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.