Welcome to the USAID-funded Health Policy Plus (HP+) project website.
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HP+ Niger worked alongside key government agencies and local leaders to hold workshops for community leaders to strengthen their advocacy skills, with an emphasis on domestic resource mobilization for family planning services and commodities. Following the workshop, participants organized into advocacy teams to help mobilize family planning resources in their communities. In Damagaram Takaya—a village in Niger’s Zinder region—the advocacy team helped to mobilize FCFA 2 million from local government and community members to open a pharmacy and purchase family planning commodities in a new district hospital. An additional FCFA 250,000 was raised by communities in the city of Maradi. These advocacy teams—with initial technical support from HP+ and under the leadership of the regional directorates of public health, population, and social affairs—will continue to mobilize local resources and pool them to support health management committees purchase health commodities and fund health services, including those related to family planning.
HP+ hosted an interactive, online policy forum on August 9, 2022, on how a stronger enabling environment for family planning can reduce contraceptive discontinuation. While much attention is given to reducing unmet need and the uptake of modern contraception, much less attention is given to helping women continue to use their methods once they start. Yet almost one in three new users of family planning discontinues within 12 months of starting for a variety of reasons. The event’s speakers, including Sara Stratton and Sandra Mapemba from HP+; Rahal Saeed from Palladium’s USAID-funded NPI EXPAND project; and Heidi Quinn from the International Planned Parenthood Federation, joined HP+’s Jay Gribble and 101 participants to discuss how program efforts can be strengthened to reduce discontinuation while helping women achieve their reproductive goals. Speakers offered examples from their work globally and in Kenya, Malawi, and Pakistan. The policy forum was the culmination of HP+’s blog series, “Rethinking Contraceptive Discontinuation: Are Solutions Being Overlooked?,” where a variety of authors detailed some of the emerging approaches, such as counseling and services, supply chain, self-care and digital solutions, financing, the development of new methods, and community norms, to address contraceptive discontinuation.
With HEP+ support, inter-institutional agreements that pave the way for the transfer of health functions to local health areas were signed on July 18 between Guatemala’s central government ministries and six municipalities. These agreements allow for improved coordination between central and local authorities and support capacity strengthening at the municipal level, empowering local health area directorates and municipal health districts to plan, operate, and monitor newly delegated responsibilities. With this increased monitoring at the local level, authorities can better monitor health outcomes according to the epidemiological profile of each municipality and thus, support the reduction of morbidity and mortality indicators. The newly delegated comprehensive healthcare approach is also anticipated to improve water and sanitation services for communities. HEP+ supported the Presidential Secretariat for Executive Coordination with designing a framework and methodology to collect input from stakeholders at all levels on the competencies to be delegated and provided input on the inter-institutional agreements.
The family planning logistics technical working group in Kenya commended the Ministry of Health’s Division of Reproductive and Maternal Health in July 2022 on significantly improved absorption of budget allocated for family planning commodities. The working group noted that for the first time, the division had absorbed all funding allocated to the family planning budget line, opening an opportunity to mobilize more funds from the national budget. Previously, poor absorption of family planning funds by the ministry had affected forecasting and quantification for the next year, with unspent funds in any year leading to a reduction in allocation for the next year. HP+’s support to track family planning allocation and the transfer of funds for the procurement of essential commodities helped the division locate and spend funding in a timely manner and avoid having the funds reallocated to other programs. At a meeting of the family planning logistics technical working group it was noted that HP+ support also enabled the division to harmonize various funding streams and procure commodities more efficiently.
USAID held the closing event of its Health Policy Plus project in Honduras in July, 14, 2022. The event was attended by Dr. José Manuel Matheu, Minister of Health; Michelle Dworkin, Acting Deputy Mission Director of USAID Honduras; as well as other key actors from the Ministry of Health and civil society. Due to gathering restrictions, 30 people attended in person, and 87 watched on livestream. Speakers noted significant accomplishments made or supported by HP+, including 25 policy actions, 5,538 healthcare workers trained, 4,567 visits to HP+’s YouTube training, and 60 workshops through the HP+ implementation period. The ministry is committed to sustaining the activities initiated by HP+ and continuing its engagement with USAID in fighting the COVID-19 pandemic through its Data.FI project. Read more in our news story.
HP+ hosted a thought-provoking webinar discussion on June 30, 2022, on the development and application of the Legal and Policy Framework to Accountability approach in different country contexts. The speakers, including Dr. Charles Mwinuna, Provincial Health Director, Zambia and representatives from Samasha Medical Foundation, the Centre for Reproductive Health and Education in Zambia, and Women and Development in Law in Africa, joined Katie Peel from HP+ to discuss the current contextual constraints, the application of the approach, and preliminary ”wins” in the accountability space for family planning. The legal and policy accountability approach looks beyond family planning, providing a framework to engage a broad range of stakeholders, tackle challenges, and drive action forward. Dr. Charles Mwinuna of the Ministry of Health expressed his gratitude for the activity implementation and noted the strengthened capacity of Neighborhood Health Committee and Family Planning Technical Working Group members in the planning and budgeting process. Moses Muwonge and Charity Nagemi from the Samasha Medical Foundation shared how the integration of the approach with the Motion Tracker enhances collaboration with partners and helps address barriers to the achievement of FP2030 commitments by considering policy or legal challenges, developing strategies to address challenges, identifying opportunities for partnership, and informing accountability efforts.
