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.
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.
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.
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.
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.
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.
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.”
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.
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.
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.
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.
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.
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.
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.”
In Malawi, HP+ has found powerful catalysts for change not just among typical stakeholder groups but in plain sight in villages, small organizations, churches, and mosques. In a series of blogs, staff describe working with individuals who, armed with facts and coaching, are able to effect change for individuals and society. An Act of Faith: Malawi Leaders Tackle HIV, published in Science Speaks, tells how religious leaders helped increase the uptake of HIV services. Sharing Information, Saving Lives: Noble Calling relates how, in just over a year, religious leaders and 632 volunteers living with HIV have brought nearly 4,000 people back to HIV care—a crucial step toward reaching epidemic control. The Power of the Pack tells the story of a group of determined women who were trained to be strong advocates to improve sexual and reproductive health policies for women and girls. The women are determined to pass on their experience, contacts, and know-how to the next generation to help deliver on commitments in Malawi’s Family Planning 2030 agenda.
A sustainability approach by HP+ is to strengthen the capacity of in-country partners to navigate the complexities of effective policy development, implementation, financing, and governance aligned to country priorities. In Mali, this approach was undertaken partly through seconded staff at the ministry level. A series of three briefs—"Case Studies on Secondments: A Promising Approach to Government Sector Capacity Strengthening in Mali”—explain the process that was undertaken to second staff and strengthen capacity across ministerial-level departments and document lessons learned, recommendations, and future activities. This approach aims to improve the enabling environment for equitable and sustainable health services, supplies, and delivery systems.
A “how-to” guide on an innovative, community-driven advocacy approach that can be used to facilitate local-level implementation of national policies and strategies has been published by HP+. HP+ used this multisectoral approach to strengthen implementation of Malawi’s national youth-friendly health services strategy, developing and piloting the approach in Mangochi District. The guide is intended to enable policymakers, government institutions, implementing partners, and others to replicate, refine, and tailor the approach used by HP+ to strengthen community-level implementation of national policies and strategies. While the HP+ pilot focused on youth-friendly health services and the guide’s contents are presented in those terms, the approach can easily be applied to support local-level implementation of other national strategies.
Following a request by the USAID Kenya Mission, HP+ conducted a high-level budget advocacy training for all USAID implementing partners (IPs) during the latest USAID Chief of Parties’ meeting. The training was aimed at sharing HP+ knowledge and expertise on identifying key opportunities and bottlenecks along the medium-term expenditure framework (MTEF) process to effectively influence budgetary allocations for priority health programs. It is expected that this engagement will enable collaboration between HP+ and IPs support resource mobilization efforts across national and county governments through the MTEF budget process, thereby facilitating efficient allocation and mobilization of domestic resources to sustainably finance key health programs.
Turkana county health leaders pledged to reinstate budget lines for HIV (Ksh 500,000), as well as restore subprogram budget lines for reproductive, maternal, neonatal, child and adolescent health care (RMNCAH) (Ksh 6.4 million) interventions. As HP+ supported the Turkana County Department of Health to hold consultative discussions with the County Treasury, it presented data to illustrate how the county historically underfunded these programs and over-relied on donor support. It advocated for the county to not only finance these critical interventions, but also realign the county budget to a program-based budget approach and ensure they receive the money budgeted to them. These funds, once implemented, will support community-based interventions such as psychosocial support and adherence counseling, as well as nutrition, immunization, and reproductive health services. By improving service delivery and institutionalizing the funds for these interventions, the county aims to improve health outcomes across HIV and RMNCAH. Moving forward, HP+ will continue training county teams to monitor fund absorption and generate evidence to advocate for subsequent increased budget allocations. In doing so, it will strengthen the county’s capacity to efficiently allocate and execute its budgets as well as generate and use evidence to advocate for and promote sustainable financing of the key disease programs.
Representatives from four district hospitals in Malawi where new nursing standards are being piloted came together this month to share experiences, challenges, and lessons learned. HP+ and the Nurses and Midwifery Council of Malawi (NMCM) developed new technical standards for nursing and midwifery practices for child and adult health, oncology care, and breastfeeding. The lack of specific standards for these key areas of practice has been an obstacle for nurses and midwives in delivering high-quality care and has prevented professional councils such as NMCM from assessing and assuring quality of care in service delivery. HP+ trained staff from NMCM and the Ministry of Health’s Quality Management Directorate as quality improvement coaches in rolling out the adult health standards in the four pilot sites. HP+ coached this team as members implemented the standards using a QI approach and facilitated the learning and review meeting. All four sites improved their compliance with the standards against the baseline assessment, despite having had only five months to adopt the concept, implement the standards, and undergo assessment. The pilot helped to identify gaps in the draft standards, which will now be revised, finalized, validated by the professional committee, and scaled up.
Through a local civil society organization (CSO) partner, HEP+ successfully delivered 12 trainings to leaders from partner civil society organizations in Guatemala. Representatives from National Alliance of Indigenous Women’s Organizations for Reproductive Health (ALIANMISAR), the National Network of Men, and Young Artists for Social Justice (JAxJS) received trainings on project and financial management, fundraising, proposal development, marketing, and conducting social audits. The 12 sessions were attended by 1,863 participants from the various networks, and the average increase in knowledge as demonstrated by pre- and post-tests was 34 percent. HEP+’s collaborative partner was the Consultora Multi-Profesional S.A., which also provided mentorship opportunities for 70 network leaders with the aim of developing their skills through practical exercises in each of the training topic areas. Following these trainings, civil society groups are more empowered to sustain their gains in skills and knowledge and to hold authorities to account. For example, after the trainings, three civil society networks of Totonicapán organized a meeting with their Health Area Directorate in June to learn about the 2020-2021 budget execution of the Crecer Sano program, which aims to combat chronic malnutrition. The civil society groups of Totonicapán will be conducting new budget analyses with the information gathered during the meeting and will develop strategies to make better use of the program's financial resources.
Frontline healthcare workers at Guatemala’s Ministry of Public Health and Social Assistance (MSPAS) recently completed an HEP+-created series of training sessions on COVID-19 care. “Improving the Quality and Hospital Care of Patients with COVID-19” covered epidemiology and management of COVID-19, COVID-19 therapy and therapeutic options, intubation, mechanical ventilation, nosocomial infections, anesthesia and management of delirium, ventilator weaning, and other topics. Thirty-nine doctors and 42 respiratory therapists and nursing staff completed the 26 hours of theoretical and practical training in June. A second training series in July and August covered mental health for health workers, the use of antibiotics in the patient with COVID-19, post-COVID-19 syndrome, and fungal infections in a COVID-19 patient. Health workers who have completed the course will train the staff under their charge on the same material. Thus far, a total number of 1,421 attendees have attended these additional sessions in July and August. HEP+ will provide technical assistance to update the infection prevention and control manuals in the coming weeks.
Guatemala and Malawi recently launched two university courses on policy modeling, data utilization, and demography and development created with HP+ support. Public Health and Demography, Reproductive Health and Nutrition at the School of Medicine of the Universidad San Carlos de Guatemala is an initiative of the Technical and Academic Commission led by USAC faculty in the School of Medicine, of which HEP+ has been a part since February 2021. HEP+ led the course's development by coordinating workshops and course approval and developed the course documentation and modules. Classes include Introduction to Public Health, Public Policy Framework, Demography and Development, and Reproductive Health and Development. In Malawi, HP+ developed the Policy Modeling curriculum at the University of Malawi’s Chancellor College alongside professors in the college’s Department of Population Studies, contributing models for policy planning such as Spectrum, DemDiv, and ImpactNow. The course, which was developed in 2019 and approved in 2021, will be mandatory for fourth-year demography students. In both courses, students will gain knowledge and skills in analyzing and communicating complex data for decision making, set policy goals, and use model results for policy analysis, implementation, and planning. These activities will prepare students to be effective public health policy influencers and practitioners.
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.
