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.
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.
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.
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
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 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+ experts showcased digital health solutions that promote sustainability, equity, and private sector engagement at the Global Digital Health Forum, held December 6–8, 2021, under the theme of Improving Health Through Digital Transformation. For HP+ Mozambique, Marcel Saraiva presented efforts to transition a digital planning and budgeting module to the government as part of a panel on “Cultivating Successful Transition of Digital Systems to Government for Long-term Sustainability,” which was moderated by HP+’s Allison Connolly. Presenting HP+ Indonesia’s work, Adhiatma Akosah was part of a session on “Making Healthcare Fairer and More Equitable,” in which he highlighted the unique challenges faced by a local technology company delivering maternal and newborn digital care tools in the COVID-19 context. Lastly, HP+’s Bryant Lee presented on “Using Blended Finance to Mobilize Private Capital for Digital Health Enterprises” to share recommendations and opportunities to leverage new financing for affordable health in lower- and middle-income countries
From November 16 to 18, 2021, HEP+ delivered a workshop to 21 participants to foster joint accountability among government and civil society on commitments outlined under Guatemala’s Law for Healthy Motherhood. This dynamic workshop gave civil society and government stakeholders the opportunity to discuss the accountability mechanisms and joint commitments related to improving maternal health in Guatemala, promoting transparency, and strengthening governance around adolescent pregnancy. Workshop participants prepared action plans to address adolescent pregnancy, which will begin with conducting qualitative research to learn more about gaps and opportunities for strengthening programs and approaches to prevent adolescent pregnancy. Applying what was taught at the workshop, participants plan to analyze the relevant health system actors, their accountability roles in the area of adolescent pregnancy, and the accountability relationships between relevant parties at the national and subnational levels. The networks will present results in March 2022.
Traditional Guatemalan midwives—comadronas—recently received property from San Juan Ostuncalco for the creation of their own clinic. HEP+ supported the Observatory on Reproductive Health (OSAR)—Guatemala’s reproductive health watchdog—in the development of a proposal to the San Juan Ostuncalco Municipal Council for clinic space to provide medical services and store equipment. After the June handover of the property, clinic construction can begin. The clinic will be attended by 93 comadronas and remain open 24 hours a day. It is expected to serve 40 percent of the young children and pregnant women in San Juan Ostuncalco.
Eight facilities that HP+ trained on the Baby Friendly Hospital Initiative (BFHI) from 2019-20 received accreditation as baby-friendly during the national launch of World Breastfeeding Week on July 30 in Lilongwe. Malawi Minister of Health and Population Khumbize Kandodo Chiponda recognized the facilities and encouraged health workers and service providers to continue to support women to breastfeed exclusively from birth until at least six months. In each facility, HP+ trained 80 percent of the clinical and support staff on the World Health Organization’s Baby-Friendly Hospital Initiative course. Community promoters are also trained to provide ongoing support to women to continue breastfeeding after they return home with their babies. HP+ provided ongoing coaching and mentorship as the facility staff prepared to undergo their external accreditation assessments by the Ministry of Health. HP+ has trained 12 facilities in Malawi on the BFHI program since 2018; all have now received accreditation.
Tanzania recently launched its fifth five-year health plan, a TSh 47 trillion roadmap for saving more than 200,000 lives and reducing HIV incidence by 50 percent. The Five-Year Health Sector Strategic Plan (HSSP V) also lays out strategies for averting more than 400,000 disability-adjusted life years and reducing infant, neonatal, and maternal mortality. To estimate the cost of the strategy, equivalent to US$20.3 billion, HP+ used the OneHealth tool. HP+ also estimated the resources available for the health sector from all sources. The mission of the plan, which covers 2021 to 2026, is to provide sustainable health services with standards that are acceptable to all citizens without financial constraints, based on geographical and gender equity. In her address during the June 24 launch, Honorable Minister for Health, Community Development, Gender, Elderly and Children, Dr. Dorothy Gwajima said the plan will expand reach of primary health services and address the prevention and treatment of both communicable and non-communicable diseases.
With HP+ technical support, Madagascar’s Ministry of Public Health recently validated the Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition Investment Case for the Global Financing Facility. The investment case outlines priorities for interventions and regions in addressing the country’s RMNCAH-N objectives and health system improvements. HP+ was the lead technical partner, in collaboration with UNICEF, the United Nations Population Fund, the World Bank, and the World Health Organization, supporting the ministry in the development of the investment case. The process offered the opportunity to improve the alignment of donor financing with government priorities and objectives. It also focused on targeting limited government resources on high-impact practices and healthcare access for the country’s most vulnerable populations. HP+ will continue to provide technical assistance to build the ministry’s capacity to monitor the implementation of the investment case at national, regional, and district levels. The investment case aims to reduce the total fertility rate—the average number of births a woman has over a typical lifetime—from 4.6 to 4.2 and aims to reduce the adolescent fertility rate from 151 to less than 130 births per 1,000 women. The five-year plan would reach 17 out of 22 prioritized regions, covering 19.1 million people (78 percent of the population) and avert more than 9,000 neonatal deaths, approximately 3,000 maternal deaths, and nearly 40,000 deaths of children under five years of age.
