On November 12, HP+, in conjunction with USAID and Indonesia’s Ministry of Health’s Centre for Health Financing and Insurance (PPJK), hosted a global practice webinar. “Public-Private Partnerships (PPPs) for Health: Nuts and Bolts from Policy to Practice—Highlights from India” is the fourth webinar in a series focused on strengthening health sector stakeholders’ understanding of global best practices in scaling up high-quality health services through PPPs. With over 100 participants hailing from government, academia, and the private sector, the webinar explored the rationale and benefits for creating PPPs, approaches to identifying opportunities for collaboration, and the tools, resources, and institutions necessary to design and implement partnership approaches. Examples were taken from India’s experience in expanding private sector engagement and blended financing mechanisms in pursuit of better health outcomes, including the Utkrisht Development Impact Bond model applied to maternal and newborn health programs. Speakers, who included representatives from PPJK, the Gates Foundation, USAID/Washington, and USAID/Indonesia, inspired the audience to think beyond traditional corporate social responsibility, toward innovative ways to harness new collaborations between the public and private sectors.
A new blog published on the Wilson Center’s New Security Beat by HP+’s Dara Carr -- Reducing the Risk of Pandemic Disease Threats Through Multisectoral Action -- looks past our current “war time” footing on COVID-19 to the importance of sustaining and strengthening multisectoral collaboration to address future shocks. She discusses barriers to multisectoral collaboration and makes the case that existing policy assessment and advocacy approaches, including evidence-generating policy models, can be readily adapted to help address these barriers. The blog is part of a series edited by HP+’s deputy director for family planning, Jay Gribble, titled A Multisectoral Endeavor Called Health. The series examines the benefits of multisectoral actions in responding to the complex environment in which we live and explores the interrelationships between health and other sectors. Other topics in the series discuss the need for multisectoral collaboration to achieve health outcomes; the link between the health and nutrition sectors; the need for a creative and flexible policy and financing environment for effective planning across sectors.
In Togo, HP+ West Africa recently convened a gathering of national and regional stakeholders to collect, review, and validate data to update the costed implementation plan (CIP) for family planning performance dashboard. Updating the dashboard—a critical first step in the CIP execution process—supports the country to monitor progress toward achieving its family planning goals, which include reaching a contraceptive prevalence rate of 22 percent by 2022 (from 17 percent in 2017). Training stakeholders on use of the CIP tool and dashboard supports family planning decision making and helps to focus family planning activities and implementation on meeting CIP goals.
HP+ hosted the second watch party in its Why Policy Matters series on November 10. “Free Maternal Healthcare in Kenya Saves Lives” features health officials, clinical staff, and patients in Port Reitz, where maternal deaths fell by 64 percent and newborn deaths by 87 percent just two years after the country’s free maternal healthcare policy, Linda Mama, was launched under the National Health Insurance Fund, with HP+ costing and data analysis support. Along with HP+ Kenya leadership, the watch party featured Dr. Isabel Maina, division head for health financing at the Ministry of Health and representatives from the Mombasa county government, Dr. Mercy Bruba and Emily Mwaringa.
In Kenya, HP+ supported Mombasa County to finalize Sector Working Group reports under the three-year budget plan, called the Medium-Term Expenditure Framework. These budget reports, used at national and county levels, are required to secure stakeholder input on family planning and other health spending priorities. HP+ provided technical and logistical assistance to develop the reports, highlighting priority needs and programs to guide resource allocation. Through HP+ support, these budgets and budget processes are better positioned to respond to citizen needs and resources specific to the county’s context.
An analysis of Kenya’s national and county health budgets revealed that, while there has been a significant increase in resources allocated to health, gaps in implementation remain. HP+ conducted the study, which found that resources for health comprise just 9 percent of the total government budget; this falls short of the 15 percent recommended by the Abuja Declaration. Furthermore, county budgets continue to be dominated by recurrent expenditures—such as personnel salaries—raising concerns about resource allocation for effective and quality service delivery. The report provides evidence to support key recommendations for national and county governments to more effectively allocate resources to health.
A new blog by HP+ family planning/reproductive health deputy director Jay Gribble and monitoring and evaluation lead Nicole Judice—"Multisectoral Actions: Creative Thinking, Effective Planning, Power Sharing”—seeks to answer the question “Why do so many policies fail to improve the problem they are designed to address?” and offers approaches to collaborate across sectors to improve health outcomes. The blog is the third in the series “A Multisectoral Endeavor Called Health,” which examines the benefits of multisectoral actions in responding to the complex environment in which we live and explores the interrelationships between health and other sectors.
As of September 30, 61 primary and secondary health facilities in Lagos State, Nigeria, have been certified to provide tuberculosis (TB) services for more than 200,000 newly enrolled clients in the state’s health insurance scheme. This certification—known as empanelment—follows HP+ support to the state’s TB program and the Lagos State Health Management Agency to initiate and simplify the process to ensure that more facilities are able to meet the required criteria and provide accessible, affordable TB services to residents of the state.
In El Salvador, HP+ engaged 83 healthcare professionals in 20 facilities across six municipalities to adapt and disseminate evidence-based guidelines and pilot a training for clinical management of COVID-19. The guidelines and training, which cover diagnosis and treatment, as well as triage, hospital referral, home care management, and infection prevention and control, have strengthened COVID-19 response efforts within primary healthcare and household settings and improved patient perceptions of safety. Moving forward, the training will be expanded to include additional content for nurses and cascaded to enhance the capacity of healthcare professionals to engage effectively in the COVID-19 response in El Salvador.
On October 23, 75 participants joined a virtual watch party and panel discussion organized by HP+ to screen the short film “Why Policy Matters: Reforms Lead to a Healthy Outlook for Nigerians.” The most successful social media post promoting the event resulted in 83 video views and, due to successful outreach to partners, had a potential reach of over 28,000. The Commissioner for Health from Osun State, Nigeria, who joined the watch party and discussion, recognized the work of HP+ and USAID in his state to successfully implement national health reforms and expand access to care.
On October 7, HP+ and the Lagos State Health Management Agency (LASHMA) engaged key ministries, departments, and agencies to discuss and reach consensus around modalities of the state’s health insurance scheme’s regulation policy to enable its effective implementation. Discussions helped to determine practical steps for supporting implementation of the scheme at the local level to expand coverage, increase access to HIV services, and reduce out-of-pocket expenditure on health within rural and poor communities and among people living with HIV. To-date, HP+ has supported LASHMA to expand enrollment in the health insurance scheme to over 200,000 people.
HP+ partner the White Ribbon Alliance launched a documentary highlighting women’s and girls’ challenges in accessing reproductive and maternal health services through the lens of the What Women Want campaign, which mobilized over 84,000 women and girls in Malawi to voice their requests for high-quality reproductive and maternal health services and outcomes. The documentary has had a wide reach thus far, including a snippet being viewed as part of the September 2020 Partnership for Maternal, Newborn, and Child Health Accountability Breakfast opening video during the UN General Assembly. The documentary will continue to serve as an advocacy tool to advance efforts to meet women’s and girls’ health needs in Malawi.
On September 14, 2020, Cambodia’s National Social Protection Executive Committee approved the adoption of a new monitoring and evaluation (M&E) system, developed with HP+ support, to enable systematic oversight of social protection results and financing to manage its portfolio, improve accountability and transparency, and inform future investment priorities. HP+ supported the development of the system by creating a logical framework and identifying indicators; drafting an operational manual and legal framework; and providing customized trainings and ongoing coaching to build capacity of a new team with no previous M&E experience. Implementation of the system will support Cambodia’s policy goals of preventing and reducing poverty, vulnerability, and inequality.
In Cambodia, General Secretariat for the National Social Protection Council (GS-NSPC) leadership reached consensus on five actionable policy recommendations to ensure high-quality health services are delivered under national Universal Health Coverage schemes. The recommendations, which include adoption and optimization of a strategic purchasing approach as well as the integration of monitoring and key progress indicators into the annual performance-based budgeting process, were documented in a peer-reviewed article developed with HP+ input, Improving Health Service Quality in the Kingdom of Cambodia: A Policy Perspective, published in the Asia Pacific Journal of Public Health in September 2020.
