In Kenya, HP+ helped national and Mombasa county government actors in 2021 and 2022 make a strong investment case for family planning during the country’s elaborate budget process. Despite decreased revenue due to COVID-19, government allocation for family planning commodities went up by about 38 percent from FY 2021/22 (about US$8.2 million) to FY 2022/23 (about US$11.3 million). Mombasa county allocated its first domestic family planning funds for FY 2022/23, around US$46,000 (KES 5.4 million). With HP+ support, Mombasa county government officials also defined priority family planning activities and a family planning commodity security action agenda.
The Government of Mali’s Ministerial Council voted to approve a decree formalizing the status of community health workers (CHW) as an official cadre of health personnel. The adoption of this policy is the culmination of seven years of HP+ partnership with Mali’s Ministry of Health and specifically its Devolution and Decentralization Support Unit (CADD). HP+’s support of CHWs began in 2015 with a diagnostic situational analysis and has since included the development of a dynamic GIS data mapping tool, resource mobilization, capacity strengthening, advocacy, and more. This is a transformative achievement which will protect the status and rights of more than 3,000 CHWs across Mali and mandate the payment of CHWs’ stipends with domestic resources rather than external funds. Dr. Baboua Traore, director of the CADD, noted, “This entire process started when your organization [HP+] drew the health department’s attention to the termination of work contracts of this type of personnel [CHWs] in the regions of Kayes and Sikasso.”
During Kenya’s budgeting process for fiscal year 2022/23, HP+ provided technical assistance to the national strategic health programs (HIV, malaria, and reproductive, maternal, neonatal, child and adolescent health) to secure increased budget allocations to finance their priorities. During the budgetary discussions, program teams presented implementation priorities and defended their budget proposals before a resource allocation panel convened by the National Treasury. HP+ supported the program teams to develop their annual budget plans and justification summaries for their proposed budgets. The final budget proposals from all ministries will be consolidated and submitted to the national legislative assembly for approval in March 2022. In the previous year, similar efforts by HP+ led to increased allocations. If approved as submitted, the programs will receive increased allocations compared to the prior year. For example, the reproductive, maternal, neonatal, child and adolescent health/family planning program will receive KES 990 million, an increase from KES 863 million allocated in FY 2020/21
At a roundtable event held on September 28, 2021, the president of the Republic of Madagascar, ministry officials, and technical and financial partners signed the country's official FP2030 commitment. HP+ supported the Ministry of Public Health to organize and facilitate the event to renew the country’s commitment to family planning, including a pledge to increase family planning resources. HP+ also supported efforts to define the country's objectives for 2030 and presented the economic incentives and investment case for family planning at the roundtable. The gathering brought together 200 participants, including senators, parliamentarians, government ministry officials, technical and financial partners, and leaders from civil society. The next step is for the Family Planning Committee, led by the Directorate of Family Health, to develop a 2022–2023 national costed implementation plan to achieve Madagascar’s FP2030 commitments through improved communication, domestic resource mobilization, service delivery and access, and monitoring and evaluation.
In August 2021, the National Alliance of Indigenous Women's Organizations for Reproductive Health (ALIANMISAR) and the Human Rights Ombudsman's Office (PDH) completed their most recent indicator data collection and health clinic monitoring using the V1000D monitoring tool. Previously, HEP+ supported the development of the tool—which houses indicators related to health services, products, and human resources—and has strengthened the capacity of ALIANMISAR to conduct data analysis and advocacy. The monitoring exercise revealed an undersupply of family planning methods, ferrous sulfate, and rotavirus and pneumococcal vaccines as most doctors were busy attending to COVID-19 patients, limiting their availability to provide other essential health services. ALIANMISAR presented department-level findings to relevant health area directorates to make the case for solutions to health service issues. PDH will compile and share findings and recommendations at the national level.
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.