How best to improve maternal health access and quality in resource-constrained settings was the focus of an online policy forum convened by HP+ on March 23. The session—Quality v. Coverage: Is There a Trade-off in Financing Maternal Health?—highlighted the continued high level of maternal mortality despite increases in facility-based births. It explored the push and pull that policymakers must face when planning and allocating resources aimed at increasing access and quality. Led by Elena Ateva, HP+’s maternal health lead, the discussion featured Alison Morgan of the Global Financing Facility, Nana Twum-Danso of the Rockefeller Foundation, and Aparajita Gogoi of the White Ribbon Alliance/India. In addition, HP+’s Dorit Stein shared recommendations from a research study on strategic health purchasing reforms for maternal and neonatal health services and Aparajita Gogoi shared results from the What Women Want campaign and accompanying dashboard of women’s responses
HP+ has helped the Kenya Ministry of Health retain its current allocations for national HIV, malaria, and reproductive health programs into the next fiscal year even in the face of economic constraints due to COVID-19. HP+ provided technical assistance to the Ministry of Health program teams to develop budget justification memos that supported the need to continue to fund these programs. The memos were used during the sector performance review and resource sharing process, helping to ensure that each program is able to continue supporting its respective critical disease area. In preserving budget allocations despite a tightened fiscal space, the health programs established their continued importance among the nation’s priorities, allowing Kenya to maintain stewardship and accountability for funding these programs. The FY 2021/22 funding for HIV, malaria, and reproductive, maternal, newborn, adolescent, and child health programs is US$12 million, $8 million, and $8.63 million, respectively.
Field, Kenya, Health
Domestic Resource Mobilization
Mali has joined the Global Financing Facility (GFF), giving the country potential access to development funding from the World Bank and other donors worldwide, and helping to improve financing efficiencies for health. The country took the final step in unlocking access to GFF funding at a December workshop, when it completed its investment case for reproductive, maternal, newborn, child, and adolescent health (RMNCAH). At the same time, Mali finished development of a monitoring framework for its Health and Social Development Plan, which is tied to the RMNCAH investment case. Finalization of these key strategic documents is essential for the social health sectors and Mali’s intention to achieve the Sustainable Development Goals. The country’s GFF investment case seeks an improvement in health outcomes, including a reduction in maternal mortality from 325 to 146 per 100,000 births by 2023 and a reduction of the proportion of women 15-49 years who have experienced gender-based violence from 10.8 percent in 2018 to 2 percent in 2023. HP+ organized the December workshop with the Ministry of Health and other stakeholders to finalize the document and facilitated remote participation of some partners.
The Malawian Ministry of Health in January officially endorsed and adopted the updated Respectful Maternity Care (RMC) Charter: The Universal Rights of Women and Newborns, which sets an international standard for the rights and services women and newborns should receive when seeking care. The charter was updated in 2019 by USAID, HP+ partner White Ribbon Alliance, and other partners to ground the charter in widely accepted international and regional human rights instruments. To advocate for adoption of the charter, WRA Malawi coordinated with key nursing and midwifery institutions including, the Directorate of Nursing and Midwifery Services and the Kamuzu College of Nursing to present, provide feedback on, and approve the updated charter. The effort was buoyed by the What Women Want campaign, whose survey had found the top priority among women and girls was respectful and dignified care. WRA Malawi also introduced and advocated for adoption of the charter with key decisionmakers, such as the Safe Motherhood Technical Working Group and the Reproductive Health Directorate and hosted the official launch event where the MOH officially endorsed and adopted the charter. The MOH and nursing and midwifery training institutions will translate the document into Chichewa and update their curricula to be in alignment with it. WRA will support the Reproductive Health Directorate in distributing the charter to all health facilities in Malawi and will begin introducing the charter to women and health workers.
A new report from HP+ curates resources to estimate maternal health costs, outcomes, and inequities in low- and middle-income settings. The report, Models and Tools for Maternal Health Decision Making, Planning, and Strategy, summarizes seven tools to enable USAID Missions, governments, and implementing partners to better understand how modeling tools and analytic approaches can answer their policy and research questions regarding target setting, prioritization, budget development, and other program issues. The tools can be used to advocate for increased domestic funding for maternal health, inform policy development, and improve project design and performance—which, in turn, can lead to improved maternal health outcomes. This report, which builds on lessons learned in the 2012 Crosswalk of Family Planning Tools, broadens policymakers’ understanding about how models and tools can guide country-level planning and evaluation efforts aimed at reducing women’s morbidity and mortality during pregnancy, childbirth, and the postpartum period.