In response to COVID-19-related stress and a 16 percent increase in domestic violence reports after the onset of the pandemic, HP+ developed and delivered a three-day training for 43 staff members from eight of Honduras's health regions in psychosocial first aid and guidelines for mental healthcare and psychosocial support for victims and survivors of all forms of violence, with a special emphasis on care of survivors of domestic and sexual violence. The training was held virtually in late April 2022. The average knowledge gain among participants who completed the pre- and post-tests was 23 percent. In addition, HP+ developed posters and a pamphlet for health facilities to inform healthcare workers and raise awareness of the critical topics of mental health and psychosocial support associated with the COVID-19 pandemic. The Ministry of Health plans to distribute the materials to approximately 400 of the country’s prioritized primary care centers.
HP+ is supporting the Honduran Ministry of Health to create a robust strategy for the surveillance, control, and prevention of healthcare-associated infections to help improve the quality of care provided in hospitals and prepare for future threats. As part of this effort, from June 2021 to May 2022, HP+ worked with the Ministry of Health to evaluate surveillance, control, and prevention of healthcare-acquired infections in 20 of the country’s 32 hospitals. For the infection, prevention, and control evaluation, findings showed significant differences between hospitals with 10% at a basic level, 55% at an intermediate level, and 35% at an advanced level. For the hand hygiene evaluation, levels were slightly lower. Findings and suggestions from hospital teams were used to develop strategic policy guidance. In late May to early June 2022, the strengthening phase of the activity began, including both a virtual pre-workshop with 91 participants and a two-day in-person workshop in Tegucigalpa with 26 participants. These activities trained infection prevention and control teams and quality coordinators from 11 hospitals in the use of quality improvement tools and supported them in the development of improvement plans for the control and prevention of healthcare-acquired infections. These activities were chaired by the Ministry of Health authorities for hospital-level care and quality who plan to continue training additional hospitals.
Health Policy Plus Madagascar held its closing event in Antananarivo on July 1, 2022, attended by representatives from the National Institute of Public and Community Health (INSPC), the Ministry of Public Health, the Ministry of Economy and Finance, USAID Madagascar, and HP+ experts. Achievements noted were the passage of a rights-based reproductive health and family planning law, a Health Sector Development Plan (2020–2024), and a National Strategic Plan for Community Health (2010–2030). Panel discussions dealt with strategic frameworks for health, increasing domestic funding, and family planning. INSPC Director Pâquerette Hanitriniala Sahondranirina urged attendees to keep working on the country’s goals: “… this day signifies that we are still together and ready to work for the good cause of health and well-being of the Malagasy population, which is a guarantee of sustainable development of the country.” Read more in the HP+ news story.
In early 2022, HP+ and several Honduran Ministry of Health units updated the Guide for Home Management of Suspected or Confirmed COVID-19 Patients to expand on vaccination, mental health and psychosocial support, and other lessons after one year of the onset of the pandemic. HP+ then facilitated several training sessions in April at different leadership levels in the health regions, delivering four four-hour training sessions to 74 people from 18 health regions (90% of all Honduran health regions). As a result, participants had a 10% improvement in knowledge (85% pre-training and 95% post-training). In early June, HP+ accompanied the trainers in two workshops where they replicated the training for over 250 healthcare staff. These activities were possible thanks to the leadership and commitment of the Ministry of Health of Honduras, specifically the Directorate of First Level of Care Services and various civil society organizations. This joint action aims to ensure the sustainability of capacity-building activities and the promotion of suitable materials for patients, families, and friends.
In May 2022, the Government of Nigeria approved two memos, presented by HP+ at the 6th National Council on AIDS Conference. The memos call for sustainable HIV health financing reforms, including implementation of Nigeria’s HIV domestic resource mobilization and sustainability strategy—developed and launched with HP+ support in 2021—and the strengthening of public financial management. Nigeria's National Agency for the Control of AIDS will now work in close collaboration with state AIDS control agencies, the Ministry of Health, domestic resource mobilization multisectoral technical working groups, civil society organizations, and HIV implementing partners to implement the domestic resource mobilization strategy and strengthen public financial management and budget advocacy efforts. This work will take place across Nigeria’s 36 states and the Federal Capital Territory to improve government financing, reduce funding gaps, and ensure improved HIV outcomes and sustainability of Nigeria’s HIV response. Read our news story for more on this accomplishment.
HP+ West Africa held an end-of-project event June 24, 2022, in Lomé, Togo and virtually to highlight the impact of HP+ activities in Burkina Faso, Côte d’Ivoire, Niger, Togo, Benin, and Guinea. The event was attended by more than 100 leaders in the region, including representatives of Togo’s health ministry, the U.S. Embassy in Togo, the Ouagadougou Partnership, and the West African Health Organization. Four panel discussions focused on costed implementation plans, joint advocacy for policy change, domestic resource mobilization for family planning, and sustainability, and featured impactful results such as Burkina Faso's increased contraception rate from 18 percent to nearly 30 percent over the course of the project. “A partner like HP+ made it possible to substantially improve the enabling environment…that allowed us to advocate for the increase of domestic financing for the repositioning of family planning,” said Marie Ba of the Ouagadougou Partnership.
In Kenya, HP+ helped national and Mombasa county government actors in 2021 and 2022 make a strong investment case for family planning during the country’s elaborate budget process. Despite decreased revenue due to COVID-19, government allocation for family planning commodities went up by about 38 percent from FY 2021/22 (about US$8.2 million) to FY 2022/23 (about US$11.3 million). Mombasa county allocated its first domestic family planning funds for FY 2022/23, around US$46,000 (KES 5.4 million). With HP+ support, Mombasa county government officials also defined priority family planning activities and a family planning commodity security action agenda.