The Burkina Faso national government, local officials, and community leaders recently agreed to a plan to coordinate family planning activities in two eastern communes. The signed partnership agreement, facilitated by HP+, enabled an annual allocation of FCFA 2 million (approximately US$3,600) for community leaders in Fada/Dori and Kaya communes to continue conducting awareness-raising activities on local radio, in health facilities, and during cross-generation dialogue. Parties to the agreement are the Ministry of Health, the East Region municipality of Fada, health districts, and the local community leaders’ union (Union des Religieux et Coutumiers du Burkina pour la Santé et le Développement or URCB/SD). The agreement is just one effort in Burkina Faso to promote family planning as a way to lower birth rates and infant mortality. Through the Sahel project, HP+ collaborated with URCB/SD to map community influencers and potential family planning spokespersons in three regions. A total of 720 local leaders were identified and trained in family planning promotion. Afterward, they held sessions on community radio and organized awareness sessions in health and social promotion centers. The messages were developed by the leaders and linked family planning advocacy to holy texts and cultural values. In each region, the leaders held an intergenerational dialogue on sexual and reproductive health with more than 30 participants including other traditional leaders, religious leaders, women, youth, teachers, and parents. Finally, leaders held advocacy meetings with local elected officials and health officials, where they shared community feedback from their family planning awareness-raising experiences and discussed ways to sustain the interventions, which were appreciated by their constituencies.
HP+ Kenya is successfully reshaping its approaches to keep project activities running in the face of COVID-19 restrictions and, in the process, strengthening capacity and implementing sustainable processes that appear likely to outlive the current pandemic. HP+ has been adapting to the restrictions on movement imposed by the COVID-19 pandemic by training local county teams in data collection and analysis as well as planning and budgeting using virtual trainings. For example, HP+ trained a Kajiado County government representative on data collection of the geocodes required to map antiretroviral treatment sites and private pharmacies. Instead of recruiting independent research teams and sending them to the field, this alternative minimizes movement of people and strengthens capacity of local county staff.
In June, HEP+ completed a series of training sessions for frontline health care workers at Guatemala’s Ministry of Health (MSPAS). HEP+ designed the content for and delivered the course, “Improving the Quality and Hospital Care of Patients with COVID-19.” The series covered topics such as epidemiology and management of COVID-19, COVID-19 therapy and therapeutic options, intubation, mechanical ventilation, nosocomial infections, anesthesia and management of delirium, and ventilator weaning. Eighty-one healthcare providers (39 doctors and 42 respiratory therapists and nursing staff) completed the 26 hours of theoretical and practical training. To continue the knowledge transfer within hospitals, those health workers who have completed the course will train the staff under their charge on the topics about which they have learned. HEP+ will provide technical assistance to update the infection prevention and control manuals in the coming weeks. A second training series is being conducted in July and August 2021, which will cover mental health for health workers, rational use of antibiotics in the patient with COVID-19, post-COVID-19 syndrome, and fungal infections in a COVID-19 patient.
In a historic accomplishment, Malawi youth clubs supported by HP+ have banded together to form the first youth-led and youth-centered cooperative in Mangochi District. The cooperative will continue the individual businesses established by the clubs—beekeeping and the sale of honey—and the businesses’ support of local family planning initiatives. Such initiatives include revamping youth corners, buying bicycles and motorbikes to ferry youth to and from facilities, and supporting youth-friendly health services/family planning coordinators to conduct limited outreach. Members also hope to establish a facility separate from the hospital space where they now hold their regular meetings. The Thema Honey Youth Producers and Marketing Cooperative Society is one of only 12 in the district. To establish the cooperative, the individual clubs completed a required training facilitated by a multisectoral government team from central, district, and community levels and with financial and technical assistance provided by HP+. After the training, members applied to the Ministry of Trade and Industry for certification. Once certified, the cooperative will be eligible to access better markets for their honey as well as other government initiatives and opportunities.
After receiving an entrepreneurial training delivered jointly by HP+ and Feed the Future’s Agriculture Diversification Activity, participants from Nankumba Traditional Authority in the Mangochi district of Malawi used the curriculum and their own resources to orient other youth clubs on the topic. This raises the total number of youth clubs conducting social enterprises (such as bee keeping, maize farming, and goat farming) from the initial 15 clubs, two years ago when the training was first provided, to 29. Since a proportion of the profits from these businesses are invested in youth-friendly health services (YFHS), an increase in the number of clubs translates to an increase in YFHS investments. The vision of these clubs is to construct a youth resource center in their community through collective contributions, beyond the other investments currently being made. The youth resource center will serve as a separate space where FP information and some services can be provided, as the YFHS facility where youth currently access services is located within the local hospital and is quite small.
HP+ recently trained Honduran microbiologists on technology that delivers faster and better targeted testing for the COVID-19 virus. The new technology, called TaqPath, incorporates a reagent that cuts the time required for diagnostics from two hours to one, increasing the number of samples that can be processed per lab per day from 500 to 800. In addition, it will allow Honduran scientists to sequence samples that they previously sent to Brazil for further analysis. USAID provided the materials and reagents for the training and processing of 100,000 samples. The May training involved more than 60 microbiologists from four laboratories in Honduras. A training of laboratory supervisors was followed by a seminar series on the use of TaqPath and molecular biology co-delivered by HP+ and manufacturer Thermo Fisher. Learn more about HP+ activities in Honduras.
The Malawi Ministry of Health recently completed a detailed review of health programs and data in all five health zones. District health management teams and national and departmental representatives used these data to discuss progress on implementing the Health Sector Strategic Plan II. MoH Chief of Health Services Dr. Queen Dube praised the quality of the review: “We have noted major improvements in the quality of the analysis in the presentations; we now need to focus on the implementation of the action plans that have been developed.” The U.S. President’s Malaria Initiative and HP+ have been providing central-level health information systems support as well as ongoing training, tools and templates, and mentorship on routine data analysis to district data management focal persons and program coordinators. For additional background, view our brief.
With special guests from the Center for Global Development, USAID Kenya and Mozambique, the Kenya School of Government, and the Mombasa Department of Health, HP+ convened an online discussion,The State of the Art in Health Financing Reform, on strengthening public financial management (PFM) in health at sub-national level as an enabling environment to advance meaningful progress towards universal heal coverage (UHC) and ensuring sustainable and adequate domestic public financing for the health sector. This discussion, featuring program-based budgeting innovations at the county level in Kenya and Mozambique and emphasis on innovative information systems and digital solutions in Mozambique, stressing the importance of capacity strengthening at local levels as an important component in strengthening efficiency, transparency, and accountability of health resources, as well as improving access to quality health care services. Sanjeev Gupta of the Center for Global Development set the scene for the discussion stressing the need to both increased funding and improved spending. Andrew Rori, the Deputy Director of Learning and Development at the Kenya School of Government, and an HP+ Kenya partner discussed the importance of building the capacity of county-level health officials at all stages of the budget cycle. Dhimn Nzoya of USAID Kenya and Adriano Nhabanga of USAID Mozambique shared USAID’s goals to catalyze domestic resource mobilization and capacity strengthening for long-term sustainability.
With the support of HEP+, the Nutrition Institute of Central America and Panama (INCAP) has made significant progress in collecting baseline data for Guatemala’s Great National Crusade for Nutrition (GCNN), which aims to reduce malnutrition in the country. As of May 25, INCAP had visited 536 homes in Chimaltenango, Sacatepéquez, and the department of Guatemala as a part of an effort to identify municipalities most in need. Once baseline data collection is complete, the information will be used to monitor and evaluate the GCNN’s efforts, help the Guatemalan government better identify local health needs, and inform nutrition intervention delivery. In addition to preventing chronic malnutrition and anemia, the national strategy aims to reduce maternal and infant mortality and morbidity, promote food security and nutrition, strengthen food services, and prevent and infectious diseases. HEP+ support of the GCNN initiative includes creating systems for technical and operational analyses, a budget based on programmatic categories, and a strategy to define the resources and activities needed to strengthen the GCNN.
Tanzania has taken some steps to broaden financing for family planning. During a two-day workshop convened last month by HP+, Tanzanian stakeholders discussed options for sustainable financing for family planning services, focusing on segmentation of the family planning consumer market and integration of family planning into the county’s national health insurance scheme. HP+ will model several policy scenarios for financing the scale-up of family planning services to reach the modern contraceptive prevalence rate outlined in the Tanzania National Costed Implementation Plan. The modeling will quantify costs to the government and to women under scenarios in which family planning is offered for free to all users, is incorporated into the health insurance benefits package, and is expanded through commercial products. The findings will be used to advocate for a sustainable option to finance family planning scale-up, with the intent of increasing domestic resource mobilization for family planning, increasing private sector engagement in the delivery of family planning services, and improving access to family planning for the underserved and vulnerable in Tanzania.