In Malawi, youth clubs are thriving, enabling young people to continue to access youth-friendly health services (YFHS) during the COVID-19 pandemic. The 45 youth clubs in Mangochi, trained by HP+ and the USAID AgDiv Project in June 2019 on enterprise and entrepreneurship, have been mentored by an HP+-trained multisectoral ministry team and youth champion during the pandemic. They have invested approximately MWK 459,000 (US$611) in their respective centers, supporting the provision of YFHS and information on COVID-19 to youth throughout the region.
In support of the Government of Cambodia’s implementation of a policy to decentralize health sector leadership to subnational and provincial levels, HP+ supported the National AIDS Authority (NAA) to facilitate an advocacy workshop in the province of Kampong Speu on August 31. Fifty participants—hailing from the provincial government, operational districts, NAA, and the National Center for HIV/AIDS, Dermatology, and STIs—reviewed policy measures and discussed implementation plans and roles. Decentralized implementation of this policy will enable the province to directly manage health resources and make decisions with regard to health planning, monitoring, and policy prioritization.
To take a closer look into women’s and girls’ self-articulated demands for their own healthcare, HP+ partner White Ribbon Alliance launched the Brave Voices, Bold Actions: Women’s Health, Rights & You podcast. Season one takes a deep dive into respectful maternity care through the lens of the Respectful Maternity Care Charter. Throughout 10 episodes, the podcast features the voices of brave women, girls, health professionals, and global leaders who discuss changes that should be made to improve sexual, reproductive, and maternal health outcomes, including during the COVID-19 pandemic.
In Madagascar, seven government ministries have signed an official commitment letter agreeing to implement the country’s Demographic Dividend Roadmap, demonstrating multisectoral support of efforts aimed at achieving the country’s demographic dividend. The commitments, obtained at a high-level roundtable organized by HP+ in March 2020, are the result of HP+ efforts to support Madagascar’s Ministry of Economy and Finance to finalize a follow-up plan for the roadmap, including details on monitoring and evaluation, budgeting, and resource mobilization for key activities. Moving forward, HP+ will support the demographic dividend team to advocate for and monitor implementation of the roadmap and decentralize it to regional committees.
In Malawi’s Mangochi district, youth clubs are supporting the construction of a standalone building to house youth-friendly health services at Nankumba Health Center. Following a training on small-scale businesses conducted by HP+ and Ag Div in June 2019 and subsequent months of advocacy efforts, the youth clubs secured financial support from the community amounting to MWK 400,000 (approximately US$540) as well as commitments from local leaders to support the initiative. By building this separate facility—expected to serve up to 50 individuals by the end of 2021—the youth aim to provide a safe, private space for their local peers to access health services.
Since July, over 129,000 new households have been enrolled in Cambodia’s largest social health protection scheme, the Health Equity Fund, which entitles families to receive free healthcare—including family planning services. This accelerated rollout follows publication of a secondary analysis, conducted by HP+, which found that 36 percent of Cambodians living under the national poverty line do not hold an equity card, making them ineligible to benefit from the fund. The study was cited by a Deputy Secretary of State of the Ministry of Economy and Finance in the rationale to accelerate national rollout of the system, which will benefit an additional 47,785 households.
Health Policy Plus (HP+) marked World Contraception Day this year with a focus on the positive, a welcome distraction from the COVID-19 pandemic, by asking our colleagues and partners, “what about contraception puts a smile on your face?” With a reflection by family planning and reproductive health lead, Jay Gribble, and a photo collage featuring messages from around the world, HP+ demonstrates many reasons to smile as voluntary contraception and method choice continue to improves the lives of women and men, their families, and communities.
HP+ explores links between food insecurity, poverty, and poor health outcomes and the need to address underlying causes such as malnutrition with a multisectoral approach. In a new blog in its series, A Multisectoral Endeavor Called Health, co-authors Jay Gribble and Joni Waldron of USAID’s Feed the Future Ag Diversification Activity showcase efforts in Malawi where project design and implementation are linking agriculture to food security, economic growth, and health for long-term, sustainable change. Read the blog, “Reducing Malnutrition: A Multisectoral Approach to Addressing Underlying Causes.
HP+ recently launched revamped message boards in the Family Planning Financing Roadmap website’s Community of Practice to support the sharing of information and resources about family planning financing among decision-makers, policy-makers, and advocates. The Family Planning Financing Roadmap is an online resource, which enables stakeholders to explore specific family planning financing options based on country context. The message boards and other learning materials are expected to help stakeholders identify sustainable ways for countries to fund their family planning initiatives and underpin their long-term health and development goals.
Last month, more than 2,300 public and private sector health professionals in Guatemala participated in five hours of live training on COVID-19. The two sessions—broadcast on YouTube—featured presentations from top local experts and interactive questions from viewers. Since airing, more than 18,000 additional views have been recorded. In coordination with key health sector stakeholders, HEP+ facilitated and moderated the sessions and solicited participant input for future trainings. With a solid foundation of knowledge on the basics of COVID-19, health professionals nationwide will be able to improve practices in service delivery to support Guatemala’s pandemic response.
In Mali, where faith leaders wield significant influence over sociocultural and health matters, the decision of these leaders to speak publicly about ways to end gender-based violence (GBV) is a monumental step. Since committing in early 2020 to join HP+ and other stakeholders in advocating against GBV and promoting a national GBV law, these leaders—both Muslim and Christian, male and female—have formulated faith-specific talking points and are sharing them with their communities. Along with advocating for passage of the law, this public discussion is a critical step in combating GBV in Mali, where 4,617 incidents were recorded in 2019 alone.
HP+ and FP2020 co-hosted a webinar exploring ways to catalyze a shift in domestic financing for family planning. The webinar introduced a new framework that provides a structure for development partners and advocacy groups to work with country governments to identify and implement catalytic interventions for family planning in advocacy, capacity development, policy, and expansion of the family planning market. USAID’s Susanna Baker provided relevant HIV case studies from PEPFAR’s Sustainable Financing Initiative; Martyn Smith of FP2020 discussed the need for such investments; and Kojo Lokko of the “Challenge Initiative” shared experiences on matching funds and other means to raise domestic resources for family planning.
A journal article authored by HP+ project staff in collaboration with local partners was published this month in a special issue of AIDS. The article, which describes the development and implementation of a three-stage approach to reducing HIV stigma in health facilities, features the approach that HP+ implemented in Ghana and Tanzania. It is an evidence-based, adaptable, scalable approach that has proven successful in generalized and concentrated epidemic settings and can be used to address stigma toward any population. Results of endline evaluations in both countries demonstrate the intervention’s effectiveness, showing significant reduction in drivers and manifestations of stigma and discrimination among facility staff.
HP+ Cambodia organized a meeting of eight Ministry of Economy and Finance Secretaries and Undersecretaries of State to discuss an internal policy note aimed at expanding social health protection coverage and enhancing financial risk protection to financially vulnerable lower-income families. As a result, the Deputy Prime Minister officially established the Ministry of Economy and Finance high-level technical working group on strategic planning to achieve universal health coverage. If the policy note recommendations are adopted, it would potentially increase population coverage of social health protection to over six million financially vulnerable Cambodians.
On August 25, HP+ supported Madagascar’s Family Health Directorate (DSFA) within the Ministry of Public Health to conduct a virtual semi-annual review and performance monitoring meeting of the country’s costed implementation plan (CIP) for family planning. Using data generated by an online CIP dashboard developed by HP+, meeting participants were able to monitor progress of CIP activities and indicators, identify bottlenecks and solutions, and provide recommendations for the next iteration of the plan. Since adoption of the CIP in 2016, the country’s contraceptive prevalence rate has improved from 33 to 44 percent and maternal deaths averted by family planning have increased from 500 to 2,600.
In collaboration with USAID, Project EpiC, and the Honduran Ministry of Health, HP+ has trained nearly 400 frontline healthcare workers providing critical care to COVID-19 patients across Tegucigalpa and San Pedro Sula, home to approximately 70 percent of COVID-19 patients in Honduras. Healthcare workers used a training curriculum, developed with HP+ support, on use of U.S. Government-donated ventilators and infection prevention and control protocols to enable them to provide mechanical ventilation to patients and protect themselves from COVID-19 in their workplaces. At an August 28 virtual celebration with the Honduran Minister of Health Alba Flores, EpiC Project Director Hally Mahler, and USAID Honduras Director of Education Meredith Fox, Flores thanked the U.S. Government and HP+ for their support. She remarked, “The capacity development processes and the ventilation equipment have strengthened care provision” in Honduras, and that “the pandemic has challenged our medical and nursing professionals to improve their knowledge and practices.”