Kenya’s Council of Governments, a consultative forum of all 47 county governors, recently adopted an HP+ recommendation to put in place county health planning units (CHPU) that will support health planning and budgeting. HP+ played an instrumental role in designing the CHPU model with the National Treasury and Council of Governments and promoted it with county health leaders. Once established, these units will help county governments streamline budget planning and implementation, generate evidence on health budget performance, track health financing indicators, and advocate for further increases in budget allocations for health. This will help counties meet the complex set of requirements and timelines outlined by Kenya’s Public Finance Management Act of 2012 that counties have struggled with, often resulting in poor prioritization of needs, loss of allocated funds, and missed opportunities to sustain increased budget allocations for HIV, family planning and reproductive health, and malaria. HP+ will provide technical assistance to USAID’s focus counties to establish the CHPUs with the goal of strengthening local capacity and promoting domestic resource mobilization.
Building digital solutions for health was the focus of a recent online policy forum convened by the Health and Education Policy Plus project (HEP+) in Guatemala. HEP+, with the Ministry of Health and Social Assistance (MSPAS) and the Office of Human Rights (PDH), delved into the importance of increasing information-sharing through digital platforms. The July 27 forum featured opening remarks by Yma Alfaro of USAID and Herminia Reyes, HEP+ Guatemala’s country director, which led into descriptions of three data dashboards that monitor health and education indicators. The panel discussion that followed focused on the experience of MSPAS and PDH in working with the HEP+ technical team and how HEP+ support helped bring solutions to the population. Claudia Maselli of PDH emphasized that “the support of USAID, HEP+, and Palladium has been hugely beneficial to the institution. This partnership and leadership [with HEP+ have] enabled us to build these tools that monitor and publish the results of our work. The technical assistance has been very valuable for our entire team.” The online policy forum was held in Spanish with live English interpretation.
The School of Medicine of the Universidad San Carlos de Guatemala recently established a course titled "Public Health and Demography, Reproductive Health and Nutrition," with Health Policy Plus deputy director and family planning expert Jay Gribble delivering the launch keynote address. At the June 11 event, Gribble stressed the importance of focusing on the need for multisectoral approaches, systems interventions, and integrated methodologies to promote local development. In a blog post building on the speech—The Data Imperative in Guatemala's COVID-19 Recovery—Gribble and Robin Brazier, assistant country activity manager for Health and Education Policy Plus (HEP+) in Guatemala, shared their perspectives on the critical role data can play in improving public health and local development, particularly in the context of a global pandemic. In the post, they discuss how, as the COVID-19 pandemic continues in Guatemala, a focus on improved data collection and systems, data use, and data triangulation across sectors is imperative for decisionmakers to best address the pandemic’s impact across other health areas.
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.
Community health stakeholders have developed a roadmap for digitization of community health information in Burkina Faso to improve data management and health service delivery at the community level. The roadmap, which describes digitization interventions in all of the country’s 13 regions, grew out of a workshop supported by HP+ and organized by the Ministry of Health. The workshop aligned technical and financial partners involved in the digitization of community health data and was chaired by Burkina Faso Health Minister Prof. Charlemagne Ouedraogo. Also participating were USAID and partners Digital Square, the U.S. Centers for Disease Control and Prevention, Living Goods, the Bill & Melinda Gates Foundation, the World Bank, UNICEF, Terre des Hommes, the Malaria Consortium, Abba’s International Healing Center, and the Red Cross. The alignment workshop explored the use of CommCare, a platform for building and deploying data applications in low-resource settings. Following the workshop, USAID announced it will contribute $1 million to the digitization effort, to include a coordination role for HP+. A task force will be established to oversee and coordinate implementation of the roadmap.
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.
HP+ Indonesia hosted a webinar on June 4, Advancing Indonesia's Equitable Health Policy through Strategic Capacity Strengthening Partnerships, to highlight a nearly a six-year collaboration with the government of Indonesia to support its ambitious health reform agenda and improve the policy, financing, and regulatory environment to promote positive outcomes in primary healthcare, maternal and child health, and HIV. The discussion, with special guest speakers from the Ministry of Health’s Institute for Health Research and Development, the Center for Health Financing and Insurance, and the Ministry of National Development Planning explored advances made in creating fiscal space for health, data analysis, and private sector engagement with an emphasis on capacity strengthening and addressing challenges of decentralization. Pamela Foster and Jack Langenbrunner from USAID’s Indonesia Mission joined the discussion on the collaboration and the need to sustain health sector gains in a post-COVID-19 era.
