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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.
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.
HP+ held an event on November 18, 2021, to mark the launch of family planning activities in Niger’s Maradi and Zinder regions, which have the highest prevalence of child marriage in the country. The activities will strengthen the use of family planning services in the two regions and address critical challenges such as child marriage and low demand for contraceptives among adolescents. The activities complement the health policy work already being done alongside the Ministry of Public Health through HP+’s West Africa regional portfolio. The event was attended by government ministry officials, nongovernmental organization partners, youth organizations, community leaders, and local elected officials. The governor of Zinder thanked HP+ and remarked that the achievement of ambitious national family planning objectives “will require the full participation not only of key actors in the field of family planning but also of all stakeholders.”
On November 9, 2021, Liberia’s Ministry of Health launched a new private sector engagement strategy, which HP+ helped develop, moving the country’s health system a step closer toward achieving universal health coverage. At the launch, representatives from the Ministry of Health, county health team, USAID/Liberia, and the private sector praised the government’s commitment to engaging the private health sector to tackle some of the country’s most pressing challenges, referring to the day as a historic moment. The strategy provides a framework for transparent, informed, and effective engagement between the public and private health sectors. It highlights four goals to be implemented collaboratively between public and private stakeholders that focus on expanding access, quality of care, and financial protection for clients. To implement the strategy, the Ministry of Health will establish a multisectoral private sector engagement technical working group, roll out the strategy at the county level, and train key focal persons on private sector engagement. With this strategy, the Ministry of Health is committing to ongoing, deliberate engagement with the private health sector to tackle some of the country’s most pressing needs in the coming years.
To ensure standards are met to access and effectively implement PEPFAR’s “Game Changer Funds,” HP+ West Africa supported training of 16 participants from two networks of civil society organizations (CSO)—CUPIDON and CORAB—working in HIV and community surveillance in Togo and Burkina Faso. Support included the design of a competency-based training package consisting of nine modules focused on strengthening organizational capacities for governance and management, community and associative leadership, networking, project management and resource mobilization, monitoring and evaluation, and documentation of results. These skills aim to strengthen the organizations’ ability to effectively implement and monitor PEPFAR activities and country-level HIV policies and strategies. During the workshop, the CSOs developed a joint workplan to support one another. Remarking on the workshop, the president of CORAB stated, “During nearly 20 years of experience, this is the first time I have seen this dynamic of exchange and knowledge transfer. I would like to thank HP+ through [sic] USAID for this great initiative…these skills should eventually allow us to professionalize so that we can increase the mobilization of resources at the level of our associations.”
Community health workers provide essential healthcare at local levels, but their status and funding are uneven, often sitting outside official health systems. Momentum is building and the case is being made to formalize and fund these essential health service providers as part of national and subnational health systems throughout many low- and middle-resource countries. HP+ teams in Mali and the West Africa Regional office developed videos to support advocacy for formalization and greater investment for this important cadre of health worker. Interviews for The Place and Role of Community Health Workers in Achieving Universal Health Coverage took place during a high-level meeting of health officials hosted by HP+ West Africa in Lome, Togo in 2019, with participation from the World Health Organization, the West African Health Organization, the United Nations Population Fund, and USAID West Africa. In addition, Togolese community health workers provided testimonials on their work in the community. Mali’s video, The Importance of Investing in Essential Care Provided by Community Health Workers, was developed to support stakeholders to advocate for greater support and funding from the Malian government.
Civil society organizations in West Africa are reporting progress in reducing stigma toward persons living with HIV and increasing access to HIV care after receiving organizational support and training from HP+. During fiscal years 2020 and 2021, HP+ supported the development of data collection tools and trained data collectors to use the tools to ensure PEPFAR-funded facilities provided a supportive environment for quality and barrier-free HIV services in 17 facilities in Burkina Faso and 25 in Togo. In initial feedback received so far, the trained organizations have seen a reduction in reports of stigma and an increase in access, specifically fewer instances of informal fees and earlier access to antiretroviral therapy. HP+ will continue to support the organizations in their efforts to secure funding and expand their monitoring objectives to better quantify the impact of HP+’s technical assistance.