HP+ has been supporting the Cambodian government to generate analytics on key universal health coverage (UHC) dimensions, including population coverage and cost modeling; coverage potential, gaps, and social equity; and healthcare seeking and financial risk protection, underpinning an evidence-to-action agenda to accelerate UHC achievement. This work, which catalyzed the formulation and alignment of policy recommendations among key health development partners and within the Cambodian government, was featured in an August 27 webinar, “Evidence to Action- Advancing UHC in Cambodia.” Moving forward, HP+ is facilitating government action to accelerate implementation of the recommendations and support the country on its journey to achieve UHC.
HP+ and Cambodia’s National Center for Tuberculosis and Leprosy (CENAT) conducted assessments and provided on-site support for the Tuberculosis (TB) Prevention Therapy module in three provinces. The assessments follow a June training that HP+ and CENAT provided to TB supervisors on use of the TB management information system at public health facilities. The recent assessments revealed that TB supervisors’ knowledge and use of the module was either “excellent” (80%) or “very good” (20%), demonstrating strengthened skill competencies. In October 2020, CENAT will lead in providing module trainings and follow-up visits to the remaining 23 provinces and 86 operational districts.
HP+ conducted a costing study in 24 districts across the five major island groups in Indonesia to support the government to implement minimum service standards (SPM) for 12 primary healthcare services. Data from the study has been used to improve existing SPM budgeting and planning tools used by local governments. This will alleviate administrative burdens on districts and support 514 district health offices in better planning to achieve SPM targets by improving allocation of resources for health. HP+ is providing virtual technical assistance on use of the tools and will develop e-modules to strengthen local government capacity to use them.
In August, HP+ facilitated a virtual training for research institutions and government representatives in Kenya, Tanzania, and Uganda on applying the Activity-Based Costing and Management methodological approach to HIV services. HP+ strengthened the capacity of these institutions and participants to implement data collection; conduct analysis; develop research protocols and data collection instruments; secure ethical clearance; facilitate stakeholder consultations; and develop reports using the approach. Findings from the analysis can help policymakers and partners to more effectively allocate resources, improve monitoring efforts, optimize investments, and drive efficiencies through improved delivery of services.
In Madagascar, HP+ has been supporting journalist trainees to provide information and news about family planning/reproductive health (FP/RH). Twenty news articles have since been produced that reach local, regional, and national audiences. Last November, 11 journalists were trained by HP+ on the fundamentals of FP/RH, the FP/RH law, and issues related to population and development. The following January, with HP+ support, nine of the trainees conducted field investigations to raise public awareness of early pregnancy, break taboos on contraception, and disseminate the FP/RH law. In July 2020, HP+ supported the development of a yearlong editorial calendar and dissemination strategy to support these efforts.
This month, HP+ and Tanzania’s Reproductive and Child Health Section of the Ministry of Health, Community Development, Gender, Elderly, and Children worked together to convene the first semi-annual family planning implementers meeting. The meeting, which was held virtually, focused on review and discussion of current progress in implementing the country’s family planning costed implementation plan (CIP) related to subnational roll-out, program and funding coverage, and achievement of results. According to performance data collected for the first year of CIP, Tanzania is on track or gaining traction to meet performance targets for six of ten results; progress has been delayed for the remaining four results.
HP+ supported the Honduran Ministry of Health to revise COVID-19 isolation criteria using a symptoms-based strategy in place of laboratory results-based processes. The new criteria, which align with international guidance, shorten required isolation time for improving non-severe and non-immunocompromised cases and asymptomatic cases and no longer require a negative real-time PCR test. HP+ supported local professional medical networks and the Pan American Health Organization to facilitate clinical discussions, update the guidance, and implement the guidelines. The revised criteria will allow facility staff who meet the revised criteria to safely leave isolation earlier and return home to their families.
In Malawi’s Chikwawa district, faith healers have been discouraging community members living with HIV from taking antiretroviral therapy (ART). Concerned that this may lead to ART defaults and increased death, religious mother body PECHANOMA facilitated a dialogue with other leaders in July, with HP+ support, to reinforce their role in emphasizing accurate messaging around HIV and COVID-19 and the importance of continuity in ART for people living with HIV. The leaders committed to continue disseminating accurate HIV messaging in their communities by holding meetings with religious and local leaders, disseminating radio and TV messages, and using mobile vans with loudspeaker systems.
Following an HP+ analysis that showed the potential impacts on maternal and neonatal deaths and stillbirths that could occur as a result of declining maternal health services due to diverted services and reduced coverage indirectly caused by the COVID-19 pandemic, HP+ partner the White Ribbon Alliance (WRA) developed and launched the “Safer Together” Respectful Maternity Care advocacy and communications campaign. The campaign is being used by WRA National Alliances and other stakeholders in USAID priority countries—including Pakistan, India, Malawi, and Indonesia—to convene stakeholders, advocate for joint action, and disseminate joint messages to women, communities, and providers.
Since the emergence of COVID-19, the debate on whether health should be re-prioritized in government budgets with explicit allocations and earmarks has re-emerged. On July 27, an HP+ webinar featured recent analyses of fiscal space for health conducted by USAID’s ProtectHealth project in the Philippines and HP+ in Indonesia. In “Fiscal Space for Health in the Era of COVID-19: Constraints and Choices in Preserving Gains for Indonesia and the Philippines,” speakers—including high-level finance ministry officials from both countries—highlighted current fiscal constraints, government budgetary responses to the COVID-19 crunch on revenues, and possible avenues through which additional financing could be raised.
Why do countries decide to decentralize their health sectors? What challenges do they face in assigning functions appropriately and agreeing on stewardship roles? Does financing follow function? An HP+ webinar on July 29 tackled these complex questions and more. Featuring the experiences of two countries that have engaged in large-scale attempts at decentralization of health sector financing and governance—Kenya and Indonesia—“Health Sector Decentralization: Can it Still Deliver?” focused on the essential question of whether decentralization can accelerate countries’ journeys to self-reliance. Among the presenters was Meral Karan, a Senior Governance Adviser at the Center of Excellence on Democracy, Human Rights, and Governance.
On July 30, an HP+ webinar, “Pivoting During COVID-19: How Health Policy Enables Service Provision in a Pandemic,” showcased the COVID-19 public health response underway in several countries, featuring ongoing service delivery activities in Brazil, El Salvador, and Honduras. Among the speakers were Mariella Ruiz-Rodriguez, an education development officer from USAID/Honduras. Evidence-based health policies allow countries to quickly and effectively pivot from business as usual to full-scale pandemic response. Longer-term strategies that ensure a continuum of care are likewise essential to support. The webinar considered what a holistic COVID-19 response looks like: focused on service delivery and informed by local realities.
HP+ provided technical assistance to the Honduran Ministry of Health to conduct a rapid assessment of 22 critical care facilities across the country. This rapid evaluation assessed the readiness of hospitals to receive and use U.S. Government-donated ventilation equipment; an in-depth assessment is scheduled to be completed by August 15 in collaboration with Project EpiC. Correspondingly, HP+ launched a training series on the use of the ventilators and infection prevention and control. More than 120 (out of 460) healthcare workers have participated to date.
With HP+ support, youth journalists in several districts in Malawi air weekly programs on community radio about topical health issues. Recently, Nkhotakota Radio youth reporters noticed that the number of pregnant adolescent girls getting HIV tests at the local district hospital had dropped significantly. In early June, the station aired a radio program urging pregnant teens to get tested for HIV. The District Health Office reported that in the two weeks following the broadcast, testing was higher than ever—about 40 pregnant girls had visited the facility to be tested. Said Nkhotakota District Hospital Nurse Chimwemwe Nyasulu, “This is what community radio is supposed to do.”
HP+ supported the development of a National Social Protection (NSPC) Monitoring and Evaluation system in Cambodia to facilitate the collection, analysis, and use of service and beneficiary statistics; budget and expenditure data; and payment and administrative information to monitor key performance indicators. HP+ trained NSPC staff on use of the system dashboard, which generates key performance metric visuals; a soft launch by September is planned. The monitoring system is expected to improve accountability and transparency between line ministries and the Ministry of Economy and Finance; strengthen social protection scheme management and decision making; inform the annual budget; and increase public transparency and accountability.