Policy implementation requires information, insight, and effective decision making, but if policymakers are unable to digest and act on new information we have fallen short. The community health worker programs in Mali used data visualization to illustrate how community health workers serve rural communities in Mali and how such scarce human resources might be better used. It’s crucial to better understand how these systems do and could work, says HP+ researcher Patrick Pascal Saint-Firmin. “Nearly 60 percent of sub-Saharan Africa’s population lives in rural areas and relies extensively on community health workers; however, the long-term financial sustainability of these programs is in question,” he says. In a Health Worker Week blog, Saint-Firmin reflects on HP+'s work to inform efforts around Mali’s community health worker program and argues that analysis isn’t enough. As data practitioners, how we make the case using data visualization matters.
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.
HP+ Kenya has helped the Kenya Ministry of Health develop budget proposals that align with its health sector priorities and craft advocacy materials in support of these proposals. The MOH requested an additional US$12 million for HIV commodities, an additional US$8 million to procure first line anti-malarial drugs and to settle tax obligations arising from donor-procured malaria commodities, and an additional US$8.6 million for family planning. HP+ Kenya supported national performance reviews of HIV, malaria, and reproductive, maternal, newborn, child, and adolescent health programs to develop sector working group reports that inform the MOH and Treasury budget allocations.
HP+ has helped the government of Honduras develop and publish an extensive epidemiological report of the COVID-19 pandemic in the country. This report has provided useful information to not only government agencies but also outside parties such as journalists and clinicians. With the publication of this report, the Health Surveillance Unit in the Secretariat of Health is positioned to produce monthly epidemiological reports that capture new and emerging data, such as that from rapid diagnostic tests, while also continuing to improve the quality of reported epidemiological indicators in the country. The report provides key epidemiological data from March 10, 2020, when the first COVID-19 case was identified in Honduras, through November 14, 2020 (epidemiological weeks 11-46).
Survey results from Kenya’s Busia, Kajiado, and Nairobi counties suggest that 38 percent of HIV clients are interested in collecting antiretroviral drug (ARV) refills from private pharmacies. Ninety-five percent of private pharmacy owners in these counties are also interested in extending current services to include dispensing refill ARVs to stable, adult clients. Clients’ willingness to pay a dispensing fee to collect ARVs from private pharmacies is well-aligned with the pharmacies’ minimum dispensing fee, suggesting that a decentralized distribution model involving a hub antiretroviral therapy site and private pharmacies for ARV pick-up may prove successful. HP+ is using these survey results to design and implement a community pharmacy ARV refill pick-up pilot in each county, intended to eventually transfer more than 1,000 clients to private pharmacies to obtain ARVs.
Last week, in conjunction with World AIDS Day, HP+ published a blog outlining recommendations detailing how Indonesia can accelerate its advancement toward HIV epidemic control. Based on their technical assistance experience, the authors explain how changes to service delivery models, populations targeted, and payment mechanisms can reduce costs while improving HIV-related outcomes. The blog was first published by the Infectious Diseases Society of America’s Science Speaks Blog and later cross-posted on Viewpoints.
A new report from HP+ curates resources to estimate maternal health costs, outcomes, and inequities in low- and middle-income settings. The report, Models and Tools for Maternal Health Decision Making, Planning, and Strategy, summarizes seven tools to enable USAID Missions, governments, and implementing partners to better understand how modeling tools and analytic approaches can answer their policy and research questions regarding target setting, prioritization, budget development, and other program issues. The tools can be used to advocate for increased domestic funding for maternal health, inform policy development, and improve project design and performance—which, in turn, can lead to improved maternal health outcomes. This report, which builds on lessons learned in the 2012 Crosswalk of Family Planning Tools, broadens policymakers’ understanding about how models and tools can guide country-level planning and evaluation efforts aimed at reducing women’s morbidity and mortality during pregnancy, childbirth, and the postpartum period.