HP+ is supporting the Government of Indonesia to advance subnational performance geared toward achieving the Minimum Service Standards in Health (SPM) for 12 primary healthcare services, including services for pregnant women, delivering mothers, and newborns, as well as family planning education and services. In partnership with PPJK, HP+ improved the planning and budgeting platform for SPM by decreasing complexity of the user interface, designing an error detection system to identify cost outliers and improve data collection from primary healthcare facilities, and enabling the platform to be interoperable with other information systems. HP+ also supported the development of e-learning modules, which are critical to the successful national rollout of the revised platform. The improved platform will equip district health officials across the archipelago with the budgeting and planning tools needed to estimate resources required to achieve SPM targets and improve allocation of resources for health to achieve better health outcomes. The revised platform was officially launched this week in Jakarta by the Secretary General of the Ministry of Health for all 514 districts across Indonesia.
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.
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.
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.
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.
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.
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.
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.
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 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.
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.
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.
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.
The National Reproductive Health Program, as coordinator of the National Contraceptive Assurance Commission, held the Contraceptive Assurance Sub-Committees Meeting on August 8 and 9, to implement Ministry of Health and Social Welfare guidelines requiring that each health area form its own contraceptive assurance subcommittee. The sub-committees, integrated with the support of HEP+, submitted their findings and challenges and exchanged experiences with representatives of the health areas and other organizations that will be part of future sub-committees. USAID representative Vikki Stein, who attended the meeting, said "I want to specially recognize the Ministry of Health as the governing entity, because it has taken a very important decision to extend the sub-committees to all health areas. This action is helping improve the lives of women by preventing maternal and infant mortality."
On May 3, Osun State—one of three states supported by HP+ in Nigeria—became the first state in the country to begin enrollment of clients into the national Basic Health Care Provision Fund (BHCPF), the federal government’s initiative to provide the rural poor with a basic package of health services. Along with the achievement of this milestone, the state will receive approximately US$2.5 million over the next nine months—delivered directly to selected primary healthcare facilities to support the delivery of high-quality health services. HP+ has supported Osun State to pilot the BHCPF for the last three months in preparation for the scheme’s statewide roll-out. “The learning from the pilot program will influence what will happen moving forward,” said HP+ Nigeria Country Director Onoriode Ezire to government officials at the launch. “We hope that, beyond the launch, access will be improved, and we will continue to address maternal and infant mortality in the state,” he added.
Nigeria’s Federal Capitol Territory (FCT) is a major step closer to accessing resources for primary health care with the passage of a previously stymied law. Bolstered with evidence gathered with support from USAID through the Health Policy Plus project and capacity development of advocates and FCT leadership, the FCT secured sponsorship of the health insurance and primary health care board bills at the National Assembly and have been able to advance the bills through the stages of the legislative process. Concurrence and presidential assent, the final stages of the process, will open the door for the FCT to access the Basic Health Care Provision Fund (BHCPF), a national and state-level mechanism that will extend health insurance coverage, and a range of free services, not only to those in the public and formal private sector, but also to the vulnerable – pregnant women, children under 5-years old, persons with disabilities, and the elderly – and those in the informal sector, for whom access and the ability to pay for primary health care was a barrier. State-by-state health reform has been advancing to secure the systems and legal backing needed to access the BHCPF, while the FCT had been delayed until now. With this advancement, access to the fund is expected to reduce maternal and under-5 mortality rates and reduce financial hardship resulting from medical costs. Momentum around the BHCPF in Nigeria increased significantly last year with approved funding under the 2018 national budget. HP+ supported FCT leadership through each step of the legislative process, which it will continue to provide as the bill moves forward for concurrence and authorization by the President of Nigeria.
On January 25, at a meeting of parliamentarians convened by HP+ partner the White Ribbon Alliance for Safe Motherhood (WRA) Malawi, a representative from the Department of Human Resources Management and Development reported that 925 midwives were recruited and 303 midwives were promoted during fiscal year 2018/2019. This success—which goes even further than the government’s initial commitment to hiring 800 midwives—is in large part due to WRA Malawi’s Bedside Midwives report that highlighted a shortage of 20,000 midwives and has been a key advocacy tool since the campaign began in 2017. At the meeting, WRA Malawi praised the government’s progress to date and asked for continued support through approval of an increased budget to recruit, train, and retain more midwives, and the creation of a district-level nursing and midwifery pathway.