HP+ is supporting district-level youth-friendly health services (YFHS) reporting performance in Malawi by analyzing monthly District Health Information System 2 reports and providing technical support to health management information system officers and YFHS coordinators to improve timely and complete reporting. The district with the highest performance each quarter receives recognition; districts share best practices and lessons learned via a WhatsApp group. As a result of this emphasis on data quality and reporting, performance has steadily improved over time. Accurate and timely information about service utilization allows decision-makers at various levels to tailor programs and allocate resources to more effectively serve youth beneficiaries across Malawi.
HP+ analyzed how COVID-19 may disrupt health services in Burkina Faso, based on the level of face-to-face interaction with healthcare workers required to deliver interventions and the degree to which the interventions are time-sensitive or can be delayed without significant health impacts. Across the five health areas analyzed—family planning, maternal and child health, tuberculosis, HIV, and malaria—authors estimate that between 4,800 and 19,700 additional deaths could occur in 2020 alone as a result of disruptions from the pandemic. Burkina Faso is taking steps to maintain essential services and find ways to adjust service delivery models to mitigate these potential impacts.
A virtual satellite session—"Data Matters: The Role of Local Stakeholders and Data in Influencing HIV Services and Programs”—was held on July 8, as part of AIDS2020. The session showcased how HIV service delivery is improved when stakeholders generate and use local evidence and data to inform community-level programs. Representatives from the International Treatment Preparedness Coalition joined Palladium and HP+ colleagues Ron MacInnis and Ratna Soehoed, who discussed the use of province-level cost and epidemiological data for HIV planning and budgeting in Jakarta, Indonesia. A recording of the session will be available to the general public next week.
An HP+ webinar on July 8 featured a discussion on Liberia's private sector response to COVID-19 and the Healthcare Federation of Liberia’s efforts to stimulate coordinated private sector engagement in health following a private sector assessment undertaken by HP+ in 2019. Dr. Cuallau Jabbeh-Howe of Liberia’s Ministry of Health, Dr. Nicole Cooper of the Healthcare Federation of Liberia, and Dr. Amit Thakker of Africa Health Business shared reflections on opportunities and challenges of private sector engagement in health and discussed possibilities for collaboration between the public and private health sectors in Liberia. Listen to the webinar here.
A local leader in Niger has invested FCFA 57 million (US$97,500) in the purchase of family planning products and the financing of income-generating activities for women in his municipality—about 2.7 million individuals—as a result of HP+ advocacy. Following an HP+-supported regional workshop aimed at engaging communities in advocacy to support costed implementation plans for family planning, Dosso Mayor Issoufou Idrissa mobilized the funds for the rehabilitation of health centers, purchase of family planning commodities, and financing of income-generating activities. Since January 2020, 966 new users have accessed health services in the municipality are a result of this investment.
On June 24, the Prime Minister of Cambodia officially launched a new cash transfer program to offset the impacts of COVID-19 on the country’s poor and vulnerable that will begin with the transfer of about US$50 million to 560,000 poor households. HP+ had supported Cambodia’s General Secretariat for the National Social Protection Council (GS-NSPC) to develop a monitoring and evaluation (M&E) concept note for the program and provided technical assistance to the GS-NSPC team and GIZ contractor implementing COVID-19 M&E activities, improving accountability among local authorities. In Cambodia, health service disruptions related to COVID-19 could potentially result in 559,900 individuals being unable to access contraceptives.
HP+ Indonesia’s partnership with Badan Litbangkes has resulted in a second article being accepted in the journal PlosOne. “The Influence of Jaminan Kesehatan Nasional (JKN) on the Cost of Delivery Services in Indonesia” aimed to identify the association between use of Indonesia’s national health insurance (JKN) and out-of-pocket expenditures in accessing delivery services. The study found that use of JKN is associated with reduced out-of-pocket expenditures for delivery as well as reduced risk of incurring catastrophic delivery expenditure, though some out-of-pocket expenditures for delivery services still exist among mothers enrolled in the scheme.
Indonesia’s Secretary General of the Ministry of Health expressed support for the swift adoption of new technical guidelines on public-private partnerships (PPPs) and encouraged national and subnational stakeholders to engage in implementation and budgeting for the new guidelines. HP+ has been working with the Indonesian government to develop a blueprint for how to engage in PPPs in non-infrastructure endeavors, such as the training of healthcare workers, management of healthcare facilities, and community-based prevention and promotion activities. The guidelines, which apply to the whole health sector, will soon be finalized and presented to Ministry of Health leadership for adoption.
In Malawi, district youth-friendly health services (YFHS) coordinators are using performance data to analyze YFHS uptake nationwide, sharing best practices and challenges encountered to improve program decision-making across all levels of the health system. Since 2018, HP+ has supported the Ministry of Health’s Central Monitoring and Evaluation Directorate to analyze district performance in reporting YFHS uptake and share these results with district-level coordinators via WhatsApp. As a result, the overall national reporting performance of the YFHS program has improved from 13 percent in 2018 to 72 percent as of March 2020, demonstrating strengthened capacity to submit complete, timely data critical to supporting informed decision-making.
A webinar on June 25 highlighted Nigeria’s successes in achieving health reform, advanced over two years with support from USAID through HP+. Presenters, including HP+ Project Director Suneeta Sharma, HP+ Nigeria Country Director Frances Ilika, and Osun State Health Insurance Scheme Executive Secretary Adeniyi Oginni, discussed domestic resource mobilization, capacity development of primary healthcare management, and health insurance coverage expansion in the Federal Capital Territory and Abia, Ebonyi, and Osun States. Advancements include the unlocking of US$58 million for health to aid advocacy and policy reform and the enrollment of 345,000 individuals in health insurance schemes in Osun State and the Federal Capital Territory.
HP+ recently conducted an analysis of available equipment and supplies required to fight COVID-19 in Niger’s capital, Niamey. The analysis pointed to the need for an increase in hygiene supplies to effectively combat the pandemic. As a result, the Bank of Africa Foundation provided handwashing kits to 20 health facilities in the city. The handwashing kits, which are valued at more than one million CFA (approximately US$1,700), are in addition to the 373 million CFA (approximately US$640,000) already granted by the Association of Banks and other financial establishments to the Nigerien government to aid in its pandemic response.
A new blog by HP+’s Laura Brazee—Opening Doors: Mentoring for Effective Advocacy—was published by Knowledge SUCCESS. The blog shares insights from an intergenerational mentoring program for youth in Malawi. It demonstrates how engagement with mentors supports emerging young leaders to engage village, district, and national stakeholders to deliver on promises related to youth-friendly health services (YFHS) and strengthens advocacy for policies to end early marriage. Mentees were supported to build partnerships with youth networks and organizations to advance their advocacy work and connect to new stakeholders. View more Malawi-specific materials.
As cases of COVID-19 continue to rise dramatically in Central America, HP+ is supporting the Honduran government to create a Ventilator Task Force to optimize distribution and use of donated ventilators for the most severe cases. Working with the USAID-funded EpiC project and other key stakeholders, the task force is launching a rapid assessment of ventilator readiness across the country’s major health facilities. The donated ventilators—anticipated to be as many as 300 from the U.S. Government alone—could almost double the current number of ventilators present in public sector facilities, saving countless lives in the midst of an unprecedented pandemic. Get more details in our news article.
HP+ launches a new blog series today, A Multisectoral Endeavor Called Health: Working Across Sectors for Quality and Sustainability. The series will tackle a range of health development challenges and examine how multisectoral actions can help address complex, interrelated issues. Focusing on high-level objectives, such as achieving universal health coverage and reducing malnutrition, the blog series considers how multisectoral actions contribute to better health status of populations and play a role in achieving economic growth and other development goals. Read the first blog by Jay Gribble, Nicole Judice, and Suneeta Sharma, Unity is Strength: Improving Health is a Multisectoral Endeavor.
The New Security Beat, a Wilson Center blog, published a piece by Sara Stratton, HP+ technical director for family planning and maternal and child health. Pandemic Preparedness: Strengthening Family Planning Policies Today to Secure Essential Services for Tomorrow discusses the COVID-19 response and threats to contraceptive access for women in low- and middle-income countries. It sets out policy recommendations to ensure essential services for women and girls are maintained during this and future pandemic responses, including policies on task sharing with private sector suppliers such as pharmacies; policies on self-injection of contraceptives; and gender-informed policies for a female-dominated healthcare workforce.