HP+ is supporting the Government of Indonesia to advance subnational performance geared toward achieving the Minimum Service Standards in Health (SPM) for 12 primary healthcare services, including services for pregnant women, delivering mothers, and newborns, as well as family planning education and services. In partnership with PPJK, HP+ improved the planning and budgeting platform for SPM by decreasing complexity of the user interface, designing an error detection system to identify cost outliers and improve data collection from primary healthcare facilities, and enabling the platform to be interoperable with other information systems. HP+ also supported the development of e-learning modules, which are critical to the successful national rollout of the revised platform. The improved platform will equip district health officials across the archipelago with the budgeting and planning tools needed to estimate resources required to achieve SPM targets and improve allocation of resources for health to achieve better health outcomes. The revised platform was officially launched this week in Jakarta by the Secretary General of the Ministry of Health for all 514 districts across Indonesia.
Quality family planning information and services have not yet reached those with the greatest need. To support progress toward equitable healthcare, HP+ developed an approach for diagnosing inequity in family planning programs. This approach identifies inequities: 1) for a diverse range of disadvantaged subgroups; 2) for various programmatic components of family planning; and 3) at national and subnational levels. Replicable across countries, this approach enables users to easily transform demographic and health survey data to better understand the profile of inequity. This information can be used to develop evidence for policy, financing, and programmatic decisions at national and subnational levels. The new methodology and replication guide describes the approach and provides step-by-step instructions for running the open source code independently. Results from the application of the approach to Uganda can be found in the brief and in this webinar.
In Togo, HP+ West Africa recently convened a gathering of national and regional stakeholders to collect, review, and validate data to update the costed implementation plan (CIP) for family planning performance dashboard. Updating the dashboard—a critical first step in the CIP execution process—supports the country to monitor progress toward achieving its family planning goals, which include reaching a contraceptive prevalence rate of 22 percent by 2022 (from 17 percent in 2017). Training stakeholders on use of the CIP tool and dashboard supports family planning decision making and helps to focus family planning activities and implementation on meeting CIP goals.
Since July, over 129,000 new households have been enrolled in Cambodia’s largest social health protection scheme, the Health Equity Fund, which entitles families to receive free healthcare—including family planning services. This accelerated rollout follows publication of a secondary analysis, conducted by HP+, which found that 36 percent of Cambodians living under the national poverty line do not hold an equity card, making them ineligible to benefit from the fund. The study was cited by a Deputy Secretary of State of the Ministry of Economy and Finance in the rationale to accelerate national rollout of the system, which will benefit an additional 47,785 households.
On August 25, HP+ supported Madagascar’s Family Health Directorate (DSFA) within the Ministry of Public Health to conduct a virtual semi-annual review and performance monitoring meeting of the country’s costed implementation plan (CIP) for family planning. Using data generated by an online CIP dashboard developed by HP+, meeting participants were able to monitor progress of CIP activities and indicators, identify bottlenecks and solutions, and provide recommendations for the next iteration of the plan. Since adoption of the CIP in 2016, the country’s contraceptive prevalence rate has improved from 33 to 44 percent and maternal deaths averted by family planning have increased from 500 to 2,600.
HP+ has been supporting the Cambodian government to generate analytics on key universal health coverage (UHC) dimensions, including population coverage and cost modeling; coverage potential, gaps, and social equity; and healthcare seeking and financial risk protection, underpinning an evidence-to-action agenda to accelerate UHC achievement. This work, which catalyzed the formulation and alignment of policy recommendations among key health development partners and within the Cambodian government, was featured in an August 27 webinar, “Evidence to Action- Advancing UHC in Cambodia.” Moving forward, HP+ is facilitating government action to accelerate implementation of the recommendations and support the country on its journey to achieve UHC.
HP+ and Cambodia’s National Center for Tuberculosis and Leprosy (CENAT) conducted assessments and provided on-site support for the Tuberculosis (TB) Prevention Therapy module in three provinces. The assessments follow a June training that HP+ and CENAT provided to TB supervisors on use of the TB management information system at public health facilities. The recent assessments revealed that TB supervisors’ knowledge and use of the module was either “excellent” (80%) or “very good” (20%), demonstrating strengthened skill competencies. In October 2020, CENAT will lead in providing module trainings and follow-up visits to the remaining 23 provinces and 86 operational districts.