HEP+ Guatemala held a virtual conference on May 6 for more than 480 healthcare and hospital workers about therapeutic options to treat COVID-19. It was the first in a series of 27 training sessions to develop capacities among frontline healthcare workers to improve quality of care for COVID-19 patients in Guatemala. Conference keynote speaker Dr. William Checkley, associate professor of medicine at Johns Hopkins University, shared resources to improve clinical practice in the care of COVID-19 patients. The session also featured remarks from Dr. Francisco Coma, vice-minister of hospitals for Guatemala’s Ministry of Public Health and Social Assistance; Dr. Yma Alfaro of USAID/Guatemala; and Herminia Reyes, country director for HEP+ Guatemala. The session improved understanding of current, evidence-based options available to treat patients diagnosed with COVID-19 and promoted the exchange of experiences, challenges, and improvements in patient care.
HP+ and Feed the Future conducted a gender-focused leadership training for 15 youth leaders under age 30 from youth-led organizations in Malawi. The training used the Gender Action Learning System methodology, which empowers communities to articulate needs, envision change, and identify gender-equitable initiatives. Suited to communities with limited literacy and numeracy skills, it communicates abstract concepts such as gender sensitivity and isolates the roots of social norms. HP+ adapted the methodology to include positive youth development domains and policy. Participants demonstrate leadership growth by replicating the training and spearheading the development agenda of their organizations, communities, and districts. Participants are expected to implement what they learned in their communities. There are already results from the training. One youth leader secured an internship with the training partner and another facilitated a similar training in her community less than two weeks later. HP+, Feed the Future, and MERAMO Consulting will continue to monitor and offer technical support to the youth leaders as they cascade the methodology within their communities.
With HP+ technical support, Madagascar’s Ministry of Public Health recently validated the Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition Investment Case for the Global Financing Facility. The investment case outlines priorities for interventions and regions in addressing the country’s RMNCAH-N objectives and health system improvements. HP+ was the lead technical partner, in collaboration with UNICEF, the United Nations Population Fund, the World Bank, and the World Health Organization, supporting the ministry in the development of the investment case. The process offered the opportunity to improve the alignment of donor financing with government priorities and objectives. It also focused on targeting limited government resources on high-impact practices and healthcare access for the country’s most vulnerable populations. HP+ will continue to provide technical assistance to build the ministry’s capacity to monitor the implementation of the investment case at national, regional, and district levels. The investment case aims to reduce the total fertility rate—the average number of births a woman has over a typical lifetime—from 4.6 to 4.2 and aims to reduce the adolescent fertility rate from 151 to less than 130 births per 1,000 women. The five-year plan would reach 17 out of 22 prioritized regions, covering 19.1 million people (78 percent of the population) and avert more than 9,000 neonatal deaths, approximately 3,000 maternal deaths, and nearly 40,000 deaths of children under five years of age.
HEP+ is actively supporting the Guatemalan Ministry of Health and Social Assistance in rolling out the country’s second phase of its vaccination plan. HEP+ is coordinating efforts among government agencies, private sector representatives, and other implementing partners to set up in-person registration stands at accessible points and help deploy vaccination posts based on population density. HEP+’s activities have resulted in the installation of 547 vaccination centers and 49 registration stations for people without an internet connection. HEP+ also supported the ministry with the IT support necessary to launch its COVID-19 Vaccine Website, where Guatemalans can register online for COVID-19 vaccinations. With these activities, Guatemala expects to speed up the second vaccination phase, forestall crowds at vaccination sites, and increase the number of vaccinated people in the country. As of May 10, more than 131,000 people 70 years of age and older had registered on the website. Guatemala hopes to vaccinate 620,000 people over the age of 70 as part of phase two of its vaccination plan.
With financial and technical support from USAID, the Pan American Health Organization, and HP+, 3 new molecular laboratories were constructed in Cortes, Copan, and Atlantida. With these additional laboratories, the turnaround time for COVID-19 test results has been reduced from almost one month to 48 hours (previously, COVID-19 diagnostics were available only at the national laboratory in Tegucigalpa). By increasing the geographic distribution of laboratory capability, the Ministry of Health is now able increase the availability of testing and sample processing for communities across the country, improving COVID-19 response efforts at the local level. To support the opening of the laboratories, HP+ created standard operating procedures and strengthened the capacity of lab staff, including microbiologists and lab technicians, through technical training and certification in microbiology and sample processing.
In March, HP+ convened and led a workshop that kicks off a six-month leadership development process in Malawi using the new model for building the capacity of health stewardship. The 23 participants are drawn from four districts and comprise district youth officers, family planning coordinators, youth development officers, youth-friendly health services coordinators, district nursing and midwifery officers. The curriculum combines in-person and virtual learning events with a virtual peer support group, a leadership assessment, one-on-one coaching and mentoring, and individual stewardship development plans that link leadership development daily professional responsibilities. Participants will be undergoing a leadership assessment in the coming weeks and begin preparing for a second learning event in June. This activity’s anticipated impact is a cohort of key actors in each of the select four districts with strengthened leadership and stewardship capacities to better address key challenges within the health system, with particular emphasis on family planning and youth-friendly health services.
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.
HP+ is working to advance implementation of a transformative reproductive health and family planning law in Madagascar by providing advocacy training to representatives of civil society organizations and government ministries. Twenty-eight participants from 17 civil society organizations and government ministries—including youth and women's organizations and three ministries (health, youth, and population)—attended an HP+-hosted advocacy training from February 24–26, 2021. Using the Advance Family Planning SMART approach, participants developed work plans, budgets, and SMART objectives. Examples of objectives include incorporating a budget line for state participation in contraceptive purchasing and conducting a situational analysis and consultation with persons with disabilities regarding access to reproductive health and family planning services. During the next 12 months, HP+ will continue to provide support and monitor the SMART objectives and advocacy plans developed and adopted during the training.
HP+ has helped Nigeria increase the availability of HIV services offered to enrollees in its insurance scheme in Lagos State, home to 12 million people and the nation’s capital city. Between September 2020 and February 2021, the Lagos State Health Management Agency (LASHMA) brought 119 new HIV facilities into the Lagos State Health Scheme. With these HIV facilities now active in the state health insurance scheme, HP+ estimates that more than 3,836 enrollees living with HIV can now access HIV services through the scheme. HP+ worked with LASHMA to simplify requirements that facilities must meet to become contracted into the state scheme and helped LASHMA approve a four-month grace period for facilities to submit the necessary documentation. By the end of 2021, assuming LASHMA meets its current target of enrolling 3.5 million people, HP+ estimates that these facilities will serve around 49,000 people living with HIV. In the upcoming months, HP+ will train contracted facilities on how to provide HIV services to clients through the state scheme, how to procure test kits, and how to submit claims.
A Malawi youth is using skills acquired at a recent USAID-funded training to advocate for youth-friendly health services (YFHS) in his home district of Mwanza. He is one of 15 Malawi youth leaders HP+ trained in health budget advocacy with the goal of increasing young people’s engagement in health budget processes. After the training in November, the youth developed an advocacy action plan focused on increased budget allocations for YFHS and presented it to representatives of the Mwanza CSO Network in December. The CSO Network pledged its support, committing to engage a member of Parliament as a strategic partner to strengthen the advocacy community in Mwanza. HP+ will be monitoring the implementation of this action plan for the next nine months.
HP+ has helped the Malawi Ministry of Health relieve an acute and long-standing shortage of data management personnel. Health and local government ministries recently absorbed 327 facility data management staff, strengthening data management and improving the quality and use of data to develop health service delivery across all levels of care. The shortage stemmed from a recruitment freeze arising from expenditure restrictions and resulted in limited use of data to inform health sector decision making and data quality concerns. HP+ is helping the government hire and recruit an additional 397 data staff by 2022, a move that will increase data management staff levels to more than 100 percent from the 2016 level of around 25 percent, before HP+ helped develop and operationalize a plan to address the shortage.
HEP+ is training local leaders and experts in Guatemala on how to plan for and deliver services related to COVID-19. The training is designed to help participants work with local authorities in planning for both COVD-19 care and prevention services. So far, 130 area chiefs, epidemiologists, statisticians, and heads of service provision from five health areas have taken the course. In addition to these three trainings, reaching leaders from Escuintla, Santa Rosa, Retalhuleu, Suchitepéquez and Sacatepéquez health areas, HP+ is planning an additional three sessions. At the conclusion of the in-person training, HP+ will index the material and make it available throughout the country, giving health experts quicker access to this information to better respond to the ongoing pandemic.