HP+ continues to build Cambodia’s domestic capacity to manage its tuberculosis response by supporting the roll-out of the new Tuberculosis Prevention Therapy (TPT) training modules to the National Center for Tuberculosis and Leprosy’s tuberculosis management information system (CENAT TB MIS). In May 2020, HP+ facilitated a three-day training-of-trainers for 16 technical staff from CENAT and partners. The training, which prepared participants to provide the training nationwide, covered data entry protocols, roles and responsibilities, and best practices for troubleshooting. CENAT staff can now execute TB-MIS trainings with limited HP+ oversight and support, extending the frequency and reach of the trainings throughout all provinces.
HP+ is strengthening relationships between communities of faith, health facilities, and district governments in Malawi to support the country’s HIV response. The project is supporting six Religious Mother Bodies (RMBs) to implement PEPFAR’s Faith and Community Initiative, which aims to rapidly increase the proportion of men and boys living with HIV to access testing and treatment. The RMBs and PEPFAR clinical partners are working together to establish how faith leaders and health facilities can coordinate to increase male access to services, including coordinating with eight district governments to establish working relationships and obtain buy-in and guidance on geographic targeting for their activities.
On May 6, representatives from Kenya’s health leadership at the county level adopted a prototype of a new County Health Planning Unit (CHPU) for each county, created to address gaps in planning and advocating for budget allocations for strategic programs such as HIV, family planning, and malaria. HP+ supported the establishment of the CHPU through multisectoral collaboration with individual counties, the Ministry of Health, the Council of Governors, and the National Treasury. Moving forward, HP+ will support CHPU capacity strengthening and mentorship to institutionalize planning and budgeting at the county level, underscoring long-term sustainability on Kenya’s journey to self-reliance.
In May, HP+ supported Madagascar’s Ministry of Public Health’s Family Health Directorate to convene two virtual meetings with the multisectoral family planning committee to address decreases in family planning and maternal and child health service use nationwide. The meetings resulted in development and finalization of a budgeted action plan to ensure continuity of family planning service availability for the 27 districts under stay-at-home orders imposed as a result of COVID-19. Plan activities include ensuring continued availability of family planning products, extending the DMPA subcutaneous auto-injection approach in three regions to prolong the amount of time between visits to health facilities, and emphasizing community health service provision.
With HP+ technical assistance, seven counties in Kenya have collectively committed over US$5.2 million in the upcoming budget cycle to improve mother and child health in public facilities—a 40 percent increase over last year’s allocation. HP+ also trained staff on Kenya’s medium-term expenditure framework planning cycle to influence budgetary allocations for critical programs. The increased allocations will enable counties to increase access to antenatal care services and skilled care deliveries, and improve family planning coverage. Mombasa County intends target improvement of antenatal care visits from 27,775 to 41,598 and deliveries under skilled care from 36,057 to 38,538 between this fiscal year and the next.
In May, with HP+ support, Madagascar validated its new Water, Sanitation, and Hygiene (WASH) sector policy through a virtual workshop led by the WASH minister and attended online by nearly 80 key stakeholders. Adoption of the new policy is a significant achievement within the context of the COVID-19 pandemic, as it enables health facilities to install running water to support handwashing guidelines. Policy implementation, which will be facilitated through the forthcoming national WASH Strategy, aims to enable public access to potable water for the entire population by 2030—a significant increase from the current level of less than half of the population with access.
An HP+ webinar on May 28—Diagnosing Inequities in Family Planning Programs: A Case Study from Uganda—introduced a new, replicable approach for diagnosing inequities across family planning programming outputs and outcomes at both national and subnational levels. Presenters showcased results from its application to Uganda, focusing on the sub-regions, disadvantaged sub-groups, and family planning components for which inequities are most pervasive, and demonstrated its applicability to other countries. Use of the model is intended to increase the quality of family planning information and services for women.
A new HP+ blog post shares key lessons to advance universal access to family planning from 16 francophone countries. The lessons emerged from discussions among representatives from 15 francophone countries and Haiti—comprising government, civil society, development partners, and youth—convened by Family Planning 2020. Recommendations from the meeting included the establishment of a legal framework to include family planning in reforms aimed at achieving universal health coverage; using evidence and advocacy to make the case for including family planning in health insurance benefits packages; and strengthening stakeholder capacity to understand and manage health financing schemes.
HP+ is supporting Cambodia’s General Secretariat for National Social Protection Council (GS-NSPC) to implement integrated systems to enable social health insurance reforms. Following an April launch by the Prime Minister of an inter-Ministerial Technical Working Group to oversee linking of health insurance reimbursement systems, HP+ is collaborating with the GS-NSPC and the Asian Development Bank to design an interoperability demonstration project to support harmonization. These efforts to boost effectiveness, transparency, and accountability will improve the operation and effectiveness of the Health Equity Fund, which includes long-acting reversible and permanent contraceptive methods, and National Social Security Fund schemes that cover nearly 5 million beneficiaries.
In December, with support from the USAID-funded Health Policy Plus (HP+) project, two Nigerian states—Ebonyi and Osun—passed a series of state-level bills legalizing state health insurance schemes. The bills’ passage marks an important milestone for Nigeria’s national Basic Health Care Provision Fund (BHCPF) by establishing the necessary structures for the fund’s rollout at the state level. HP+ and other partners also secured government approval of the BHCPF’s previously stalled Operations Guidelines, unlocking US$150 million in appropriated funds. Once in place, the BHCPF will substantially improve Nigerians’ access to high-quality healthcare, especially among the poor. In addition, HP+ successfully advocated for the inclusion of Nigeria’s Federal Capital Territory (FCT) as one of the states to benefit from initial implementation of the fund, along with Abia, Edo, Katsina, Osun, and Yobe.
An HP+ webinar delivered by Christine Lasway and Laura Hurley on May 14 – What’s Measured Matters: Monitoring Family Planning Costed Implementation Plans – presented an overview of the CIP Performance Dashboard, a data management tool to track CIP performance targets. The discussion included case studies from Madagascar and Ghana, countries using it to monitor execution of their CIPs. The CIP Performance Dashboard, available in Excel and now as an online tool, was developed based on DHIS2. This webinar is ideal for stakeholders looking for a strategic planning performance monitoring tool.
HP+ supported Cambodia’s National AIDS Authority to conduct a legal and regulatory assessment of private sector provision of HIV services. The assessment concluded that, while the private sector can legally provide HIV services, these services are insufficiently regulated and reported. Findings informed private sector engagement strategies for the five-year National Health Sector Strategic Plan for HIV. If these strategies are adopted, Cambodia can expect to see higher-quality HIV services provided by the private sector, and the government will be able to use more reliable data to program resources.
A secondee from HP+ embedded in Mali’s Ministry of Health’s Immunization Subdirectorate supported national and district leaders to improve management of cold chain equipment and vaccines by developing, testing, and validating operational tools for monitoring cold chain equipment. Until now, no monitoring tools were available, making coordination among donors challenging. Availability of performance data on a quarterly basis will allow for informed decision making about forecasting cold chain supply and vaccine needs. This, in turn, will improve performance of cold chain equipment, efficiency of vaccine and distribution expenditures, and coordination of the overall system, contributing to the administration of quality vaccines to children throughout Mali.
Two civil society networks supported by HEP+ in Guatemala—Young Artists for Social Justice (JAxJS) and the Sexual and Reproductive Health Watchdog’s Youth Branch (OSAR Youth)—are disseminating key messages to contain the spread of COVID-19 through social media and radio. Local members of JAxJS have produced songs and poetry on preventing contagion, which target young Guatemalans, that receive an average of 7,000 daily views. OSAR Youth has disseminated key messages on the importance of continuing to provide reproductive health services and prevent teenage pregnancies. These civil society partners continue their advocacy efforts amidst the pandemic to maintain FP/RH, human rights, and policy development for disenfranchised populations on the government's policy agenda.
In December 2019, Burkina Faso’s Ministry of Health launched a monitoring and evaluation (M&E) plan to measure its progress on increasing contraceptive access. The finalization and implementation of the Costed Implementation Plan M&E plan is an important milestone showcasing the country’s commitment to increasing modern contraceptive prevalence, which at 30.7 percent, is the highest in the West Africa region. The M&E plan was developed following the formation of a multisectoral steering committee and thematic groups comprised of public, private sector and civil society representatives who advocated for a tool to track progress, a model for the region. Read our news story for more details.