Senegal’s Ministry of Health and Social Action used HP+ supported resources to raise the visibility of and consensus around the need for domestic resources for family planning, helping lead to an increase in the government’s budget allocation to contraceptives. In 2019, HP+ worked with the MSAS and other family planning stakeholders to identify and evaluate opportunities to catalyze domestic resources for family planning, based on an HP+ framework. HP+ also led a budget advocacy training, supporting stakeholders to develop an action plan to influence the next budget cycle. In a recent news article, MSAS Cabinet Director Alphonse Ousmane Thiaw discusses a consultation on mobilizing domestic resources for family planning. He quotes a report supported by HP+ that suggested a focus on national and subnational government advocacy and strengthening support for family planning under Senegal’s Agency for Universal Health Coverage. Thiaw reaffirms the government’s commitment to financing family planning and announces an increased allocation for contraceptives in 2021. This allocation of CFA 500 million (US$926,000) aligns with the country’s FP2020 commitment, reverses the trend of decline in this allocation between 2016 (CFA 300 million) and 2019 and 2020 (CFA 117 million) and will support the annual contraceptive needs of approximately 160,000 family planning users.
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.
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.
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.
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 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.
After a decade of aid suspension, Gambia’s newly-elected President met with US government officials and a health assessment team to discuss the lifting of the country’s suspension and what it could mean for Gambia. Modibo Maiga and Pascal Saint-Firmin, representing the USAID-funded Health Policy Plus project’s West Africa program, attended the meeting, which also included the United States Ambassador, Eleonore Rabelahasa, and Rachel Cintron from USAID.
Members of the U.S. House of Representatives Foreign Affairs committee were briefed on US-funded health programs in Burkina Faso on October 4, 2019, during the delegation’s visit to Ouagadougou. The delegation of Karen Bass and Representative Sheila Jackson-Lee joined U.S. Ambassador Andrew Young, staff of the Centers for Disease Control and Prevention and USAID partners to share successes in health support and discuss challenges related to the ongoing strike of health professionals, security, and support for internally displaced people. Modibo Maiga, HP+ country director, and other implementing partners highlighted the strong collaboration between the US and Burkina Faso and the important role that community leaders, including religious leaders and youth, have played in mobilizing domestic resources for health and catalyzing policy change in support of family planning, adolescent reproductive health, and HIV/AIDS. Maiga also briefed the delegation on efforts by the Ministry of Health to integrate community health workers into its health workforce and stressed that the formalization of this cadre of workers at the community level will reduce the impact of the striking health professionals and will help defuse security tensions in communities.
Government and civil society health leaders from nine Francophone countries of West Africa called for the integration of community health workers into their nations’ health systems at a ground-breaking meeting in Lomé, Togo. The three-day workshop, held from September 16 – 19, gathered health officials and implementing partners, and local community health workers, who shared their perspectives. Senior officials from Togo’s Ministry of Health, WAHO and WHO’s West Africa office, along with U.S. Ambassador, Eric Stromayer joined a high-level opening ceremony. Eleonore Rabelahasa, the Senior Health Systems Strengthening and Policy Advisor in USAID’s regional health office, also participated in the three-day workshop. Five Togolese CHWs, who deliver a range of family planning, malaria and health consultations interventions, discussed the challenges and opportunities they face as front-line health workers and their perspectives to improve their capacity to improve equitable access to health services. The delegates developed action plans for each country with a goal to convene key stakeholders and put in place a plan of action by June 30, 2020.
The Ministry of Public Health has announced it will more than triple its budget to procure contraceptives in 2019. The budget item jump, from 62 million FCFA in 2018 to 200 million FCFA in 2019 comes as result of USAID-supported advocacy by family planning groups and support from Health Policy Plus (HP+), and promises to vastly increase the country’s capacity to provide voluntary family planning to meet demand. HP+ assisted Nigeren family planning advocates in forming The Network of Champions in Advocacy for Adequate Health Financing (RCPFAS) and, with the Directorate of Maternal and Child Health, provided guidance to its members to make the case for the increase, which meets a pledge made by the government at the Family Planning Summit in London in 2017. HP+ also helped organized a series of meetings with civil society and key Ministry of Health and Ministry of Finance decision makers to secure the commitment and the sign off by the Secretary General Ranaou Abache on November 22, 2018. Read more in our news story.