HP+ conducted a costing study in 24 districts across the five major island groups in Indonesia to support the government to implement minimum service standards (SPM) for 12 primary healthcare services. Data from the study has been used to improve existing SPM budgeting and planning tools used by local governments. This will alleviate administrative burdens on districts and support 514 district health offices in better planning to achieve SPM targets by improving allocation of resources for health. HP+ is providing virtual technical assistance on use of the tools and will develop e-modules to strengthen local government capacity to use them.
In August, HP+ facilitated a virtual training for research institutions and government representatives in Kenya, Tanzania, and Uganda on applying the Activity-Based Costing and Management methodological approach to HIV services. HP+ strengthened the capacity of these institutions and participants to implement data collection; conduct analysis; develop research protocols and data collection instruments; secure ethical clearance; facilitate stakeholder consultations; and develop reports using the approach. Findings from the analysis can help policymakers and partners to more effectively allocate resources, improve monitoring efforts, optimize investments, and drive efficiencies through improved delivery of services.
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.
HP+ supported the development of a National Social Protection (NSPC) Monitoring and Evaluation system in Cambodia to facilitate the collection, analysis, and use of service and beneficiary statistics; budget and expenditure data; and payment and administrative information to monitor key performance indicators. HP+ trained NSPC staff on use of the system dashboard, which generates key performance metric visuals; a soft launch by September is planned. The monitoring system is expected to improve accountability and transparency between line ministries and the Ministry of Economy and Finance; strengthen social protection scheme management and decision making; inform the annual budget; and increase public transparency and accountability.
HP+ is supporting district-level youth-friendly health services (YFHS) reporting performance in Malawi by analyzing monthly District Health Information System 2 reports and providing technical support to health management information system officers and YFHS coordinators to improve timely and complete reporting. The district with the highest performance each quarter receives recognition; districts share best practices and lessons learned via a WhatsApp group. As a result of this emphasis on data quality and reporting, performance has steadily improved over time. Accurate and timely information about service utilization allows decision-makers at various levels to tailor programs and allocate resources to more effectively serve youth beneficiaries across Malawi.
HP+ analyzed how COVID-19 may disrupt health services in Burkina Faso, based on the level of face-to-face interaction with healthcare workers required to deliver interventions and the degree to which the interventions are time-sensitive or can be delayed without significant health impacts. Across the five health areas analyzed—family planning, maternal and child health, tuberculosis, HIV, and malaria—authors estimate that between 4,800 and 19,700 additional deaths could occur in 2020 alone as a result of disruptions from the pandemic. Burkina Faso is taking steps to maintain essential services and find ways to adjust service delivery models to mitigate these potential impacts.
A virtual satellite session—"Data Matters: The Role of Local Stakeholders and Data in Influencing HIV Services and Programs”—was held on July 8, as part of AIDS2020. The session showcased how HIV service delivery is improved when stakeholders generate and use local evidence and data to inform community-level programs. Representatives from the International Treatment Preparedness Coalition joined Palladium and HP+ colleagues Ron MacInnis and Ratna Soehoed, who discussed the use of province-level cost and epidemiological data for HIV planning and budgeting in Jakarta, Indonesia. A recording of the session will be available to the general public next week.
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.
HP+ recently conducted an analysis of available equipment and supplies required to fight COVID-19 in Niger’s capital, Niamey. The analysis pointed to the need for an increase in hygiene supplies to effectively combat the pandemic. As a result, the Bank of Africa Foundation provided handwashing kits to 20 health facilities in the city. The handwashing kits, which are valued at more than one million CFA (approximately US$1,700), are in addition to the 373 million CFA (approximately US$640,000) already granted by the Association of Banks and other financial establishments to the Nigerien government to aid in its pandemic response.