In March, HP+ conducted a strategic planning and business viability assessment for SijariEMAS Teknologi Inovasi (PT STI)—an information and communication technology private sector start-up focused on improving health sector referrals for pregnant mothers and newborns in Indonesia—using an adaptation of Palladium’s Strategy Execution Bootcamp. As a result of the assessment, the start-up was able to successfully identify key areas to strengthen. HP+ will continue to support PT STI to make strategic adjustments regarding scale-up and expansion of the referral network to new districts, improve marketing and pricing strategies, streamline procurement and contracting processes, and diversify resources.
This month, a project-authored article on reducing stigma and discrimination in health facilities in Ghana was published in the Journal of the International AIDS Society. The article, which evaluates the impact of a “total facility” stigma‐reduction intervention on the drivers and manifestations of stigma and discrimination among health facility staff, found that respondents at stigma intervention facilities were 19 percent more likely to report that staff behavior towards people living with HIV had improved over the last year, compared to those at non-intervention facilities. These results provide a solid foundation for scaling up health facility stigma‐reduction within national HIV responses.
An original article authored by HP+ in coordination with a research team at Cambodia’s Ministry of Economy and Finance’s General Secretariat for the National Social Protection Council was published in the International Social Security Review. The research, which assesses current coverage potential, gaps, and social equity considerations with regard to the expansion of social health protection in Cambodia, is being used to inform a comprehensive policy proposal to expand coverage to about 5.7 million financially vulnerable people, improve healthcare quality, and strengthen institutional systems within Cambodia.
Malian mayors, community health associations, and communities mobilized over 7,850,000 FCFA (approximately US$13,305) in local resources to support payments of community health worker (CHW) stipends in Mali. The funds, mobilized by local stakeholders in the regions of Kayes and Sikasso between October 2019 and January 2020, enable CHWs to continue to continue providing essential care following the end of funding from USAID via the SSGI Project this past September. CHWs, who reach Malians who live more than five kilometers from community health centers, have contributed to increased modern contraceptive prevalence. According to the 2018 Mali DHS, modern family planning use among married women age 15-29 increased from 10% in 2012-13 to 16% in 2018.
In March, following an HP+ policy advocacy training and ongoing mentorship, two student youth advocates at Malawi’s University of Livingstonia established a Sexual and Reproductive Health and Rights (SRHR) club on campus to provide information and referrals for students seeking to access contraceptives, counseling, HIV testing, and information on SRHR. The advocates are now seeking to establish a youth-friendly health services space at the university where students can access information, services, and referrals to the closest hospital and mobile clinic. There are currently 700 students attending Livingstonia University and 64 have expressed interest in joining the SRHR network.
In the Kyrgyz Republic, HP+ is providing technical support for the implementation of the first social contracting projects in the country. In 2019, the Ministry of Health Republican AIDS Center (RAC) awarded projects for six NGOs to support adherence to HIV treatment and reduction of viral load for a total of 3 million soms (about US$45,000 at the time of the allocation). HP+ provided extensive support to strengthen stewardship and management capacity at all stages of implementation. The NGOs successfully linked 68 people living with HIV to care and initiated antiretroviral therapy. The RAC plans to continue social contracting in 2020 and has committed to increasing the allocated amount to 5 million soms. HP+ is also supporting the MOH Oncology and Psychiatry departments to launch social contracting.
A blog post co-authored by HP+’s Director for Family Planning and Reproductive Health, Jay Gribble, and gender adviser Beth Rottach discussing the importance of gender considerations amid the COVID-19 pandemic response was published by the Infectious Diseases Society of America’s ScienceSpeaks blog. The article was also cross-posted to the International Conference for Family Planning 2021’s COVID and Reproductive Health blog. These platforms reach a wide audience of infectious disease and family planning experts, offering recommendations to ensure that the ongoing health needs of women and the people who care for them are positioned at the forefront in the global response to the pandemic.
In Cambodia, HP+ supported the Ministry of Economy and Finance and the National Social Protection Council (NSPC) to develop a monitoring and evaluation (M&E) operations manual and indicators to monitor progress on social protection in Cambodia. Included is an indicator on rates of contraceptive prevalence. Due to COVID-19-related social distancing measures, HP+ has facilitated rapid transition of this activity to an online platform to validate indicators with 11 line ministries. In addition, HP+ developed an online course catalogue that offers 27 free, online social protection courses for colleagues to pursue self-study while working remotely.
In Malawi, youth trained in policy communication have successfully advocated for policy changes at the district level. The training, facilitated by HP+ in coordination with partner Population Reference Bureau (PRB) in July 2019, resulted in the creation of policy advocacy plans by youth advocates. Recent follow-up by PRB revealed multiple successes in the implementation of these plans, including implementation of a differentiated care model for antiretroviral therapy service delivery, expanded clinic hours to target youth, and inclusion of youth leaders in local decision-making committees and district structures. These policy changes improve youth access to health services and family planning information, contributing to improved health outcomes across Malawi.
In January 2020, Cambodia’s Ministry of Economy and Finance’s inter-departmental health working group accepted 32 recommendations crafted by the National Social Protection Council. The recommendations, which include expanding coverage to dependents and raising the income threshold for premium contributions, came from HP+-generated evidence aimed at advancing the government’s social health protection agenda by promoting ownership and empowering key influencers to effectively advocate for policy change. The recommendations, which the government will begin to implement over the coming year, could significantly benefit Cambodia’s most vulnerable citizens by expanding social health insurance to 3.8 million family dependents and 3.1 million vulnerable people, who will gain improved access to long-acting and reversible and permanent family planning methods to be reimbursed under the HEF benefits package
This month, HP+ supported researchers from Indonesia’s National Institute for Health Research and Development (Balitbangkes) to publish a journal article in BMC Public Health. HP+ strengthened capacities of the researchers to analyze data about potential risk factors for adverse maternal and newborn health (MNH) outcomes and write and submit five academic articles to peer-reviewed journals. Balitbangkes’ research will contribute to the dissemination of MNH scholarship among learned communities, inform a wide audience beyond technical subject-area experts about key MNH risk factors in Indonesia, and support the development of informed decisions by policymakers.
In January 2020, leadership of a key legislative committee endorsed Ethiopia’s first HIV Domestic Resource Mobilization and Sustainability Strategy, developed with support from HP+. Once approved by the Council of Ministers, the strategy will put in place groundbreaking HIV financing mechanisms, including a US$14 million increase in general government budget allocation to HIV programming and the earmarking of a 0.2 percent tax on the profits of all companies, public and private, with an annual revenue of approximately US$3 million. The strategy is estimated to mobilize US$93 million over five years, increasing from US$15 million in 2021 to US$23 million in 2025.
The HP+-supported Healthcare Federation of Liberia is working alongside the Ministry of Health and the National Public Health Institute of Liberia (NPHIL) to scale-up trainings to private sector providers across Montserrado County to address COVID-19. The three-hour rapid training, conducted by NPHIL with social distancing measures in place, will cover infection prevention and control, case management, and emergency response protocols. Up to 250 private providers (from 150 facilities) will be trained in two weeks, covering over 50 percent of Liberia’s health facilities.
In Cambodia, the National Center for Tuberculosis and Leprosy Control (CENAT) is using evidence generated by an investment case and recommendations from a joint program review to advocate for greater funding for the tuberculosis (TB) response. HP+ is providing technical support to CENAT to employ the TB TIME model to analyze a variety of scenarios of programmatic impact against potential investment requirements. HP+ found that scaling up active case finding and contact investigation and improving the diagnostic algorithm could result in a 33% reduction in the number of TB incident cases and a 27% reduction in costs borne by individuals from 2019 to 2025.
In February, the newly launched Healthcare Federation of Liberia (HFL) elected its inaugural board of directors, who also participated in their first Ministerial Stakeholder Forum. The association was launched following an HP+ assessment of the private health sector that identified the need for a unifying body as well as opportunities to improve the private health system, create a framework for collaboration with the government, and better leverage private sector actors for improved health outcomes. With HP+ support, the HFL will offer financial management skills-building courses to health small- and medium-sized enterprises and partner with Access Bank to support the development of loan products tailored to the health sector.