Under the leadership of Senegal’s Ministry of Health and Social Action, HP+ West Africa organized an unprecedented family planning advocacy workshop in Dakar in August to secure support and financial commitments from the private sector. The workshop resulted in more than US$630,000 pledged for family planning funding. The International Management Group (IMG), a private company from Cote d'Ivoire that took part in the Dakar meeting disbursed funds for family planning advocacy and clinic services in December 2018. Their contribution provided access to contraceptive pills, injectables, implants and IUDs to 121 additional women on voluntary contraception. This is just a start. IMG expressed a commitment to sustain its engagement moving forward.
Under the leadership of the Senegal’s Ministry of Health and Social Action, USAID-funded HP + West Africa organized an unprecedented reproductive health and family planning advocacy workshop August 30 and 31, 2018, in Dakar to secure support and financial commitments from the private sector resulting in more than approximately USD 630,000 pledged for family planning funding. Participants, including representatives of Banque of Africa, Nantou Mining SA, Mata Holding and other private sector groups, signed a collective declaration in support of reproductive health and family planning policies and programs in their respective countries. USAID Senegal representative, Omar Sanga, the senior government-to-government financing advisor, said of the workshop: "It is exceptional what I saw, such a success with the Private Sector of the sub-region. It is thanks to the expertise of HP+." Follow-up will be done by HP+ at the country level to ensure that the commitments made by the private sector will be implemented.
In late July, close to 100 traditional and religious leaders hailing from 10 West African nations gathered in Burkina Faso to share experiences and renew commitments in implementing innovative strategies to take advantage of the region’s demographic dividend—the accelerated economic growth that can result from changes in the age structure of a population. Among the nine-point pledge announced by the religious leaders is a commitment to advocate with their peers for the acceptance of family planning through use of methods that conform with their values and a commitment to fostering dialogue between couples on reproductive health issues. The forum, organized with support from the USAID-funded Health Policy Plus (HP+) project, “Reaping the Demographic Dividend: Religious and Traditional Leaders Get Committed,” held July 24-26 in Ouagadougou, was attended by the President of Burkina Faso, Roch Marc Christian Kaboré; the Mossi Emperor, Moogho Naaba Baongho; and the U.S. Ambassador to Burkina Faso, Andrew Young. HP+ plans to support the implementation and monitoring of action plans developed during the regional meeting.
Ministries of Health across West Africa are taking action to meet ambitious family planning commitments made in the past several years in support of FP2020 goals. In Burkina Faso, where the use of reproductive health services is only 22.5 percent, the government has issued its 2017-2020 Family Planning Acceleration National Plan (PNAF 2017-2020). The action plan is part of the nation’s strategic vision for improving modern contraceptive prevalence to 32 percent by 2020. In Niger, with a goal of 50 percent contraceptive prevalence by 2020, the Ministry of Health has issued a new operational plan that focuses on identifying and mobilizing resources for contraceptive products. Mauritania is repositioning family planning to focus on birth spacing as an appropriate strategy to improve the supply of family planning and other health services. There, the Ministry of Health has issued a National Action Plan on Birth Spacing with the goal of increasing the modern contraceptive prevalence rate for women in union from 11 percent in 2013 to 18.5 percent in 2018. The USAID-funded Health Policy Plus project provided technical assistance to each of the ministries and key partners, conducted reviews and analyses, and provided recommendations in support of implementing these crucial plans.
The government of Mauritania, on International Women’s Day (March 8, 2018), signed a regulatory decree to implement a new reproductive health law in focus counties. The law was originally passed in January 2017. With the signing of this new regulatory guidance, there is now approval for community health workers to provide birth control pills and injectables. Nurses are now allowed to provide IUDs and implants. This policy advance, which promises to bring efficiency and scale to contraceptive use, comes as a result of advocacy efforts led by USAID and supported by the HP+, FP2020, AgirPF, Stop Sida, UNFPA, and local partners.