With technical support from HP+ Niger, in December 2021, the Governor of Maradi signed a decree for the creation and functioning of the Regional Technical Committee that will monitor the implementation of the Budgeted National Action Plan for Family Planning 2021–2025 in Niger. In addition to monitoring the implementation strategies defined in the action plan, the decree also mandates: promotion of any innovative strategy falling within the framework to achieve objectives, coordination of local family planning interventions, and monitoring the availability of the full range of modern contraceptive products and methods to allow clients free and informed choice. As part of next steps, in March 2022, HP+ supported efforts in Maradi and Zinder to finance the action plan through a capacity building workshop for members of health center management committees and community leaders on the mobilization of domestic resources for the well-being of mothers and children. The workshop concluded with commitments being made to support the government’s effort.
The Kenya Ministry of Health, for the first time, published the National and County Health Budget Analysis, FY 2020/21 to its public website, demonstrating the importance of this report in providing evidence for the country’s health sector resource mobilization and health planning and budgeting efforts. HP+ supported Kenya’s Ministry of Health to develop the analysis report, which examines how public health sector financial resources were allocated for the 2020/21 fiscal year in comparison to the allocation patterns of the preceding two years. Findings show that while Kenya has not yet attained the recommended allocation to health contained in the Abuja Declaration, the government has made significant progress, increasing allocation to 11 percent of the total government budget in 2020/21, from 7.5 percent allocated in 2014/15. Continuing this trend will help Kenya progress toward achieving sustainable financing for health and reduce dependence on external assistance. Other findings show that county governments spend the majority of their funds on the payment of staff salaries, which can limit funds available for other key inputs such as drugs. Further, county governments allocate more funding to curative care than to preventive and promotive care. These and other findings in the report provide evidence for national and county policymakers and decisionmakers to inform public health budget allocation planning at both the national and county level. The report is also available on the HP+ website.
Health Policy Plus’s health financing lead, Eduardo Gonzalez-Pier, participated in the Annual Health Financing Forum (AHFF) on June 14–16 in Washington, DC. The annual event was co-hosted by the World Bank, USAID, and the Global Financing Facility. This year’s meeting, which assembled government officials, policy experts, and donor agencies from the health and financing sectors focused on mobilizing and pooling funds to pay for primary healthcare. Dr Gonzalez-Pier joined three deep-dive panels that explored how to protect primary healthcare resources through the frontline, building trust in health financing decisions for universal health coverage, and the role of taxes to promote health and increase funding. The meeting agenda was designed around the new “Lancet Global Health Commission on Financing Primary Health Care: Putting People at the Centre,” which promotes the vision that healthcare needs to be more effective, responsive, equitable, comprehensive, and primary healthcare-centered to be fully aligned with the objectives of universal health coverage. The forum discussions made evident that spending more and spending better on primary healthcare requires a balanced technical and political approach that needs to be supported by data-driven collaborative research, adoption of implementation science, and a deep understanding of political economy considerations. Promoting increased and open cross-country dialogue on lessons learned from locally relevant universal health coverage experiences is essential as countries emerge from the pandemic and set health systems back on track to meet the 2030 agenda.
Health and Education Policy Plus (HEP+) in Guatemala marked its completion featuring advancements in health reform and civil society leadership with a hybrid event on June 14. Derek Sedlacek, USAID Guatemala Director of the Health and Education Office, highlighted the collaborative nature of HP+’s work: The results achieved respond to the priorities identified collaboratively with the Guatemalan government and the Ministry of Health.…We are sure that all of the positive achievements from this [project] period will be maximized to continue improving health outcome indicators for the Guatemalan population, especially in rural areas. Two breakout sessions presented themes of civil society engagement and governance and health sector reform, with a focus on the project’s response to COVID-19. During the civil society breakout session, representatives from ALIANMISAR, the Men’s Network, and OSAR described their strengthened capacity as a result of partnering with HEP+ and how this had supported their health service provision, quality monitoring, and advocacy. Both sessions emphasized that the project’s achievements were possible because of collaboration, trust, and partnerships struck between the project and its key partners—the Guatemalan government and civil society organizations.
For seven years, HP+ has worked with government and partners across Mali’s health system. Results and accomplishments were highlighted Thursday, June 9 with an end-of-project event in Bamako. Over the last two years, HP+ in Mali focused on health financing, health system strengthening, and health equity. Representatives of Mali’s National Health Insurance Fund and Devolution and Decentralization Support Team emphasized the importance of the in-depth health financing analyses HP+ conducted to support Mali’s health system. Analyses have focused on provider payment systems, health finance flows, and efficiency and equity at all levels, and were completed in collaboration with key partners. Also noted at the event was HP+’s role in advancing advocacy for community health worker (CHW) rights and legal status. These efforts led to the recent adoption of a decree enshrining the formal status and rights of CHWs, marking a transformative step toward making essential community healthcare sustainable and accessible for all Malians. In closing her remarks at the ceremony, Director of Health at USAID/Mali Julia Henn emphasized, “Although HP+ is coming to a close, we are still with you and will continue to support the Malian population.”
