or following the decision of country selection by the GFF Trust Fund Committee, during the development of the project appraisal document, at the start of the World Bank project implementation phase, and throughout implementation. The report also offers 15 family planning intervention ideas for stakeholders to consider. The GFF, housed at the World Bank, presents an opportunity for low- and middle-income countries to leverage additional funding for family planning. However, its grant mechanisms can be complex and the role of family planning programs within them not always clear. The report also describes how family planning has been included in GFF-funded programs and what family planning interventions are most often financed.