As cases of COVID-19 continue to rise dramatically in Central America, HP+ is supporting the Honduran government to create a Ventilator Task Force to optimize distribution and use of donated ventilators for the most severe cases. Working with the USAID-funded EpiC project and other key stakeholders, the task force is launching a rapid assessment of ventilator readiness across the country’s major health facilities. The donated ventilators—anticipated to be as many as 300 from the U.S. Government alone—could almost double the current number of ventilators present in public sector facilities, saving countless lives in the midst of an unprecedented pandemic. Get more details in our news article.
HP+ 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.
An HP+ webinar delivered by Christine Lasway and Laura Hurley on May 14 – What’s Measured Matters: Monitoring Family Planning Costed Implementation Plans – presented an overview of the CIP Performance Dashboard, a data management tool to track CIP performance targets. The discussion included case studies from Madagascar and Ghana, countries using it to monitor execution of their CIPs. The CIP Performance Dashboard, available in Excel and now as an online tool, was developed based on DHIS2. This webinar is ideal for stakeholders looking for a strategic planning performance monitoring tool.
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.
An original article authored by HP+ in coordination with a research team at Cambodia’s Ministry of Economy and Finance’s General Secretariat for the National Social Protection Council was published in the International Social Security Review. The research, which assesses current coverage potential, gaps, and social equity considerations with regard to the expansion of social health protection in Cambodia, is being used to inform a comprehensive policy proposal to expand coverage to about 5.7 million financially vulnerable people, improve healthcare quality, and strengthen institutional systems within Cambodia.
In January 2020, Cambodia’s Ministry of Economy and Finance’s inter-departmental health working group accepted 32 recommendations crafted by the National Social Protection Council. The recommendations, which include expanding coverage to dependents and raising the income threshold for premium contributions, came from HP+-generated evidence aimed at advancing the government’s social health protection agenda by promoting ownership and empowering key influencers to effectively advocate for policy change. The recommendations, which the government will begin to implement over the coming year, could significantly benefit Cambodia’s most vulnerable citizens by expanding social health insurance to 3.8 million family dependents and 3.1 million vulnerable people, who will gain improved access to long-acting and reversible and permanent family planning methods to be reimbursed under the HEF benefits package
This month, HP+ supported researchers from Indonesia’s National Institute for Health Research and Development (Balitbangkes) to publish a journal article in BMC Public Health. HP+ strengthened capacities of the researchers to analyze data about potential risk factors for adverse maternal and newborn health (MNH) outcomes and write and submit five academic articles to peer-reviewed journals. Balitbangkes’ research will contribute to the dissemination of MNH scholarship among learned communities, inform a wide audience beyond technical subject-area experts about key MNH risk factors in Indonesia, and support the development of informed decisions by policymakers.
In Cambodia, the National Center for Tuberculosis and Leprosy Control (CENAT) is using evidence generated by an investment case and recommendations from a joint program review to advocate for greater funding for the tuberculosis (TB) response. HP+ is providing technical support to CENAT to employ the TB TIME model to analyze a variety of scenarios of programmatic impact against potential investment requirements. HP+ found that scaling up active case finding and contact investigation and improving the diagnostic algorithm could result in a 33% reduction in the number of TB incident cases and a 27% reduction in costs borne by individuals from 2019 to 2025.
In Madagascar, the Ministry of Public Health’s Family Health Directorate (DFSa) is using a web-based dashboard tool to facilitate data analysis and visualization as part of its semi-annual costed implementation plan (CIP) execution review meetings. HP+ developed the dashboard and trained the DSFa and CIP committee on its use. The dashboard, which is owned by CIP committee members, allows for strategy adaptation and orientation for improved family planning programming and CIP implementation in the country. The dashboard encourages country ownership of the CIP process and progress toward achieving its goals, including increasing the contraceptive prevalence rate to 50 percent.
Kenya’s Mombasa County has chosen to increase its allocation to health by 25% over the previous year’s allocation as a result of a report by the Mombasa County Health Sector Working Group. The report, which aligns with the country’s Domestic resource mobilization agenda, identifies resource needs and allows the county to negotiate for additional funding within the health sector. HP+ provided technical support in the areas of expenditure analysis and budget estimates, supporting the working group through a consultative process. As a result of the report, Mombasa County will now allocate KES 3.5 billion in fiscal year 20/21, which will allow facilities to stock pharmaceuticals and supplies, ultimately reducing out-of-pocket expenditure for clients.