In October, 2018, the government of Nepal passed the Safe Motherhood and Reproductive Health Rights Act. The act ensures that important aspects of respectful maternity care such as privacy, confidentiality, and consent are well defined and protected in public as well as private healthcare facilities. This comes as the result of decades of advocacy work by Health Policy Plus partner, White Ribbon Alliance Nepal, supported by USAID under successive health policy projects, to ensure high-quality, respectful care for women and babies in Nepal. Read the WRA news story.
Two district hospitals in Malawi were recently certified as “baby-friendly,” meaning that they meet World Health Organization standards under the Baby-Friendly Hospital Initiative, bringing the total number of baby-friendly district hospitals in the country to seven. This achievement comes as Malawi is witnessing stagnating improvements in child survival rates. A baby-friendly hospital encourages and assists mothers to exclusively breastfeed until six months of age, which contributes to improving these survival rates. Since 2018, HP+ has been training, mentoring, and coaching district hospitals on exclusive breastfeeding. The Malawian Ministry of Health intends to achieve baby-friendly certification for all hospitals that provide maternity and antenatal care services; HP+ will continue to support these critical efforts to improve child survival rates in Malawi. Read more about recent progress.
USAID’s Health Evaluation and Applied Research Development (HEARD) project is shining a spotlight on HP+ partner the White Ribbon Alliance and their work under HP+ and its predecessor, the Health Policy Project, to build a movement for respectful maternity care. The White Ribbon Alliance—as an integral part of the Health Policy Project and now Health Policy Plus project—has grown the multi-sectoral Global Respectful Maternity Care Advisory Council and continues to support the role of midwives and women’s right to high-quality respectful maternity care by mobilizing civil society to advocate for accountability for respectful maternity care and advocating for the inclusion of women’s voices within global maternal health dialogues.
The World Bank approved the equivalent of US$105 million in non-reimbursable grants for the Government of Mozambique’s Primary Health Care Strengthening Program‐for‐Results—US$25 million from the Global Finance Facility (GFF) and US$80 million from the International Development Association (IDA). This announcement is due in part as a result of efforts by the USAID-funded Health Policy Plus project. HP+ had assisted the Mozambican government to develop an “investment case” to demonstrate the potential benefits of reproductive, maternal, neonatal, child, and adolescent health investment for the country. The investment case is the result of consultations about priority interventions to help increase service effectiveness, stimulate user demand, and strengthen the health system—initiatives that are needed to improve maternal and neonatal mortality rates while sustaining progress on reducing infant mortality in Mozambique. Read the World Bank Press release.
Based on advocacy by HP+ partner White Ribbon Alliance Malawi, the Government of Malawi committed to train Health Advisory Committee members throughout the country on Respectful Maternity Care. The training aims to sensitize communities about the right to respectful maternity care and open an avenue for women to report issues of disrespect and abuse. The government has also committed to hiring 800 midwives, an important step in addressing the country’s critical shortage of midwives. Similarly, White Ribbon Alliance Zimbabwe conducted three Respectful Maternity Care trainings for all provincial and district nursing officers in Zimbabwe, including midwifery tutors and senior managers from the private sector. Among other materials, each participant was given a locally produced video showing women's experiences of maternity care that the nursing officers can use as an advocacy and education tool at their institutions. This advocacy led to Respectful Maternity Care being incorporated into the monitoring and evaluation criteria used to monitor maternity care in all of Zimbabwe’s health facilities.
Kenya’s free maternity care program was first introduced in 2013. Since then, facility deliveries rose from 44 percent before the policy was in place to 66 percent in FY 2012/13. The maternal death rate also declined by 7.9 percent. After several months of intensive work, Kenya has launched Linda Mama—a revamped free maternity services program that expands the types of services available to mothers and babies and access. The program will be offered at all public health facilities and a combined 2,700 private sector and faith-based facilities. USAID, through the Health Policy Plus project, supported Kenya’s Ministry of Health and National Health Insurance Fund to redesign the program; cost the program’s benefits package; determine the resources required for implementation; ensure adequate government allocations; inform the program’s reimbursement rates; and prepare technical, implementation, and funding policy documents. The new program will reach an estimated 700,000 women each year.
Madagascar’s current family planning (FP) law was adopted around 1920, and restricts contraceptive access to young people. HP+ co-facilitated a workshop on Advanced Family Planning SMART to train stakeholders on FP advocacy techniques and develop a plan of action to assure that the country’s newly revised family planning and reproductive health law—created with drafting and technical review support from HP+—is reviewed and passed by parliament this year. The project is also active in the development and advancement of universal health coverage (UHC) and is represented on the UHC technical working group. The project has collaborated with the World Bank to introduce the RMNCAH (reproductive, maternal, newborn, child, and adolescent health) investment case to the MOH, and will support the ministry in its development.