Two HP+ activities in Machinga, Malawi increased knowledge and demand for family planning services through a matching funds scheme that HP+ devised to encourage multiple districts to boost local investment in family planning while strengthening capacity to fulfill costed implementation plan priorities. HP+ provided funds to match domestic resources allocated by the District Health Office (DHO) for key family planning activities. One of the activities, a community mobilization campaign that raised awareness of available family planning services, led to women in the community opting for modern contraceptive methods rather than natural methods, which they found ineffective in delaying pregnancy. Also through the matching funds activity, the Machinga DHO trained providers from five health facilities on the Family Planning Reference Manual developed by Ministry of Health, with support from the HP+ and OPTIONS Wish projects. Through the training, providers learned that some of their approaches were outdated, such as offering family planning methods to women six weeks after delivery. Now, the providers, who will further train other providers, know they should discuss family planning method choice even before delivery. These approaches will be integrated within antenatal care services. Overall, these efforts reflect a “learning by doing” approach to capacity strengthening in policy implementation. To secure matching funds, HP+ coached actors in Machinga (and other districts) to review the costed implementation plan, identify the highest priority activities for domestic and HP+ support, finalize their matching funds application and detailed budget, and implement and report on activities.
On May 26, 2022, HP+ participated in FP2030’s CIP Toolkit launch webinar, presenting key findings from an HP+ analysis of lessons learned through the CIP process in 30 countries. Both quantitative and qualitative data were collected, providing a wide range of detailed insights into strengths and weaknesses of existing CIP processes. HP+ developed four new tools for the updated toolkit:
HP+ also revised three existing tools on team roles and responsibilities for CIP development and execution; the 10-step process for CIP planning, development, and execution; and an illustrative CIP development timeline. These efforts have focused on making the CIP planning, development, and execution processes more user-friendly, effective, and efficient for stakeholders on a global scale. The new tools were created to fill gaps identified in the previous resource kit and enable stronger CIP management and implementation.
Many health workers and patients are not aware of the rights guaranteed to them by Madagascar’s new reproductive health/family planning (RH/FP) law adopted in 2019, nor of the duties required of health workers regarding RH/FP care. To support broader dissemination, HP+ Madagascar worked with Madagascar’s Directorate of Family Health to develop a job aid highlighting health workers’ RH/FP rights and obligations, including excerpts of the law adapted into simpler language to aid comprehension. The intended impact of the job aids is twofold: (1) to enable health personnel to educate their patients on the RH/FP rights and benefits protected by the law, and (2) to remind health workers of their own rights and responsibilities as outlined in the law, as well as the penalties for neglecting their duties. The job aid will be disseminated throughout USAID’s 13 regions of intervention in Madagascar.
Two HP+-trained organizations are seeing results from capacity strengthening activities. Building on HP+'s approach of integrating entrepreneurship and youth-friendly health services through empowering youth in rural areas of Mangochi, the National Youth Council of Malawi received a grant from GIZ to implement its project "EYA! Empowering Youth in Agribusiness." The activity, which will be implemented in eight districts in collaboration with the Ministry of Industry, focuses on creating employment opportunities for youth to improve their income and linking labor supply and demand in the agriculture and food sector. Another youth club trained in proposal writing, Ekwaiweni Tafika, was awarded a 36-million-kwacha grant (US$43,200) by the UK-based Zambia-Malawi Partnership. Activities, which began in March 2022, include drilling boreholes and purchasing land to plant trees for commercial use, working with school children and providing them with meals.
Kenyans from national and county government, donor organizations, and stakeholders gathered in Nairobi and online May 24 to celebrate seven years of work by Health Policy Plus (HP+). The event marked the tangible results of the project in HIV and malaria response, family planning, maternal health, capacity building at the national and county levels, and sustaining work throughout the COVID-19 pandemic. Several speakers noted that HP+ helped Kenya adapt to the 2010 mandate that healthcare services and governance would shift from the national government to Kenya’s 47 county governments. David Khaoya, country director for HP+ in Kenya moderated the session that included invited dignitaries from USAID Kenya, the Ministry of Health, the Council of Governors, and the leadership of the County Executive Committee (CEC) health caucus, along with project director, Dr. Suneeta Sharma. Kisumu County assistant director of medical services, Dr. Kennedy Otieno, remarked that HP+ strengthened their capacity to analyze data to the extent that Treasury counterparts began requesting county guidance on financial analysis. “I really appreciate HP+ and the funders for this program, for democratizing esoteric information for so many technical officers…This reversal of roles has really enabled the county departments, especially Kisumu, to realize the potential of planning, especially financial planning, for service delivery.”
On May 19, Nigeria marked seven years of work between the government, local stakeholders, and the Health Policy Plus (HP+) project with an in-person event, streamed live. The event focused on sharing knowledge and discussing how to sustain gains in locally led development, equity for health services, and improved access to care in family planning and reproductive health, maternal and child health, HIV, and tuberculosis across Nigeria. As Dr. Ngozi Azodoh, director of the Planning, Research and Statistics Department, of Nigeria’s Federal Ministry of Health (FMOH) told the gathering: “Like Oliver Twist, the FMOH wants more. [More] support from the HP+ team and the project director and an expansion of the scope of work in Nigeria … to help the Ministry of Health build a stronger health system and work towards meeting the country’s health goals.” Project director, Suneeta Sharma, attended the event and spoke to the more than 70 attendees present, including representatives of the FMOH, the National Agency for Control of AIDS, the National Health Insurance Scheme, the National Primary Health Care Development Board, the chairman of the Senate Committee on Primary Health Care and Communicable Diseases, implementing partners, civil society and private sector organizations, USAID Nigeria, and the media.