HP+ helped officials in Indonesia assess their available budget space for family planning and other health interventions. HP+ conducted an initial budgetary space analysis with the Ministry of Finance to validate macroeconomic, provincial, and district government spending as well as key financial projections. The techniques offered as part of the analysis can push policymakers and health planners to identify and tap into additional sources of funding by re-prioritizing health budgets, identifying efficiency gains, increasing health-specific resources, and managing health sector grants and assistance. The fiscal space analysis was followed by development of a manual and a class on the process in early December attended by 50 representatives from the National Development Planning Agency, the Ministry of Finance, and the Ministry of Health. The manual will be hosted on the University of Indonesia’s website, allowing access by all government representatives.
HP+ has helped coordinate the donation of 50 ventilators, facilitated by USAID, to the Guatemalan Ministry of Health. In early December, HP+ provided more than 100 medical and paramedical personnel from five Guatemalan hospitals in-person training in the use of ventilators. Equipped with improved treatment protocols and patient care options, healthcare workers will be able to immediately use the ventilators to treat COVID-19 patients. They will also be able to provide other necessary therapies for adults and children in need of ventilator support. In upcoming weeks, HP+ will provide training for two additional hospitals and will continue to provide technical assistance to ensure adequate use and handling of the equipment.
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.
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.
On November 12, HP+, in conjunction with USAID and Indonesia’s Ministry of Health’s Centre for Health Financing and Insurance (PPJK), hosted a global practice webinar. “Public-Private Partnerships (PPPs) for Health: Nuts and Bolts from Policy to Practice—Highlights from India” is the fourth webinar in a series focused on strengthening health sector stakeholders’ understanding of global best practices in scaling up high-quality health services through PPPs. With over 100 participants hailing from government, academia, and the private sector, the webinar explored the rationale and benefits for creating PPPs, approaches to identifying opportunities for collaboration, and the tools, resources, and institutions necessary to design and implement partnership approaches. Examples were taken from India’s experience in expanding private sector engagement and blended financing mechanisms in pursuit of better health outcomes, including the Utkrisht Development Impact Bond model applied to maternal and newborn health programs. Speakers, who included representatives from PPJK, the Gates Foundation, USAID/Washington, and USAID/Indonesia, inspired the audience to think beyond traditional corporate social responsibility, toward innovative ways to harness new collaborations between the public and private sectors.
In El Salvador, HP+ engaged 83 healthcare professionals in 20 facilities across six municipalities to adapt and disseminate evidence-based guidelines and pilot a training for clinical management of COVID-19. The guidelines and training, which cover diagnosis and treatment, as well as triage, hospital referral, home care management, and infection prevention and control, have strengthened COVID-19 response efforts within primary healthcare and household settings and improved patient perceptions of safety. Moving forward, the training will be expanded to include additional content for nurses and cascaded to enhance the capacity of healthcare professionals to engage effectively in the COVID-19 response in El Salvador.
On October 23, 75 participants joined a virtual watch party and panel discussion organized by HP+ to screen the short film “Why Policy Matters: Reforms Lead to a Healthy Outlook for Nigerians.” The most successful social media post promoting the event resulted in 83 video views and, due to successful outreach to partners, had a potential reach of over 28,000. The Commissioner for Health from Osun State, Nigeria, who joined the watch party and discussion, recognized the work of HP+ and USAID in his state to successfully implement national health reforms and expand access to care.
On September 14, 2020, Cambodia’s National Social Protection Executive Committee approved the adoption of a new monitoring and evaluation (M&E) system, developed with HP+ support, to enable systematic oversight of social protection results and financing to manage its portfolio, improve accountability and transparency, and inform future investment priorities. HP+ supported the development of the system by creating a logical framework and identifying indicators; drafting an operational manual and legal framework; and providing customized trainings and ongoing coaching to build capacity of a new team with no previous M&E experience. Implementation of the system will support Cambodia’s policy goals of preventing and reducing poverty, vulnerability, and inequality.
In Malawi, youth clubs are thriving, enabling young people to continue to access youth-friendly health services (YFHS) during the COVID-19 pandemic. The 45 youth clubs in Mangochi, trained by HP+ and the USAID AgDiv Project in June 2019 on enterprise and entrepreneurship, have been mentored by an HP+-trained multisectoral ministry team and youth champion during the pandemic. They have invested approximately MWK 459,000 (US$611) in their respective centers, supporting the provision of YFHS and information on COVID-19 to youth throughout the region.
In support of the Government of Cambodia’s implementation of a policy to decentralize health sector leadership to subnational and provincial levels, HP+ supported the National AIDS Authority (NAA) to facilitate an advocacy workshop in the province of Kampong Speu on August 31. Fifty participants—hailing from the provincial government, operational districts, NAA, and the National Center for HIV/AIDS, Dermatology, and STIs—reviewed policy measures and discussed implementation plans and roles. Decentralized implementation of this policy will enable the province to directly manage health resources and make decisions with regard to health planning, monitoring, and policy prioritization.
In Malawi’s Mangochi district, youth clubs are supporting the construction of a standalone building to house youth-friendly health services at Nankumba Health Center. Following a training on small-scale businesses conducted by HP+ and Ag Div in June 2019 and subsequent months of advocacy efforts, the youth clubs secured financial support from the community amounting to MWK 400,000 (approximately US$540) as well as commitments from local leaders to support the initiative. By building this separate facility—expected to serve up to 50 individuals by the end of 2021—the youth aim to provide a safe, private space for their local peers to access health services.
Last month, more than 2,300 public and private sector health professionals in Guatemala participated in five hours of live training on COVID-19. The two sessions—broadcast on YouTube—featured presentations from top local experts and interactive questions from viewers. Since airing, more than 18,000 additional views have been recorded. In coordination with key health sector stakeholders, HEP+ facilitated and moderated the sessions and solicited participant input for future trainings. With a solid foundation of knowledge on the basics of COVID-19, health professionals nationwide will be able to improve practices in service delivery to support Guatemala’s pandemic response.
In Mali, where faith leaders wield significant influence over sociocultural and health matters, the decision of these leaders to speak publicly about ways to end gender-based violence (GBV) is a monumental step. Since committing in early 2020 to join HP+ and other stakeholders in advocating against GBV and promoting a national GBV law, these leaders—both Muslim and Christian, male and female—have formulated faith-specific talking points and are sharing them with their communities. Along with advocating for passage of the law, this public discussion is a critical step in combating GBV in Mali, where 4,617 incidents were recorded in 2019 alone.
HP+ and FP2020 co-hosted a webinar exploring ways to catalyze a shift in domestic financing for family planning. The webinar introduced a new framework that provides a structure for development partners and advocacy groups to work with country governments to identify and implement catalytic interventions for family planning in advocacy, capacity development, policy, and expansion of the family planning market. USAID’s Susanna Baker provided relevant HIV case studies from PEPFAR’s Sustainable Financing Initiative; Martyn Smith of FP2020 discussed the need for such investments; and Kojo Lokko of the “Challenge Initiative” shared experiences on matching funds and other means to raise domestic resources for family planning.
In collaboration with USAID, Project EpiC, and the Honduran Ministry of Health, HP+ has trained nearly 400 frontline healthcare workers providing critical care to COVID-19 patients across Tegucigalpa and San Pedro Sula, home to approximately 70 percent of COVID-19 patients in Honduras. Healthcare workers used a training curriculum, developed with HP+ support, on use of U.S. Government-donated ventilators and infection prevention and control protocols to enable them to provide mechanical ventilation to patients and protect themselves from COVID-19 in their workplaces. At an August 28 virtual celebration with the Honduran Minister of Health Alba Flores, EpiC Project Director Hally Mahler, and USAID Honduras Director of Education Meredith Fox, Flores thanked the U.S. Government and HP+ for their support. She remarked, “The capacity development processes and the ventilation equipment have strengthened care provision” in Honduras, and that “the pandemic has challenged our medical and nursing professionals to improve their knowledge and practices.”
HP+ and Cambodia’s National Center for Tuberculosis and Leprosy (CENAT) conducted assessments and provided on-site support for the Tuberculosis (TB) Prevention Therapy module in three provinces. The assessments follow a June training that HP+ and CENAT provided to TB supervisors on use of the TB management information system at public health facilities. The recent assessments revealed that TB supervisors’ knowledge and use of the module was either “excellent” (80%) or “very good” (20%), demonstrating strengthened skill competencies. In October 2020, CENAT will lead in providing module trainings and follow-up visits to the remaining 23 provinces and 86 operational districts.