In recent months, HP+ has supported Cambodia’s National AIDS Authority to identify and budget for HIV-related activities for the coming year in coordination with non-health line ministries. Using the National Strategic Plan for a Multi-Sectoral, Comprehensive HIV/AIDS Response (2019-2023) as guidance—a strategic plan for coordinating the country’s HIV response, produced with HP+ support—the ministries committed approximately US$500,000 to fund HIV-related activities in Cambodia. This commitment supports progress toward achieving the vision of government funding of 50% of the HIV response by 2023 (up from 24% in 2017).
In Madagascar, the Ministry of Public Health’s Family Health Directorate (DFSa) is using a web-based dashboard tool to facilitate data analysis and visualization as part of its semi-annual costed implementation plan (CIP) execution review meetings. HP+ developed the dashboard and trained the DSFa and CIP committee on its use. The dashboard, which is owned by CIP committee members, allows for strategy adaptation and orientation for improved family planning programming and CIP implementation in the country. The dashboard encourages country ownership of the CIP process and progress toward achieving its goals, including increasing the contraceptive prevalence rate to 50 percent.
In Malawi, cervical cancer data management and program monitoring systems are generating crucial data to be used in decision making at national and district levels. With technical support from HP+, the Ministry of Health and Population’s Cervical Cancer Task Force developed quality assurance standard operating procedures, guidelines, and data tools, and trained health workers on how to screen for and treat cervical cancer. The tools have been integrated into the country’s health information system to support evidence-based decision making. Over 180 health facilities have received screening and treatment equipment, and linkages and referrals for specialized treatment and care have been strengthened as a result.
Early results from districts in Malawi where hospitals have been accredited as baby-friendly (BFHI) have revealed great success: on average, in the nine hospitals HP+ has trained, early initiation of breastfeeding increased from 43 to 75 percent. In Dedza, exclusive breastfeeding contributed to a reduction in neonatal deaths from 24 to 13 percent over six months. Learning from prior experience, HP+ adapted the BFHI program to train hospitals sequentially. The revised approach provides immediate feedback and ongoing mentorship and ensures that at least 80 percent of clinical staff are trained in each facility, as well as support staff and community mentors.
Mali’s Alliance of Muslim and Christian Religious Leaders has expanded their organizational by-laws to include working against gender-based violence (GBV), an important step forward for a country where faith leaders have significant influence over sociocultural practices that impact health. According to Mali’s 2018 Demographic Health Survey, 45% of women ages 15-49 have experienced violence. Following an orientation by HP+ on the types and prevalence of GBV in Mali, the faith leaders felt compelled to act. With the modified by-laws, the alliance joins forces with the National Program to Abandon GBV and other stakeholders to revive efforts to advance a law to combat GBV in Mali.
In Burkina Faso, one mayor has successfully mobilized more than US$124,100 to support the implementation of family planning activities under his jurisdiction. Following an HP+-supported sub-regional family planning workshop in 2018, Bobo-Dioulasso mayor Bourahima Fabéré Sanou committed to allocating 20 million CFAF (US$33,000) to family planning. Under his stewardship, the municipality mobilized an additional US$91,000 from the International Association of Francophone Mayors to support training and awareness-raising activities, contraceptive procurement, and the promotion of service delivery campaigns in secondary health and professional establishments. As a result of these activities demand for sexual and reproductive health services have increased 52 % in Bobo-Dioulasso, adding 1,335 users to the existing 2,578.
Kenya’s Mombasa County has chosen to increase its allocation to health by 25% over the previous year’s allocation as a result of a report by the Mombasa County Health Sector Working Group. The report, which aligns with the country’s Domestic resource mobilization agenda, identifies resource needs and allows the county to negotiate for additional funding within the health sector. HP+ provided technical support in the areas of expenditure analysis and budget estimates, supporting the working group through a consultative process. As a result of the report, Mombasa County will now allocate KES 3.5 billion in fiscal year 20/21, which will allow facilities to stock pharmaceuticals and supplies, ultimately reducing out-of-pocket expenditure for clients.
Nigeria’s Abia State government has formally approved the release of US$137,000 as take-off grant to be used for procuring technology infrastructure—a critical need that has delayed the rollout of the state insurance scheme since its official launch in September 2019. HP+ has supported Abia State Health Insurance Agency (ABSHIA) in multi-layered advocacy efforts that resulted in the release of the take-off grant. The release of the grant will enable an effective rollout of the ABSHIS toward providing health insurance for about 200,000 residents—a major leap forward in improving access to affordable and equitable quality healthcare in the state.
A newly launched private sector healthcare association – the Healthcare Federation of Liberia -- on February 13, 2020, elected its first board of directors who also participated in their first Ministerial Stakeholder Forum. HP+ is informing the creation of the federation with technical assistance and an assessment of the private health sector that delivers family planning and maternal and child health services in Greater Monrovia. The assessment identifies opportunities to efficiently and intentionally create improvements in the private health system, create a framework for collaboration with the government, and better leverage private actors for improved health outcomes. The locally created federation will prioritize building the capacity of the members to deliver health services, including assisting members to gain access to formal business loans and targeted financial management training with the support of HP+.
Cambodia took a major policy implementation step in its national HIV/AIDS response this month when the Prime Minister approved a resolution directing operational funding for the response and other key advancements, notably the eligibility of all people living with HIV to receive a Health Equity Card and recognition of the important role played by civil society organizations. The resolution also guides the Ministry of Health to amend policies for health center and hospitals to use their own funds for HIV/AIDS activities, in addition to Ministry’s national budget. This achievement represents the culmination of an extensive effort by HP+ Cambodia and its health advisors, who are embedded at the National AIDS Authority (NAA), to advance health financing policy implementation for people living with HIV. This effort included sensitization and capacity building with the NAA leadership and ongoing support for the entire policy advocacy process including the drafting of the board resolutions and proposal to the Prime Minister’s office. Moving forward, the Prime Minister’s directive calls for the Supreme National Economic Council to further study the fiscal space to ensure implementation of the commitments and to sustainably mainstream the HIV/AIDS response through strengthened human resources, procurement, supply chain management, and health information systems. HP+ will continue to support the NAA in implementation of the new guidance.
Kenya’s Public Financial Management Act requires that all funds collected at health facilities be channeled to a country revenue fund, blocking local health departments from control of revenue and compromising quality of care as a result. To address this challenge, HP+ supported the Kilifi Department of Health to assess the legal and policy environment and identify a strategy to redirect US$1.25 million in user fees back to the health sector to support purchase of commodities and cover operational costs. Returning control of domestic resources for health to the health sector is expected to improve quality of care and accessibility of commodities at health facilities.
In Mozambique, HP+ developed, installed, and tested the Apache Superset Data Visualization Tool as part of its support to the Department of Administration and Finance (DAF) to improve financial management. Leveraging comprehensive data from the Ministry of Finance and the Ministry of Health, the visualizations showcase health sector coverage based on expenditure and allocation data, efficiency of financial processes, and payments made. Currently, 21 local users have been trained and have access to the tool. When fully implemented, this tool will help DAF and provincial directors to achieve greater effectiveness in financial decision making at both national and provincial levels.
In Mali, three members of the Association of Malian Municipalities (AMM) are independently facilitating advocacy meetings to mobilize local financing for community health workers (CHWs), following a HP+ training in AFP SMART methodology. The AMM has secured funding from the Aga Khan Foundation to advocate for communes to assume financial responsibility over their CHWs, and two municipalities have signed service contracts with 210 CHWs to ensure stipend support. Increasing domestic financing for CHWs will increase access to services for women and children, particularly those living more than 5 km from a health facility.
Recent data indicates that Ghana is on track to meet the milestones in its costed implementation plan for family planning, including achieving the goal of increasing modern contraceptive prevalence among currently married women from 22.2% (2014) to 29.7% (2020). HP+ has supported the development of performance indicators to monitor execution of key results and established and rolled out a web-based performance monitoring dashboard to government stakeholders and implementing partners. Ghana is estimated to have added 590,000 contraceptive users since 2012, bringing coverage to a total of 1,676,000 users and averting 213,000 unsafe abortions and 1,100 maternal deaths.
In Tanzania, 90% of district councils (167) have been oriented to the country’s national family planning costed implementation plan (CIP) and supported to develop action plans for inclusion in councils’ 2020/21 budget requests. In 2019, HP+ supported the Ministry of Health, Community Development, Gender, Elderly, and Children in national dissemination of the CIP. These efforts involved supporting the facilitation of dissemination workshops to enable local government authorities to understand and buy into the plan—important steps toward increasing budget allocation for family planning at the local level.