The Global Digital Development Forum was held virtually on May 4 and 5, where select HP+ staff joined leaders from around the world to discuss the changing paradigm for implementing development in a digital world. The forum explored three key areas of digital development: climate change response, emerging technologies, and locally created technologies. HP+’s Meryn Robinson presented on “Digital Solutions for Family Planning Policy,” sharing how digital solutions can transform the development and implementation of health policies so they are more efficient, responsive, transparent, and effective. HP+’s Ida Kagone and Ryan Ubuntu Olson led a session alongside TechChange’s Allison Prell, where they shared recent work to build the policy advocacy capacity of rising youth leaders representing 23 countries in francophone West Africa. The session, “Reaching Youth Leaders in West Africa through Innovative Locally Led Approaches to Advance Health Policies,” showcased how they used a virtual platform to inspire and enlighten rising youth leaders to understand and take action on important policies that affect their health and the health of their local communities. Jointly, the two HP+ sessions gathered 167 attendees. Recordings of sessions are available for conference registrants on the GDDF website.
The Health Policy Plus (HP+) project in Malawi celebrated almost seven years of accomplishments with an in-person and live-streamed event in Lilongwe April 28, showcasing three major pillars of achievement in improved policy implementation and monitoring, health governance and sustainable health systems, and multisectoral engagement to improve the lives and health of Malawians. Featured at the session was HP+ Malawi’s purposeful collaborative approach with the Malawian government and civil society. As Gerald Manthalo, deputy director of planning for the Ministry of Health, said: “The project was implemented government’s way. Supporting us to support ourselves was running throughout, and now we have strengthened ability to raise resources, better governance across all levels, and a holistic approach to health development.” Project Director, Suneeta Sharma, attended the event led by Country Director Olive Mtema. The more than 100 participants included the deputy speaker of Parliament and the chair of the Parliamentary Health Committee, development partners, faith leaders, youth, the media, and health ministry representatives from the planning unit, the Reproductive Health Directorate, the Family Health and Health Systems Strengthening Division, and USAID Malawi.
In Madagascar, HP+ has supported seven government ministries over the past several years as they committed to implementing the country’s Demographic Dividend Roadmap, demonstrating multisectoral support of efforts aimed at achieving the demographic dividend. The roadmap is centered around four pillars: health and family planning, education, employment, and governance. Under each pillar, the roadmap monitoring plan details key actions to take to attain the demographic dividend and indicators to measure progress throughout implementation. The plan serves as an implementation, monitoring, evaluation, and decision-making tool for stakeholders from the seven government ministries, private sector, civil society, and technical and financial partners to ensure the execution of the Demographic Dividend Roadmap in Madagascar.
HP+ assisted the government of Mozambique to align budgeting systems used by the Ministry of Planning and Ministry of Finance. The goals were to (1) develop a single information system that links plans with budgets and interoperates with three systems, (2) ensure data are accurate and easily retrievable, and (3) integrate approved budgets with actual spending for monitoring and transparency. To sustain these gains, HP+ trained and mentored staff to gradually transfer responsibility to the government. Get more details in our policy brief.
Government stakeholders collaborated with HP+ to reduce the resource need gap and ensure efficient and needs-based resource prioritization for the health sector. Using the OneHealth Tool and other classification methodologies, stakeholders reached consensus on the essential health programs, interventions, and inputs for the strategic plan. Presenting key challenges, lessons learned, and recommendations for the future, this brief can be used to advocate for increasing domestic resources for Madagascar’s health system and to inform the Malagasy government, as well as a wider audience beyond Madagascar, about best practices and potential pitfalls with the financial planning process for a health sector strategic plan.
HP+’s capacity strengthening activities in three regions in Burkina Faso are part of efforts to increase the rate of COVID-19 vaccination. At the grassroots level, HP+ conducted advocacy activities with more than 800 community and religious leaders to facilitate their engagement in the promotion of COVID-19 vaccination. These leaders adapted HP+’s tailored messages to drive behavior change. In the Center, Hauts-Bassins, and Centre-Nord regions, vaccination coverage increased from 1.6, 4.3, and 1.5 percent in December 2021, respectively, to 5.1, 15.5, and 6.2 percent after campaigns in January 2022. At the governmental level, HP+ helped organize workshops in the three regions where more than 50 regional health directorate staff and 86 health district staff were briefed in COVID-19 vaccine logistics and management as well as communication and key messages for the population. HP+ also supported the organization of 19 district-level advocacy meetings in the three regions. The national Ministry of Health is planning to implement HP+’s approach in other regions of the country as part of its vaccination rollout.
The COVID-19 vaccination rollout strategy in Burkina Faso has been challenged by the proliferation of misinformation spread through the community, including through social media and other local media, which can lead to vaccine hesitancy. To address the situation, HP+, in concert with the Communications Unit of the Ministry of Health, first identified rumors and misinformation. The project then identified themes and developed messages with key responses stratified by audience (healthcare workers and the general population). Evidence-based information to address rumors and increase vaccination coverage has been disseminated through training and advocacy briefings with government, healthcare workers, civil society, bloggers, influencers, and local radio.