HP+ conducted a costing study in 24 districts across the five major island groups in Indonesia to support the government to implement minimum service standards (SPM) for 12 primary healthcare services. Data from the study has been used to improve existing SPM budgeting and planning tools used by local governments. This will alleviate administrative burdens on districts and support 514 district health offices in better planning to achieve SPM targets by improving allocation of resources for health. HP+ is providing virtual technical assistance on use of the tools and will develop e-modules to strengthen local government capacity to use them.
In August, HP+ facilitated a virtual training for research institutions and government representatives in Kenya, Tanzania, and Uganda on applying the Activity-Based Costing and Management methodological approach to HIV services. HP+ strengthened the capacity of these institutions and participants to implement data collection; conduct analysis; develop research protocols and data collection instruments; secure ethical clearance; facilitate stakeholder consultations; and develop reports using the approach. Findings from the analysis can help policymakers and partners to more effectively allocate resources, improve monitoring efforts, optimize investments, and drive efficiencies through improved delivery of services.
In Madagascar, HP+ has been supporting journalist trainees to provide information and news about family planning/reproductive health (FP/RH). Twenty news articles have since been produced that reach local, regional, and national audiences. Last November, 11 journalists were trained by HP+ on the fundamentals of FP/RH, the FP/RH law, and issues related to population and development. The following January, with HP+ support, nine of the trainees conducted field investigations to raise public awareness of early pregnancy, break taboos on contraception, and disseminate the FP/RH law. In July 2020, HP+ supported the development of a yearlong editorial calendar and dissemination strategy to support these efforts.
HP+ provided technical assistance to the Honduran Ministry of Health to conduct a rapid assessment of 22 critical care facilities across the country. This rapid evaluation assessed the readiness of hospitals to receive and use U.S. Government-donated ventilation equipment; an in-depth assessment is scheduled to be completed by August 15 in collaboration with Project EpiC. Correspondingly, HP+ launched a training series on the use of the ventilators and infection prevention and control. More than 120 (out of 460) healthcare workers have participated to date.
On June 24, the Prime Minister of Cambodia officially launched a new cash transfer program to offset the impacts of COVID-19 on the country’s poor and vulnerable that will begin with the transfer of about US$50 million to 560,000 poor households. HP+ had supported Cambodia’s General Secretariat for the National Social Protection Council (GS-NSPC) to develop a monitoring and evaluation (M&E) concept note for the program and provided technical assistance to the GS-NSPC team and GIZ contractor implementing COVID-19 M&E activities, improving accountability among local authorities. In Cambodia, health service disruptions related to COVID-19 could potentially result in 559,900 individuals being unable to access contraceptives.
HP+ Indonesia’s partnership with Badan Litbangkes has resulted in a second article being accepted in the journal PlosOne. “The Influence of Jaminan Kesehatan Nasional (JKN) on the Cost of Delivery Services in Indonesia” aimed to identify the association between use of Indonesia’s national health insurance (JKN) and out-of-pocket expenditures in accessing delivery services. The study found that use of JKN is associated with reduced out-of-pocket expenditures for delivery as well as reduced risk of incurring catastrophic delivery expenditure, though some out-of-pocket expenditures for delivery services still exist among mothers enrolled in the scheme.
In Malawi, district youth-friendly health services (YFHS) coordinators are using performance data to analyze YFHS uptake nationwide, sharing best practices and challenges encountered to improve program decision-making across all levels of the health system. Since 2018, HP+ has supported the Ministry of Health’s Central Monitoring and Evaluation Directorate to analyze district performance in reporting YFHS uptake and share these results with district-level coordinators via WhatsApp. As a result, the overall national reporting performance of the YFHS program has improved from 13 percent in 2018 to 72 percent as of March 2020, demonstrating strengthened capacity to submit complete, timely data critical to supporting informed decision-making.
A webinar on June 25 highlighted Nigeria’s successes in achieving health reform, advanced over two years with support from USAID through HP+. Presenters, including HP+ Project Director Suneeta Sharma, HP+ Nigeria Country Director Frances Ilika, and Osun State Health Insurance Scheme Executive Secretary Adeniyi Oginni, discussed domestic resource mobilization, capacity development of primary healthcare management, and health insurance coverage expansion in the Federal Capital Territory and Abia, Ebonyi, and Osun States. Advancements include the unlocking of US$58 million for health to aid advocacy and policy reform and the enrollment of 345,000 individuals in health insurance schemes in Osun State and the Federal Capital Territory.
A new blog by HP+’s Laura Brazee—Opening Doors: Mentoring for Effective Advocacy—was published by Knowledge SUCCESS. The blog shares insights from an intergenerational mentoring program for youth in Malawi. It demonstrates how engagement with mentors supports emerging young leaders to engage village, district, and national stakeholders to deliver on promises related to youth-friendly health services (YFHS) and strengthens advocacy for policies to end early marriage. Mentees were supported to build partnerships with youth networks and organizations to advance their advocacy work and connect to new stakeholders. View more Malawi-specific materials.
HP+ continues to build Cambodia’s domestic capacity to manage its tuberculosis response by supporting the roll-out of the new Tuberculosis Prevention Therapy (TPT) training modules to the National Center for Tuberculosis and Leprosy’s tuberculosis management information system (CENAT TB MIS). In May 2020, HP+ facilitated a three-day training-of-trainers for 16 technical staff from CENAT and partners. The training, which prepared participants to provide the training nationwide, covered data entry protocols, roles and responsibilities, and best practices for troubleshooting. CENAT staff can now execute TB-MIS trainings with limited HP+ oversight and support, extending the frequency and reach of the trainings throughout all provinces.
On May 6, representatives from Kenya’s health leadership at the county level adopted a prototype of a new County Health Planning Unit (CHPU) for each county, created to address gaps in planning and advocating for budget allocations for strategic programs such as HIV, family planning, and malaria. HP+ supported the establishment of the CHPU through multisectoral collaboration with individual counties, the Ministry of Health, the Council of Governors, and the National Treasury. Moving forward, HP+ will support CHPU capacity strengthening and mentorship to institutionalize planning and budgeting at the county level, underscoring long-term sustainability on Kenya’s journey to self-reliance.
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.
Field, POP/HIV
In May, with HP+ support, Madagascar validated its new Water, Sanitation, and Hygiene (WASH) sector policy through a virtual workshop led by the WASH minister and attended online by nearly 80 key stakeholders. Adoption of the new policy is a significant achievement within the context of the COVID-19 pandemic, as it enables health facilities to install running water to support handwashing guidelines. Policy implementation, which will be facilitated through the forthcoming national WASH Strategy, aims to enable public access to potable water for the entire population by 2030—a significant increase from the current level of less than half of the population with access.
HP+ supported Cambodia’s National AIDS Authority to conduct a legal and regulatory assessment of private sector provision of HIV services. The assessment concluded that, while the private sector can legally provide HIV services, these services are insufficiently regulated and reported. Findings informed private sector engagement strategies for the five-year National Health Sector Strategic Plan for HIV. If these strategies are adopted, Cambodia can expect to see higher-quality HIV services provided by the private sector, and the government will be able to use more reliable data to program resources.
A secondee from HP+ embedded in Mali’s Ministry of Health’s Immunization Subdirectorate supported national and district leaders to improve management of cold chain equipment and vaccines by developing, testing, and validating operational tools for monitoring cold chain equipment. Until now, no monitoring tools were available, making coordination among donors challenging. Availability of performance data on a quarterly basis will allow for informed decision making about forecasting cold chain supply and vaccine needs. This, in turn, will improve performance of cold chain equipment, efficiency of vaccine and distribution expenditures, and coordination of the overall system, contributing to the administration of quality vaccines to children throughout Mali.
In March, following an HP+ policy advocacy training and ongoing mentorship, two student youth advocates at Malawi’s University of Livingstonia established a Sexual and Reproductive Health and Rights (SRHR) club on campus to provide information and referrals for students seeking to access contraceptives, counseling, HIV testing, and information on SRHR. The advocates are now seeking to establish a youth-friendly health services space at the university where students can access information, services, and referrals to the closest hospital and mobile clinic. There are currently 700 students attending Livingstonia University and 64 have expressed interest in joining the SRHR network.