As a result of HP+ advocacy support to Cambodia’s National AIDS Authority, the country’s Ministry of Economy and Finance (MEF) agreed to significantly increase funding for antiretroviral drugs (ARVs) over the next three years. The annual increases in funding—from the current allocation of US$1.5 million to US$5 million by 2023—will allow the Global Fund to reallocate resources to critical, underfunded HIV prevention activities. The MEF’s decision supports progress toward achieving the country’s national strategic plan directive that 50 percent of HIV response funding be derived from domestic sources by 2023 and sets a new contribution floor for government ARV funding.
In December 2019, Madagascar integrated a tax exemption for contraceptives into the country’s finance law. The exemption, which will remove the 20% value-added tax applied at customs, followed HP+ support to the Ministry of Public Health’s Family Health Directorate to write advocacy messages encouraging key decisionmakers to make contraceptives tax-exempt. This exemption will reduce purchase costs, contributing to operationalization of the new Reproductive Health and Family Planning Law (2018) that promises access to contraceptives for all, and encourage private sector engagement in family planning service delivery.
Nudges such as mobile airtime or membership in a health insurance scheme might be helpful in motivating someone to get tested for HIV, suggest the results of a USAID-funded analysis carried out in Tanzania by Health Policy Plus (HP+). HP+ staff met February 5 with officials from the Tanzania health ministry, PEPFAR, implementing partners, and other stakeholders in Dar es Salaam to discuss the study results. Patients and health providers in the study found the incentives attractive and easy to administer. Only 61 percent of the country’s estimated 1.5 million HIV-positive individuals know their status, and Tanzania is looking for cost-effective ways to increase testing uptake.
HP+ applied the Family Planning-Sustainable Development Goals (FP-SDGs) Model with stakeholders in Tanzania to project how family planning investments can accelerate progress toward the SDGs. HP+ worked alongside local stakeholders to strengthen their capacity to generate projections from the model and interpret results. Advocates have used results to make the case to Parliamentarians and others to prioritize and expand family planning in support of broader development goals. Model results estimate that increasing family planning investments in Tanzania could, by 2030, reduce maternal mortality by 47% and increase the proportion of the population using safe drinking water by 20%, among others.
Representatives from HP+ Cambodia and Indonesia teams participated in the Prince Mahidol Award Conference 2020, adding to discussions on universal health coverage with case studies on HIV financing, social protection, and private sector engagement. HP+ collaborated with USAID to host a well-attended satellite session entitled Harnessing the Private Sector for UHC through Smart Policy, with participation by Elaine Menotti and Pellavi Sharma of the Office of Population and Reproductive Health.
HP+ led a webinar on January 30th to discuss how countries -- with examples from Botswana, Nigeria, Tanzania, Kenya and Indonesia -- have met PEPFAR’s minimum program requirements for policies and practices essential for success. With special guest Sylvain Bowra of the State Department in Botswana, HP+ contributors shared a new resource illustrating the status of each of the minimum requirements across all PEFPAR countries.
FDH Bank of Malawi was awarded the first-ever Positive Youth Development Award at the annual Marketing Excellence Awards by Malawi’s only association of professional marketers. The award, recognizing the bank for excellence in developmental and social services targeting young people ages 10-35, was recently introduced as a new award by Chartered Institute of Marketing (CIM Malawi). The award aims at mobilizing the private sector to support implementation of the country’s National Youth Friendly Health Services Strategy in order to improve youth empowerment and access to health services through strengthened public-private partnerships. At the awarding ceremony, private sector attendees expressed enthusiasm about the introduction of the youth award category, which is expected to stimulate the private sector to invest more in youth related interventions as the companies compete to win in coming years. This all comes as a result of HP+ support to the Ministry of Health to prioritize and promote youth friendly health services.
“No other organization supports [the National Health Insurance Scheme] like HP+.” That was the first reaction of Professor Muhammed Sambo, Executive Secretary of Nigeria’s National Health Insurance Scheme last week when reviewing recent results that come in part from technical and financial support given to establish state-level insurance agencies in four Nigerian states. The health reform goal is to reach women and children under five, and to date, Osun state has enrolled over 200,000 participants into their insurance scheme. In the Federal Capital Territory health insurance coverage has been extended to 85,000 formal sector workers and $2.19 million was released to pay for nine months of capitation and fee-for-service. Likewise, in November 2019, Nigeria’s National Primary Health Care Development Agency presented HP+ with an award in recognition of the project’s technical contribution to strengthening the country’s primary healthcare system, specifically for their work in helping states implement Nigeria’s Primary Health Care Under One Roof policy, aimed at improving the quality of and access to care at the community level. More information about efforts in Osun State
The HP+ “total facility approach” to reducing stigma and discrimination in health facility settings is being featured on the PEPFAR solutions website. This showcases the work carried out by HP+ in Tanzania and Ghana as an important solution for the HIV response. PEPFAR Solutions are impactful, data-proven approaches intended to guide others in program design and implementation. U.S. government staff and partners around the world use the solutions website as a resource for HIV program design. Having the stigma-reduction approach featured also makes it accessible to mission staff around the world as they embark on their COP20 planning processes.
Malawi reached a key milestone in decentralization of the health sector at the end of 2019 with the establishment of district-level condom coordination committees to enhance distribution and access in all 28 districts. The District Condom Coordination Committees (DCCCs), oversight groups with clearly defined roles and responsibilities for accountability, were outlined as a priority in Malawi’s National Condom Strategy (2015-2020), which was developed with USAID support. Initially, HP+ helped to establish the coordinating committees in five priority districts and shared the approach with PSI to reach an additional three districts. HP+ scaled it up further in two more districts and then leveraged funding from UNFPA through the Family Planning Association of Malawi to set up committees in the remaining 18 districts to establish a Comprehensive Condom Program in every district. During the set-up process, HP+ oriented district staff and community partners on reporting tools for the community and facilities to improve distribution and prevent stockouts. Malawi’s National Condom Strategy was launched in 2017 by the Ministry of Health and Population’s Department of HIV/AIDS to improve availability of and access to male and female condoms and condom compatible commodities, for the purpose of preventing unintended pregnancies, HIV, and other sexually transmitted infections. Read local coverage
HP+ recently launched Growing Together: Multisectoral Investments in Malawi’s Youth, an ENGAGE multimedia presentation that describes how investments in young people’s health, education, employment opportunities, and participation in governance can create a window of opportunity for accelerated economic development. The presentation was developed with the guidance of a multidisciplinary taskforce chaired by Malawi’s Ministry of Health and included youth leaders and representatives from government and civil society. The presentation was utilized by UNFPA to launch their event “Road to Nairobi for the ICPD” on World Population Day 2019, and stakeholders across sectors will continue to use the resource in their call for increased cross-sectoral investments in Malawi’s young people.
The Economic Association of Malawi (ECAMA), an independent association of economists, committed in early November 2019, to the management of population growth and investments in youth and articulated the importance of policies that support job creation as key in harnessing Malawi’s demographic dividend. At their annual meeting, ECAMA members published a resolution detailing 10 steps that will improve human development. Health Policy Plus provided evidence from RAPID to support the Ministry of Health and Population’s planning team make a case for the integration of population in planning. HP+ technical advisor of family planning, Julius Chingwalu participated as a discussant on the population and development panel.
On December 19, the Pharmaceutical and Other Health Technologies Policy was approved by ministerial decree in the presence of authorities from the Ministry of Public Health (MSPAS), the Guatemalan Institute of Social Security (IGSS), over 70 health sector public officials, and representatives of international cooperation agencies. The event where the policy was approved was led by the Minister of Health. The policy represents a strategic mechanism that guides, directs, and implements comprehensive actions with national reach. It strengthens health sector governance by establishing criteria and strategies to define roles and responsibilities in the management of medicines and other health technologies. It also unifies guidelines for health and public sector institutions to guarantee access to medicines to all Guatemalans. During the event, IGSS committed to adhere to the policy and collaborate with MSPAS to achieve its full implementation. The MSPAS Logistics Management Unit Director acknowledged the technical assistance received by the Pan American Health Organization, World Health Organization, and USAID/HEP+ during the design, development, validation, and approval process of the policy.
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