The Guatemalan Registry of Legal Entities on April 5, 2022, authorized the formal registration of three HEP+ civil society partners as nongovernmental organizations (NGOs). With NGO status, the National Alliance of Indigenous Women’s Organizations for Reproductive Health (ALIANMISAR), Network of Men for Health, Education, and Nutrition (REDHOSEN), and Young Artists for Social Justice (JAxJS) can gain stronger financial security through more fundraising channels. This will contribute to the sustainability of their networks and their work to continue advocating for improved access to health, education, and nutrition services in their communities. HEP+ has provided capacity development and financial support for the advocacy activities of its civil society partners for years, and over the past year has helped the organizations navigate the NGO-registration application process. You can read more about HEP+’s efforts to strengthen CSO capacity. in our brief.
The Government of Mali’s Ministerial Council voted to approve a decree formalizing the status of community health workers (CHW) as an official cadre of health personnel. The adoption of this policy is the culmination of seven years of HP+ partnership with Mali’s Ministry of Health and specifically its Devolution and Decentralization Support Unit (CADD). HP+’s support of CHWs began in 2015 with a diagnostic situational analysis and has since included the development of a dynamic GIS data mapping tool, resource mobilization, capacity strengthening, advocacy, and more. This is a transformative achievement which will protect the status and rights of more than 3,000 CHWs across Mali and mandate the payment of CHWs’ stipends with domestic resources rather than external funds. Dr. Baboua Traore, director of the CADD, noted, “This entire process started when your organization [HP+] drew the health department’s attention to the termination of work contracts of this type of personnel [CHWs] in the regions of Kayes and Sikasso.”
Under the leadership of the Ministry of Health, HP+ West Africa supported the development of a new costed implementation plan for 2021–2025. The operational plan details the program activities and costs associated with achieving national objectives, providing clear information at the program level on the resources needed to promote voluntary, safe, and affordable family planning and provide better access to family planning services for all. Adopted by family planning stakeholders in Niger in August 2021 and now being disseminated, the plan details targets, actions, and indicators for success and suggests redirecting funding to priority needs. The adoption of the plan translates Ouagadougou Partnership and FP2030 commitments into concrete actions and constitutes a genuine advocacy tool for the mobilization of resources for family planning.
A new HP+ video tells the story of a cooperative partnership among national and local governments, private sector businesses, and civil society to open a maternity waiting home in Gowa District, South Sulawesi, Indonesia. Combining health expertise, educational outreach, and technical and practical resources from the private sector, the home provides a safe environment for pregnant women living far from modern health facilities and engages the women and the local community in classes on safe birth, mother and child nutrition, income generation, and healthy lifestyle practices.
Following years of advocacy by the National Alliance of Indigenous Women’s Organizations for Reproductive Health, Nutrition, and Education (ALIANMISAR) through letters and petitions to congressional committees, the Guatemalan Congress approved Law Initiative 6026 in March 2022. The law declares May 19 “National Day for the Dignity of Comadronas” (midwives) and allocates an annual payment of GTQ 3,000 (approximately USD 380) to each of the 23,000 nationally registered traditional midwives in the country. Approval of the law is a major step in symbolically and financially recognizing the important and demanding work of midwives, who provide maternal and neonatal health services in Guatemala. This law will be enacted as a part of the 2022 budget and is a result of the capacity strengthening HEP+ provides its civil society partners in the areas of political dialogue and advocacy.
HEP+ support came to fruition with the publication of two Guatemalan Ministry of Health (MSPAS) agreements that create new offices to support water, sanitation, and hygiene. In 2021, HEP+ provided technical assistance to an MSPAS team that assessed the flow of the water and sanitation project approval process and identified solutions through which to streamline project authorization. Following the assessment, HEP+ assisted MSPAS’s Integral Health Care Directorate with the technical, legal, and financial validation of two proposals before they were presented to MSPAS authorities. One establishes a Coordination Unit for Healthcare and Environment within MSPAS’s Integral Health Care Directorate. The other creates health authorization offices in each of the 29 health area directorates with the aim of streamlining the management of water, sanitation, and hygiene infrastructure projects in the country. With the creation of these new offices, approximately 400,000 Guatemalans from 22 different communities will have better access to potable drinking water and will benefit from future sanitation projects.
A March 3, 2022, article in the Zodiak, “HP+ Ends 5-Year Journey with Praises,” reports on the project’s achievements and closure in the district of Mangochi, where it provided technical and financial support around implementation of the country’s youth-friendly health services strategy. Support included orienting community groups and developing action plans to improve youth access to and uptake of health services. Later, activities evolved to include entrepreneurship training and supporting youth clubs as they grew, generated resources, secured funding, and formed the first ever youth-led cooperative in the district. As their businesses have grown, the youth clubs have continued to invest a portion of their profits into making youth-friendly health services accessible to their peers. “Since we were trained as a group, now our total assets are valued at over K5 million and, as individuals, we have progressed so well that some of us have built better houses,” said Gift Unyolo, Chairperson for Alinafe Youth Club in Nankumba Traditional Authority. The leader of Nankumba hailed HP+ for its achievements and said, given a chance to talk to the donors, he would lobby for more funding as the project has left a notable impact in the area.
Indonesia’s Minister of Health approved a regulation for public-private partnerships (PPPs) in the health sector in mid-February 2022. HP+ supported the ministry’s Center for Health Financing and Decentralization Policy in spearheading the development, adoption, and sensitization process for the regulation. PPPs are helpful in mobilizing the private sector to address gaps in health services within the public health sector. This regulation, which focuses on non-infrastructure needs within the health sector, will allow private companies and organizations to address government health priorities through various contracting and partnership mechanisms. This is expected to contribute to sustainable and equitable scale-up of those services. Read our report on Building the Foundation for Public-Private Partnerships for Indonesia’s Health Sector.