In the Kyrgyz Republic, HP+ is providing technical support for the implementation of the first social contracting projects in the country. In 2019, the Ministry of Health Republican AIDS Center (RAC) awarded projects for six NGOs to support adherence to HIV treatment and reduction of viral load for a total of 3 million soms (about US$45,000 at the time of the allocation). HP+ provided extensive support to strengthen stewardship and management capacity at all stages of implementation. The NGOs successfully linked 68 people living with HIV to care and initiated antiretroviral therapy. The RAC plans to continue social contracting in 2020 and has committed to increasing the allocated amount to 5 million soms. HP+ is also supporting the MOH Oncology and Psychiatry departments to launch social contracting.
In Cambodia, HP+ supported the Ministry of Economy and Finance and the National Social Protection Council (NSPC) to develop a monitoring and evaluation (M&E) operations manual and indicators to monitor progress on social protection in Cambodia. Included is an indicator on rates of contraceptive prevalence. Due to COVID-19-related social distancing measures, HP+ has facilitated rapid transition of this activity to an online platform to validate indicators with 11 line ministries. In addition, HP+ developed an online course catalogue that offers 27 free, online social protection courses for colleagues to pursue self-study while working remotely.
In Malawi, youth trained in policy communication have successfully advocated for policy changes at the district level. The training, facilitated by HP+ in coordination with partner Population Reference Bureau (PRB) in July 2019, resulted in the creation of policy advocacy plans by youth advocates. Recent follow-up by PRB revealed multiple successes in the implementation of these plans, including implementation of a differentiated care model for antiretroviral therapy service delivery, expanded clinic hours to target youth, and inclusion of youth leaders in local decision-making committees and district structures. These policy changes improve youth access to health services and family planning information, contributing to improved health outcomes across Malawi.
In January 2020, Cambodia’s Ministry of Economy and Finance’s inter-departmental health working group accepted 32 recommendations crafted by the National Social Protection Council. The recommendations, which include expanding coverage to dependents and raising the income threshold for premium contributions, came from HP+-generated evidence aimed at advancing the government’s social health protection agenda by promoting ownership and empowering key influencers to effectively advocate for policy change. The recommendations, which the government will begin to implement over the coming year, could significantly benefit Cambodia’s most vulnerable citizens by expanding social health insurance to 3.8 million family dependents and 3.1 million vulnerable people, who will gain improved access to long-acting and reversible and permanent family planning methods to be reimbursed under the HEF benefits package
This month, HP+ supported researchers from Indonesia’s National Institute for Health Research and Development (Balitbangkes) to publish a journal article in BMC Public Health. HP+ strengthened capacities of the researchers to analyze data about potential risk factors for adverse maternal and newborn health (MNH) outcomes and write and submit five academic articles to peer-reviewed journals. Balitbangkes’ research will contribute to the dissemination of MNH scholarship among learned communities, inform a wide audience beyond technical subject-area experts about key MNH risk factors in Indonesia, and support the development of informed decisions by policymakers.
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.
Mali’s Alliance of Muslim and Christian Religious Leaders has expanded their organizational by-laws to include working against gender-based violence (GBV), an important step forward for a country where faith leaders have significant influence over sociocultural practices that impact health. According to Mali’s 2018 Demographic Health Survey, 45% of women ages 15-49 have experienced violence. Following an orientation by HP+ on the types and prevalence of GBV in Mali, the faith leaders felt compelled to act. With the modified by-laws, the alliance joins forces with the National Program to Abandon GBV and other stakeholders to revive efforts to advance a law to combat GBV in Mali.
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.
In Burkina Faso, one mayor has successfully mobilized more than US$124,100 to support the implementation of family planning activities under his jurisdiction. Following an HP+-supported sub-regional family planning workshop in 2018, Bobo-Dioulasso mayor Bourahima Fabéré Sanou committed to allocating 20 million CFAF (US$33,000) to family planning. Under his stewardship, the municipality mobilized an additional US$91,000 from the International Association of Francophone Mayors to support training and awareness-raising activities, contraceptive procurement, and the promotion of service delivery campaigns in secondary health and professional establishments. As a result of these activities demand for sexual and reproductive health services have increased 52 % in Bobo-Dioulasso, adding 1,335 users to the existing 2,578.
Cambodia took a major policy implementation step in its national HIV/AIDS response this month when the Prime Minister approved a resolution directing operational funding for the response and other key advancements, notably the eligibility of all people living with HIV to receive a Health Equity Card and recognition of the important role played by civil society organizations. The resolution also guides the Ministry of Health to amend policies for health center and hospitals to use their own funds for HIV/AIDS activities, in addition to Ministry’s national budget. This achievement represents the culmination of an extensive effort by HP+ Cambodia and its health advisors, who are embedded at the National AIDS Authority (NAA), to advance health financing policy implementation for people living with HIV. This effort included sensitization and capacity building with the NAA leadership and ongoing support for the entire policy advocacy process including the drafting of the board resolutions and proposal to the Prime Minister’s office. Moving forward, the Prime Minister’s directive calls for the Supreme National Economic Council to further study the fiscal space to ensure implementation of the commitments and to sustainably mainstream the HIV/AIDS response through strengthened human resources, procurement, supply chain management, and health information systems. HP+ will continue to support the NAA in implementation of the new guidance.
Kenya’s Public Financial Management Act requires that all funds collected at health facilities be channeled to a country revenue fund, blocking local health departments from control of revenue and compromising quality of care as a result. To address this challenge, HP+ supported the Kilifi Department of Health to assess the legal and policy environment and identify a strategy to redirect US$1.25 million in user fees back to the health sector to support purchase of commodities and cover operational costs. Returning control of domestic resources for health to the health sector is expected to improve quality of care and accessibility of commodities at health facilities.
In Mozambique, HP+ developed, installed, and tested the Apache Superset Data Visualization Tool as part of its support to the Department of Administration and Finance (DAF) to improve financial management. Leveraging comprehensive data from the Ministry of Finance and the Ministry of Health, the visualizations showcase health sector coverage based on expenditure and allocation data, efficiency of financial processes, and payments made. Currently, 21 local users have been trained and have access to the tool. When fully implemented, this tool will help DAF and provincial directors to achieve greater effectiveness in financial decision making at both national and provincial levels.
In Mali, three members of the Association of Malian Municipalities (AMM) are independently facilitating advocacy meetings to mobilize local financing for community health workers (CHWs), following a HP+ training in AFP SMART methodology. The AMM has secured funding from the Aga Khan Foundation to advocate for communes to assume financial responsibility over their CHWs, and two municipalities have signed service contracts with 210 CHWs to ensure stipend support. Increasing domestic financing for CHWs will increase access to services for women and children, particularly those living more than 5 km from a health facility.
In Tanzania, 90% of district councils (167) have been oriented to the country’s national family planning costed implementation plan (CIP) and supported to develop action plans for inclusion in councils’ 2020/21 budget requests. In 2019, HP+ supported the Ministry of Health, Community Development, Gender, Elderly, and Children in national dissemination of the CIP. These efforts involved supporting the facilitation of dissemination workshops to enable local government authorities to understand and buy into the plan—important steps toward increasing budget allocation for family planning at the local level.
The HP+ “total facility approach” to reducing stigma and discrimination in health facility settings is being featured on the PEPFAR solutions website. This showcases the work carried out by HP+ in Tanzania and Ghana as an important solution for the HIV response. PEPFAR Solutions are impactful, data-proven approaches intended to guide others in program design and implementation. U.S. government staff and partners around the world use the solutions website as a resource for HIV program design. Having the stigma-reduction approach featured also makes it accessible to mission staff around the world as they embark on their COP20 planning processes.