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.
Nudges such as mobile airtime or membership in a health insurance scheme might be helpful in motivating someone to get tested for HIV, suggest the results of a USAID-funded analysis carried out in Tanzania by Health Policy Plus (HP+). HP+ staff met February 5 with officials from the Tanzania health ministry, PEPFAR, implementing partners, and other stakeholders in Dar es Salaam to discuss the study results. Patients and health providers in the study found the incentives attractive and easy to administer. Only 61 percent of the country’s estimated 1.5 million HIV-positive individuals know their status, and Tanzania is looking for cost-effective ways to increase testing uptake.
HP+ applied the Family Planning-Sustainable Development Goals (FP-SDGs) Model with stakeholders in Tanzania to project how family planning investments can accelerate progress toward the SDGs. HP+ worked alongside local stakeholders to strengthen their capacity to generate projections from the model and interpret results. Advocates have used results to make the case to Parliamentarians and others to prioritize and expand family planning in support of broader development goals. Model results estimate that increasing family planning investments in Tanzania could, by 2030, reduce maternal mortality by 47% and increase the proportion of the population using safe drinking water by 20%, among others.
A blog published by Health Policy Plus in the lead up to Universal Health Coverage Day December 12th, considers a governance angle on Universal Health Coverage and identifies three areas that are particularly critical: 1) politically aware and savvy champions committed to inclusive processes; 2) leadership and management that fosters a culture of accountability; and 3) more data on the costs of effective management and administration of UHC programs. The authors, Jay Gribble, the deputy director for family planning and reproductive health and Alyson Lipsky, the project’s lead on governance and stewardship, draw on results from HP+ Nigeria and other case studies as they argue that these governance, stewardship, and accountability elements will be key to reaching UHC goals.
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.
In late September, HP+ participated in the Kenya Malaria Program Review to inform development of a comprehensive report documenting the program’s achievements, enabling factors, and challenges. As part of the end term report, HP+ Kenya conducted a comprehensive financial analysis of the program. The team also participated in the program review in several other ways, including conducting a desk review; participating in an external review by the World Health Organization to inform financial analysis; undertaking field visits to Nairobi and Kwale, Kilifi, Kisumu and Busia counties; and hosting a consensus meeting with county directors of health and the third Kenya National Malaria Forum. These engagements revealed inadequate finances for program interventions and a high level of dependence on external sources for key commodities. The Kenya Malaria Program Review end term report will inform the design and implementation of the next iteration of the Kenya Malaria Strategy, which HP+ is supporting.
Indonesia's MoF and other ministries have an interest in understanding whether Indonesia’s national health insurance scheme—Jaminan Kesehatan Nasional (JKN) - delivers a positive and equitable impact on Indonesian’s health and welfare. HP+ worked with the MoF to design a M&E framework for health and with the Government of Indonesia to conduct a comprehensive assessment of JKN. The assessment considers JKN’s long-term financial sustainability and the impact of JKN from various perspectives, including on private health providers' investment decisions, competitiveness, the efficiency of healthcare service delivery, and the impact on the private health market overall, including labor gains. These findings are being used to inform continued investment in JKN and changes to the legal framework for health in the country. In October, HP+ was recognized for ‘Excellence in the Use of Theory of Change’ by the USAID Mission in Indonesia for their work on the JKN comprehensive assessment.
Three recent launches of results from HP+ led state-level applications of the RAPID (Resources for the Awareness of Population Impacts on Development) model in Nigeria are raising awareness of the potential impact that family planning and child spacing can have on the country’s development, and leading to pledges of new resources and support in Bauchi, Ebonyi, and Sokoto states. Factsheets for each state, as well as national-level, results are available.
HP+ published a notable brief summarizing critical considerations and key steps for implementing a single national health insurance (SNHI) scheme in Tanzania. Based on an actuarial study to project the SNHI scheme's financial viability, the brief’s primary worth is in how it can inform efforts by other countries in the region to implement similar insurance reforms.