In Mali, HP+ has been supporting the Sub-Directorate of Immunization (SDI) of the Ministry of Health to prepare the country’s health system to receive the Pfizer vaccine in March of 2022. As part of this effort, the country recently received 10 pieces of ultra-cold chain equipment from UNICEF/Japan, with distribution managed by SDI. HP+ has been strengthening SDI staff capacity on the management of cold chain equipment and vaccines, bolstering SDI’s resilience against COVID-19 and capacity to effectively deliver routine vaccinations throughout Mali. HP+’s secondee to SDI, Dr. Famoussa Konaté, has played a principal role in Mali’s COVID-19 response and the Expanded Vaccination Program. Read more about lessons learned from his technical support to strengthen SDI capacity, improve processes, and bolster the health system.
On February 8, 2022, the Nurses and Midwives Council of Malawi (NMCM) held an event to roll out nursing standards developed and piloted with HP+ support in four facilities using a quality improvement (QI) approach. The technical standards for the provision of healthcare for children, adults, oncology, and breastfeeding will help ensure the delivery of high-quality care and accountability. At the event, Deborah Banda, a nursing officer representing Kamuzu Central Hospital, assured the other nurses that QI is doable, “When you implement those you achieve a great improvement and clients are satisfied.” The pilot brought forward champions for change, who pushed for support of the QI activities. NMCM expressed gratitude to USAID and HP+ and interest in continued support to develop standards in areas such as community health, midwifery, intensive care, neonatal health, accident, and emergency. A guide and presentation based on the Malawi pilot on how to rollout standards following a quality improvement approach is available.
During Kenya’s budgeting process for fiscal year 2022/23, HP+ provided technical assistance to the national strategic health programs (HIV, malaria, and reproductive, maternal, neonatal, child and adolescent health) to secure increased budget allocations to finance their priorities. During the budgetary discussions, program teams presented implementation priorities and defended their budget proposals before a resource allocation panel convened by the National Treasury. HP+ supported the program teams to develop their annual budget plans and justification summaries for their proposed budgets. The final budget proposals from all ministries will be consolidated and submitted to the national legislative assembly for approval in March 2022. In the previous year, similar efforts by HP+ led to increased allocations. If approved as submitted, the programs will receive increased allocations compared to the prior year. For example, the reproductive, maternal, neonatal, child and adolescent health/family planning program will receive KES 990 million, an increase from KES 863 million allocated in FY 2020/21
President Uhuru Kenyatta launched the 2020–2030 Kenya Health Financing Strategy during the Annual Universal Healthcare Conference on February 7, 2022. The launch signals the government’s commitment to reform the health sector and achieve sustainable, high-quality services for all Kenyans. Among other priorities, the strategy recommends instituting mandatory pre-payment revenue generation from health insurance premiums, replacing out-of-pocket payment at the point of service, guided by fairness and affordability for different income levels. (This recommendation was adopted in a 2022 amendment to the National Health Insurance Fund Act, which has made membership in the fund mandatory for all Kenyans 18 years of age and above.) HP+ provided technical assistance to the Ministry of Health to develop and finalize the strategy, including facilitating stakeholder engagement and advocacy, generating evidence to inform policy priorities, and assisting with drafting the document. HP+ also supported the ministry to develop a communications and advocacy plan, an abridged version of the strategy, frequently asked questions, and a poster to facilitate dissemination. Read more about HP+’s support, lessons learned, and recommendations, including an interview with HP+ Kenya staff Stephen Muchiri and David Khaoya.
Three years in the making, HP+-supported work has been published in the February edition of Global Health: Science and Practice. Co-authored by HP+ partner staff and in collaboration with colleagues from USAID, Harvard, Johns Hopkins University, and Save the Children, the article focuses on a study of “Global Research Priorities for Understanding and Improving Respectful Care for Newborns.” The study developed, for the first time, a prioritized list of research questions focusing exclusively on respectful care for newborns. It highlighted the absence of agreed-upon terminology and tools needed to advance both theoretical and practical efforts. This list should guide researchers and other stakeholders in developing further research.
The Guatemalan Congress approved a Vaccination Law on February 1, 2022, that will guarantee immunization against vaccine-preventable diseases for the country’s population. The Reproductive Health Watchdog (OSAR), which HEP+ has supported since 2017 in the areas of advocacy and networking, contributed to the law’s review and expanded its contents, providing expertise in health budget monitoring and processes to promote transparency and accountability. The law’s decree provides an allocation in the federal budget for the Ministry of Health’s Immunization Program, ensuring the necessary resources to purchase vaccines, supplies, and promote vaccination programs. It also establishes a technical body to ensure effective vaccination as well as mechanisms for transparency, citizen monitoring, compliance with the federal vaccination scheme, and joint accountability for the distribution of resources for these initiatives. HEP+ will continue to support OSAR in the coming months to spread community awareness about the new law.
HP+ and Feed the Future’s Agricultural Diversification Project collaborated with government leaders in Malawi’s Mangochi district to support a group of youth clubs to become an official, registered cooperative. Three months after being registered, the Thema Honey Cooperative secured a $56,500 grant from a World Bank financing project, Agricultural Commercialization, to continue to grow their honey production business. HP+ and Feed the Future supported the growth and capacity development of the clubs and the cooperative, which invest a portion of their revenue into youth-friendly health services. HP+ and the Mangochi Business Unit Team supported Thema to develop the grant application and raise the 30 percent of total requested funding as required by the World Bank.