Malawi reached a key milestone in decentralization of the health sector at the end of 2019 with the establishment of district-level condom coordination committees to enhance distribution and access in all 28 districts. The District Condom Coordination Committees (DCCCs), oversight groups with clearly defined roles and responsibilities for accountability, were outlined as a priority in Malawi’s National Condom Strategy (2015-2020), which was developed with USAID support. Initially, HP+ helped to establish the coordinating committees in five priority districts and shared the approach with PSI to reach an additional three districts. HP+ scaled it up further in two more districts and then leveraged funding from UNFPA through the Family Planning Association of Malawi to set up committees in the remaining 18 districts to establish a Comprehensive Condom Program in every district. During the set-up process, HP+ oriented district staff and community partners on reporting tools for the community and facilities to improve distribution and prevent stockouts. Malawi’s National Condom Strategy was launched in 2017 by the Ministry of Health and Population’s Department of HIV/AIDS to improve availability of and access to male and female condoms and condom compatible commodities, for the purpose of preventing unintended pregnancies, HIV, and other sexually transmitted infections. Read local coverage
HP+ recently launched Growing Together: Multisectoral Investments in Malawi’s Youth, an ENGAGE multimedia presentation that describes how investments in young people’s health, education, employment opportunities, and participation in governance can create a window of opportunity for accelerated economic development. The presentation was developed with the guidance of a multidisciplinary taskforce chaired by Malawi’s Ministry of Health and included youth leaders and representatives from government and civil society. The presentation was utilized by UNFPA to launch their event “Road to Nairobi for the ICPD” on World Population Day 2019, and stakeholders across sectors will continue to use the resource in their call for increased cross-sectoral investments in Malawi’s young people.
A key component of successful advocacy is engaging media to promote issues relevant to a wide audience in order to build awareness of critical issues and garner support for change. To this end, HP+ conducted a training workshop for national journalists on the fundamentals of family planning and reproductive health (FP/RH) and their importance in underpinning the country’s development and future growth. The workshop, held November 12-14 in Antananarivo, brought together 11 national and local journalists from radio, television, and print media to learn about the importance of FP/RH and provided the opportunity to role play interviews with health workers and clients from primary healthcare centers. Moving forward, HP+ will serve as a bridge between journalists and experts on FP/RH in Madagascar, supporting journalists to network with and source their information from knowledgeable health personnel. As a follow up with a stipend from HP+, each journalist will undertake investigative reporting on topics such as early pregnancy, early marriage, barriers to family planning use, access to family planning services, and family planning for homeless people to be published in January and February. These stories on reproductive health will bolster advocacy efforts.
In Nigeria, HP+ has been working to support implementation of the Basic Health Care Provision Fund (BHCPF)—a critical health reform aimed at improving and expanding high-quality, affordable, accessible primary healthcare services to all Nigerians. This month, the first-ever BHCPF scorecard, intended to showcase state-level readiness and initial implementation of one of the key sources of federal-level funding for the BHCPF, was rolled out. The evaluation revealed that, of all 24 states assessed, only three (Abia, Osun, and the Federal Capital Territory)—all of which were supported by HP+—met all of the requirements. A fourth HP+-supported state (Ebonyi) met all but one requirement. The scorecard assessed whether proper structures were put in place to accept federal-level funds for implementation, facility baseline assessments were conducted, and a significant cascade of facility-level trainings on BHCPF implementation were completed. HP+ support to this effort is critical, as the project has worked to improve institutional capacity and facility-level readiness to implement a ground-breaking health reform, that if successful, could significantly move the needle towards achieving universal health coverage goals in Nigeria.
HP+ has demonstrated its value to USAID Eswatini in facilitating the transitioning of two local organizations from subs to primes. During March and April 2019, HP+ supported USAID Eswatini to assess the landscape of local organizations working in the HIV sector with regard to their institutional and technical capacity. HP+ conducted organizational capacity assessments (OCAs) with 11 local non-governmental organizations (NGOs) and faith-based organizations (FBOs) and provided recommendations to USAID on organizations exhibiting strong capacity that could be transitioned to primes with some further preparation. HP+ was recently notified of USAID Eswatini’s desire to transition two of the more highly ranked organizations to primes and will be drawing on HP+’s assessment findings and materials in lieu of doing NUPAS with the current subs. World Vision Eswatini is a current sub to Pact and has HIV expertise in OVC, economic strengthening, youth, key populations, and the HIV care continuum. Young Heroes is also a sub to Pact and is known for its work in OVC and youth, although it has expanded into additional HIV sub-areas as the organization has grown.
Nigeria’s Abia State launched its social health insurance scheme on September 26, 2019, taking a major step forward in ensuring its citizens gain access to equitable, affordable, and quality health services. The launch comes after a year’s long engagement by Health Policy Plus (HP+), which provided technical support to the health insurance scheme that includes defining and costing of health benefit package, developing the mechanism for claims management and provider payments, and strengthening of the organizational capacity of the agency’s governing board, management, and staff. The launch event was attended by HP+ project director Suneeta Sharma and HP+ Nigeria deputy country director Gani Alabi and several high-level government officials, including the deputy Governor of Abia state, Dr Udeh Oko Chukwu and representative of Senator Orji Uzor Kalu, former governor of Abia state, who committed to enrolling vulnerable populations from his constituency through his eponymous foundation. The chairman of the House of Assembly’s committee on health also demonstrated political will reinforcing the legislatures’ commitment to policies and frameworks for universal access. The governor’s representative announced that disbursement of funds through the Basic Health Care Provision Fund would begin on October 1, flowing to the 292 accredited ward-level primary health centers. The event demonstrated community leadership and the importance of traditional leaders in overseeing the success of the health scheme at the local level. Moving forward, payroll deductions of formal sector employees will begin in October.
Read additional background from local reporting
The Kyrgyz Republic has been advancing efforts to ensure sustainability of its HIV programming by developing mechanisms to provide government funding to NGOs to deliver services, or social contracting. HP+ is supporting the Ministry of Health and Republican AIDS Center to develop the regulations and mechanisms required to implement social contracting across the health sector. On September 2-3, in Bishkek, HP+ supported the Republican AIDS Center to conduct a grant launch meeting for the first round of social contracting in the health sector. The meeting, which brought together the grantor and organizations awarded approximately $43,000 to deliver services to people living with HIV – the Republican AIDS Center and six NGOs, respectively – focused on the processes and procedures of social contracting, as well as programmatic and financial reporting requirements. With HP+ facilitation, the participants developed tools and forms required for implementation of social contracting, such as an indicator matrix, an implementation action plan, a draft memorandum on interaction between regional AIDS centers and awarded NGOs, and draft reporting forms. Looking forward, HP+ will continue to support the process of implementation of social contracting in the Kyrgyz Republic through direct technical assistance and mentoring to the Republican AIDS Centers, the Ministry of Health, and grant recipients. HP+ is also supporting the national TB, oncology, and psychiatry program to advocate for funding and establish required regulatory documents for social contracting.
In late June, HP+ held a three-day training workshop in Mbabane on the oral pre-exposure prophylaxis implementation, planning, monitoring, and evaluation tool (PrEP-it) for 33 Ministry of Health officials, representatives of implementing partners, USAID, and other stakeholders including the World Health Organization and UNAIDS. The pilot workshop, which took place from June 24-27, gave participants hands-on experience in the five modules of the tool: PrEP cascade, capacity, target-setting, costing, and impact. Meanwhile, the development team garnered valuable feedback on the usability and functionality of the tool. The Ministry of Health utilized the segment on target-setting to set their actual national targets for PrEP scale-up based on desired coverage of eSwatini’s PrEP priority populations. As a result of the workshop, the eSwatini government was able to establish and set PrEP targets for the next five years—the first country to do so—by capitalizing on the participation and concurrence of stakeholders at the training. Version 1.0 of PrEP-it is scheduled for release in September 2019.
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.
Developing Radio Partners (DRP), has leveraged its HP+ work with PRB in Malawi to garner more funding that is significantly expanding the listening audience for a community radio project broadcasting messages about youth-friendly health services. With HP+ support, DRP has trained and mentored teams of teenagers over the past two years to produce weekly programs that are aired by community radio stations in three districts in Central and Southern Malawi. Last year, it added two more stations, raising the project’s audience to more than 3 million. Building on the success, DRP has received $30,000 from the Conservation, Food & Health Foundation, based in Boston, to fund similar activities at two more stations through September 2019. Mzati Radio in Mulanje in southern Malawi and the Voice of Livingstonia in Mzuzu in the north were chosen in part because their listening areas have high rates of HIV, and early marriage is prevalent in Mzuzu. DRP is working with teams at the two new stations to produce weekly programs. This includes instruction on technical production as well as information about the National Youth-Friendly Health Services Strategy so the young journalists can accurately spread word via their radio programs to their peers about the services they are entitled to receive.