USAID and PEPFAR, through HP+ is providing technical support to Guyana’s national AIDS program secretariat to plan for the country’s transition from external to domestic financing of HIV programs and services. This support includes the development mechanisms the government can use to directly support civil society through new “social contracting” measures. A meeting held in mid-November resulted in consensus among nearly 50 civil society, private sector, and government stakeholders and donors to move forward with a social contracting model. In addition to implementation of the model, HP+ will provide additional support to Guyana’s mobilization of domestic resources for HIV programs, including developing costing of civil society-led services and programs and technical assistance to Guyana’s high-level HIV Transition and Sustainability Steering Committee.
Burkina Faso’s Ministry of Finance's 2018 general budget includes a line item for purchase of contraceptives, which represents 68% of the total estimated cost of contraceptives the country requires for 2018. The Ministry is recommending an increase from CFA 500 million to CFA 1.300 billion to purchase contraceptives. With this recommendation, Burkina Faso is demonstrating political will and prioritizing family planning for investment. No other Francophone West African country has committed this level of domestic resources for contraceptives to date.
The decision to increase domestic resources for family planning commodities is based on the activities outlined in Burkina Faso’s new Costed Implementation Plan (CIP 2017-2020) for family planning. The costed implementation plan’s stated objective is to attain a modern contraceptive prevalence rate (mCPR) of 32% by 2020. Burkina Faso’s current mCPR is estimated at 22.5%, so given that objective Burkina Faso’s contraceptive need for 2018 will cost about CFA 1.900 billion. USAID/West Africa’s Health Policy Plus activity supported Burkina Faso’s multi-sectorial reproductive health steering committee to develop the costed implementation plan.
This story originally published by USAID WA in its newsletter, written by Eleonore Rabelahasa, USAID/West Africa
Côte d'Ivoire’s Ministry of Health and Public Hygiene in April 2017 issue new guidance scaling up post-partum family planning to increase women's access to family planning services. The new guidance directs health facilities and qualified service providers to inform new mothers of the full range of family planning methods to ensure free and informed choice of options immediately following delivery. This comes as a result of advocacy efforts by a range of stakeholders. The USAID-funded Health Policy Plus (HP+) provided guidance and capacity development for advocates using the AFP SMART advocacy tool.
To fulfil national family planning commitments, countries must be strategic in how they invest limited resources. A costed-implementation plan (CIP) is a multi-year roadmap designed to help governments achieve their family planning goals by the most effective, efficient means possible. In May 2017, Sierra Leone’s Ministry of Health Services and its partner the UNFPA incorporated contraceptive commodity forecast data into their procurement planning. The data, based on the anticipated method mix and growth in contraceptive use generated by increased support for family planning, was drawn from Sierra Leone’s CIP, which is currently being developed with support of the USAID-funded Health Policy Plus (HP+). Evidence-based decisions using the CIP are already helping the ministry to calculate its budget requirements and will help ensure a sustainable supply of family planning commodities throughout Sierra Leone.
The regional director of the USAID-funded Health Policy Plus West Africa region, Modibo Maiga, participated in the annual ECOWAS Health Ministers meeting with WAHO and WHO in Abuja this month. WAHO and WHO selected Mr. Maiga from among all the partner representatives to draft the Partners’ Resolution. Mr. Maiga led a small committee to draft the resolution on task shifting/sharing in the ECOWAS region, which will help advance the sustainable development goals. The resolution was presented during the June 15 plenary session to the delegates. The same resolution was presented by WHO to the Ministers of Health on June 16.
Mauritania’s Council of Ministers, on October 6, 2016, approved the text of a new Reproductive Health Law, which explicitly states that the right to reproductive health care is a universal right guaranteed to all throughout the course of their lives and prohibits forms of violence against women, including female genital mutilation. The law, submitted by the Minister of Health, brings Mauritania’s national policies into alignment with those of other countries of the Ouagadougou Partnership pursuing commitments on family planning outlined in FP2020 goals. This comes as a result of nearly a decade of unceasing effort by USAID and its policy advocacy partners, including UNFPA, Health Policy Plus and its predecessor projects, which helped draft an early version of the law for FP2020 advocacy efforts across West Africa. The bill will be presented to Parliament for passage in the coming months.