To capture and share the positive impact of health policy implementation, HP+ uses storytelling featuring local partners through film. On January 25, HP+ hosted a virtual watch party that featured a short film—“Why Policy Matters: Strengthening Family Planning Services for Guatemala's Indigenous People”—about Guatemala's National Contraceptive Security Commission (CNAA) and a network of local, multisector subcommittees helping to improve access to family planning services and commodities, especially to meet need among rural and Indigenous communities. The discussion featured representatives from the Reproductive Health Program of the Ministry of Health, the CNAA’s Observatory on Reproductive Health, and a community-based logistics coordinator for medicine. Similarly, on January 13, HP+ held a watch party for "Messages of Hope: Reaching Boys and Men with HIV and AIDS Information," followed by an interactive panel discussion with representatives from Malawi’s National AIDS Commission, the Evangelical Christian and Qadria Muslim associations, and the Chikwawa District Health Office. The short film documents how the Faith and Community Initiative in eight Malawi districts worked with religious leaders to engage previously hard-to-reach men and boys. The religious leaders incorporated “Messages of Hope”—accurate HIV messages that correspond with religious texts from the Bible or Qu'ran—into their sermons and day-to-day community engagement work. This effort is helping dispel myths and misconceptions about HIV, fight stigma, and increase willingness to access HIV services and treatment. View the full Why Policy Matters series.
HP+ Madagascar has been supporting the Ministry of Public Health to draft a national health financing strategy to advance universal health coverage in the country. In December 2021, the ministry’s Secretary General led a workshop to validate the strategy with participants from technical and financial partners, civil society organizations, and the private sector. Throughout the strategy development process, HP+ supported staff to assess the country’s existing health financing mechanisms, develop national health financing goals, and define the strategy’s vision, objectives, and strategic axes. HP+ also played a role in supporting government partners to understand the purpose and importance of the strategy while facilitating dialogue between government actors, parliamentarians, donors, partners, and civil society representatives to ensure collective ownership of the strategy through a participatory, collaborative, and inclusive process. HP+ will now integrate stakeholder input into the strategy, coordinate finalization and dissemination, and support the development of an implementation plan and monitoring, evaluation, and governance frameworks.
The Indonesian government launched its first health-related public-private partnership (PPP) to support a maternity waiting home in South Sulawesi in November, 2021. The move is a pilot of a new regulation by the country's Ministry of Health on non-infrastructure PPPs for health. The partnership, which includes the government, a private company, and three local nongovernmental organizations, was facilitated by the Gowa district government and the USAID-funded Health Policy Plus project. The PPP and resulting maternity home, aimed at addressing Gowa’s high rates of maternal deaths, will serve as a model for other districts in South Sulawesi and throughout the country for how to engage the private sector in improving maternal health. Speaking ahead of the event, USAID/Indonesia's Deputy Director of Health, Daryl Martyris, reflected that these types of initiatives are proof that collaboration between the two sectors is a good way to address local problems with local solutions.
HP+ and Mali’s National Health Insurance Fund (CANAM) co-facilitated a workshop in December 2021 for government and parastatal agencies on HP+’s analysis of CANAM’s provider payment system. At the workshop HP+ shared its recommendations, which included improving efficiency through new communications processes, reducing inefficient healthcare provision practices, and adopting performance-based management practices. The workshop included facilitated discussions and sought input from participants representing the National Federation of Community Health Associations, the Union of Community-Based Insurance in Mali, the Malian social mutuality agency, the World Health Organization, USAID, and UNICEF. A representative from USAID/Mali praised the efforts being made to strengthen Mali’s health system and increase health coverage. CANAM’s Director General noted that HP+’s recommendations will significantly improve the provider payment system, which will strengthen CANAM’s provision of health insurance for Malian citizens. HP+ is working with CANAM to prepare its team to implement the recommendations.
At the end of December 2021, the government of Guatemala issued a ministerial decree to create the Special Unit for Medical Emergencies (SUME), which will serve as a 911-like service to assist Guatemalans in medical emergencies. HEP+ worked with the Vice Minister of Hospitals and other departments within the Guatemalan Ministry of Health (MSPAS) to ensure the legal, technical, financial, and administrative elements for creating this unit were established and integrated efficiently. SUME will be available nationwide and contribute to MSPAS efficiency and service quality for COVID-19 patients during the pandemic, as well as support Guatemalans with other medical emergencies. This month, MSPAS will develop a timeline for SUME implementation and a manual to guide SUME operations and functions.
At the request of USAID, HEP+ presented to USAID Washington and members of the Bureau for Latin America and the Caribbean on November 23, 2021, on the case for health sector decentralization in Guatemala and the flagship decentralization successes of the project. Some of these decentralization successes include the enactment of the National Decentralization Agenda, 10 prioritized ministries producing their own decentralization plans, assessing municipal capacity to take on decentralization responsibilities through HEP+-developed information systems, and leading capacity development to support municipal ability to take on new responsibilities. Between 2016 and 2018, the number of municipalities deemed capable of implementing the newly delegated functions doubled to 14. Health sector decentralization is a priority for HEP+ and the Guatemalan Ministry of Health. In 2022 the project will be prioritizing further legal reform, the continuation of municipal capacity development, and a “territorial ordainment” tool that will help the project prioritize municipalities for decentralization.