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 2017 and 2018, HP+ began developing tools and approaches to advance public financing for non-governmental organizations working in HIV and other health related areas. HP+ supported the Global Fund for AIDS, Tuberculosis and Malaria (the Global Fund) efforts to prioritize public financing to civil society organizations (CSOs) and non-governmental organizations (NGOs) as a critical factor in all countries’ paths to sustaining and financing their HIV, TB and Malaria programs. This included support to develop the social contracting diagnostic tool, and setting standards for analyzing the legal/regulatory factors inhibiting or enabling this government health system reform. The tools and approaches are now being used around the world by the Global Fund, HP+, and other technical assistance providers to support the uptake of social contracting. HP+ developed a policy brief to summarize the importance of advancing public financing for NGOs/CSOs/private sector as critical to HIV services and epidemic control. The brief outlines the key competencies and capacities needed to advance social contracting into government health systems. In Guyana, HP+ worked with government and other country stakeholders to identify the legal and regulatory barriers for public financing of CSO-led HIV services. In Kyrgyzstan, HP+ supported the Ministry of Health to develop regulations and protocols to implement public financing contracts to non-governmental organizations. In 2018, the government allocated funding to the mechanism.
The Office of the Human Rights Ombudsman (PDH) in Guatemala announced a commitment to expand its strategic alliance with ALIANMISAR, a local civil society organization, to assume the responsibility of monitoring the educational quality in the five education departments prioritized USAID and expand the program to schools in all 22 departments of the country starting on February 1, 2019. This commitment is a direct result of HP+’s efforts to build capacity within civil society networks and track progress on the program’s influence on the educational system; in the years since the program’s monitoring began in 2013, these networks have leveraged over US$3.8 million to improve 138 schools. Based on these positive responses to these results, the PDH and ALIANMISAR designed six questionnaires aimed at students, parents, teachers, and directors to collect demographic and institution-specific data that will provide a baseline for future educational interventions in the region. Additionally, the PDH has developed an online app to track and review the answers provided in these questionnaires, highlighting the visibility and accessibility of the data. The strategic alliance marks an important milestone for HP+’s efforts to achieve sustainable results that will have lasting effects in Guatemala as the PDH will accompany civil society networks to advocate for positive changes in the quality of educational services and will actively monitor future cases of human rights violations reported by students and educators.
In recent weeks, Guatemala’s Ministry of Education (MINEDUC) officially established the National Workforce Training System (SINAFOL) for school and extracurricular education systems. SINAFOL—a system that has been supported by HEP+ for over a year—is the structure that manages and coordinates the government, private sector, and social agents to define and implement policies and strategies that guide education and technical occupational training in the country. It incorporates standardization processes, training, evaluation and certification of labor skills, entrepreneurship, and citizenship in a permanent learning context. In addition to establishing the system in early November by ministerial degree, on January 3, MINEDUC published two additional decrees to (1) support the creation of six new careers in order to expand opportunities for young people in the education system, and (2) create a system of skill certification. HEP+ will continue to support the operation of SINAFOL and the skill certification system in coming months. Read the press coverage.
On May 15, during the official launch of Mali’s 2018 National Family Planning Campaign, the USAID-funded Health Policy Plus (HP+) project was awarded a certificate of recognition as a family planning champion by First Lady of Mali, Mrs. Keita Aminata Maiga. The certificate serves as a recognition of HP+’s valuable contribution to the Division of Reproductive Health over the past two years, particularly in capacity strengthening, improving coordination of family planning stakeholders, and in support of the country’s costed implementation plan. At the event, Dr. Boré Saran Diakité, Head of the Division of Reproductive Health said, “HP+ stands out for the relevance of their support, the quality of the products produced with their support, and their partnership with all the [family planning] stakeholders in Mali.” Rokia Sissoko, who accepted the certificate on behalf of HP+, thanked the First Lady for her collaboration in improving the lives of women and children in Mali. The launch—which took place as part of Mali’s annual event to provide family planning outreach and services—attracted approximately 2,500 people, including representatives from USAID, WHO, UNFPA, and various implementing partners.
On December 28, HP+ Mali participated in the presentation of the Segou Declaration, in favor of the essential health care (EHC) package, to the president of Mali's National Assembly. HP+ Mali has been integral to this initiative, conducting a pivotal assessment on the funding of community health workers (CHWs) and leading ongoing advocacy in favor of these workers and the EHC package. HP+ provided technical and financial support for a preparatory workshop to draft the declaration and participated in its official presentation. At the event, the president of the National Assembly welcomed an initiative promoting women and children's health, recognizing the role that CHWs have played in reducing malnutrition and managing cases of diarrhea and upper respiratory infections, and the important potential impact on development that these efforts have had. As a result of the presentation, the president encouraged stakeholders to continue to invest in CHWs to build knowledge and capacity, and urged parliamentarians to prioritize issues pertaining to EHC and CHWs in the upcoming legislative session. This public declaration of support is a critical step in promoting the passage of a community health law to regulate and protect CHWs and the EHC program, which HP+ has spearheaded since 2017.
The USAID-funded Health Policy Plus project was represented at the Global Health Mini University on September 14, 2017. In Roadmaps and Mapping: Two Tools to Promote Governance and Accountability for Stronger Health Systems, Alyson Lipsky and Sue Richidei presented data on strengthening the capacity of women leaders in Africa and Asia to hold local health officials accountable. Breakout sessions provided attendees an opportunity to use presented data to brainstorm ways to create stronger health systems. In a separate session, In or Out? Adding Sayana Press to Your FP Methods Mix, Erin McGinn and Jim Rosen provided an in-depth look into the future prospects of accessible and effective family planning through self-injecting Sayana Press. Sayana Press has been referred to as a “game-changing” family planning method and attendees engaged in interactive exercises that evaluated its potential community-level impacts.
The Health Policy Project, the predecessor to HP+, with funding from PEPFAR provided Gender and Sexual Diversity trainings for 2,825 participants including PEPFAR staff and program implementers, U.S. government staff, and local stakeholders in 38 countries. Results from the first study to report on GSD attitude change among a global sample of almost 180 individuals from 33 countries were published in PLOS on September 19, 2017. The paper, Changing hearts and minds: Results from a multi-country gender and sexual diversity training, reports that attitudes toward gender and sexual minorities were more positive after the training compared to before the training. Additionally, positive attitudes toward gender and sexual minorities not only persisted 3 – 6 months after that training but improved even further. These changed attitudes were not only sustained for months after the training, but they were also associated with changes in the workplace and, to a lesser extent, HIV programming.
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.
Participants in the USAID-funded Health Policy Plus (HP+) project’s Women's Leadership initiative in Pakistan have had tremendous success, directly contributing to policy and other efforts aimed at expanding outreach and access to family planning services for youth. Collectively, the women successfully advocated for the inclusion of youth-specific indicators to monitor the country's costed implementation plan and developed youth-specific guidelines for Pakistan's Manual of Standards for Family Planning Services. They provided recommendations to Sindh province's FP2020 working group and to the government—the latter of which ensured the funding and operationalizing of critical youth-friendly activities.
These wins come on the heels of three HP+ Women's Leadership for Family Planning workshops focused on increasing the women's confidence, capacity, and connections to achieve health policy and governance outcomes. HP+ initiated the Women's Leadership program in Pakistan late last year. The last of the three workshops was held in April.
Now, HP+ is continuing to support the women in their advocacy efforts and tracking their successes in our unfolding story on their progress.
In 2015/16 health budgets, 12 of Kenya’s counties collectively committed US$2 million to HIV programs, enhancing these programs’ sustainability. These budget commitments come as a result of program-based budgeting (PBB) training provided to county health teams by USAID through the Health Policy Plus (HP+) project. Additionally, in Turkana county, the health department’s budget allocation increased in the 2016/2017 budget by 16 percent. These increases were informed through the PBB training and the USAID-supported county health accounts, which provided evidence to support the request. HP+ is now in the process of training a further 14 counties to improve program-based budgeting.
The Malawi Network of AIDS Service Organisations (MANASO) supported several of its member organizations and associate members in writing successful grant proposals, which will advance health budget advocacy work and training funded through the Tiltonse Fund (which receives funds from DIFD, the Royal Norwegian Embassy, and Irish Aid). The success of these proposals flows from a USAID-supported training conducted by HPP in 2015 for local civil society organizations; and through the use of Health Budget Advocacy: A Guide for Civil Society in Malawi, also created under HPP. Activities funded under these grants will help to further disseminate HPP’s guide, training, and knowledge to the local level.