The Governor of Nigeria’s Ebonyi State, David Umahi, pledged new resources and called for traditional leaders to promote family planning in their communities on November 1, 2017, at the launch of the Ebonyi State RAPID (Resources for the Awareness of Population Impacts on Development), which was developed with support by the USAID-funded Health Policy Plus (HP+). The Ebonyi State RAPID provides easy-to-use facts and figures that support the case for investment in family planning in Ebonyi based on a model application projecting the impact of rapid population growth on various sectors. The RAPID estimates that a total fertility rate reduced to three births per woman by 2037 and then reduced to about two births per woman by 2050 could save approximately $107 million (Naira 38 billion) in primary education costs between now and 2050. Governor Umahi pledge a bus to be used for community mobilization and outreach services in rural parts of the state. The event was broadcast live on state TV and included the HP+ country director, Onoriode Ezire, members of the state executive council and traditional leaders.
On September 13th 2017, His Excellency Governor Mohammed Abdullahi Abubakar, the Executive Governor of Bauchi State announced the launch of the first Bauchi RAPID. The launch represents the first RAPID among the three states HP+ is currently supporting. In his remarks, Abubakar noted that, “Bauchi state has consistently allocated 16 percent of its annual budget to health since 2016 according to the 2001 Abuja Declaration.” Yet, while meeting the Abuja spending targets is a positive step, the RAPID application highlighted additional steps the state could take to lessen the impacts of rapid population growth. HP+ country director Onoriode Ezire highlighted the high growth rate of the Bauchi State populace as a result of high fertility rates, noting that the state government will have to implement adequate policies related to health, education, and employment to support a growing population with already high numbers of unemployed youth and dependents. At the launch event, Abubakr insisted that Bauchi state “will implement the recommendations of the Bauchi RAPID for the good of the people of Bauchi State.”
Participants in the HP+ Women Leadership activity in Pakistan successfully developed and advocated to the Plan Implementation Unit (PIU) of the Population Welfare Department (PWD) for the inclusion of youth-specific standards in the National Manual on Family Planning Standards & Guidelines. As a result, the manual now has a section on youth-friendly family planning services, which includes a youth-friendly facility description and checklist for all district level outlets where family planning services are being provided. For the first time, district health facilities will have guidance to ensure youth find services tailored to their needs. Using results from the RAPID model , the HP+ Pakistan team developed a video showing the effects of population growth on agriculture, water, education and health, and illustrated the number of unintended pregnancies and maternal and child deaths that will be averted if the contraceptive prevalence rate goal in the Costed Implementation Plan is met. The Plan Implementation unit showed the video during a high-level policy forum on August 11th.
The USAID-funded Health Policy Project (HP+) supported the “Midwives’ Voices, Midwives’ Realities” policy dialogue at the Wilson Center, in Washington, DC, on February 27th. The event featured Midwives Voices, Midwives Realities, a global survey conducted by the World Health Organization, International Confederation of Midwives, and White Ribbon Alliance. HP+’s work supporting comprehensive midwifery policy reforms was featured at the event, by Nancy Kamwendo, National Coordinator for HP+/White Ribbon Alliance, Malawi, who provided a country perspective on the broader global survey findings. HP+/White Ribbon Alliance Malawi recently conducted a “headcount” survey of Malawian midwives that found that only one-third the number of midwives previously thought to be in service are actively providing direct midwifery services. This headcount, highlighting the shortage of midwives needed to provide adequate pre and postnatal care, will inform policy-making decisions on midwifery. WRA Malawi and HP+ have shared the findings with the Ministry of Health, Parliament, citizens, and journalists. This advocacy campaign is paying off. Ministry officials have recently agreed to use the country-level survey data generated by the HP+/White Ribbon Alliance Malawi team to inform their health sector strategic planning process.
A collection of peer-reviewed articles on male circumcision modeling and costing were published in Plos One and released during the International AIDS Conference. Most of the articles are based on work completed under the Health Policy Project and use data generated with an HPP-developed model called DMPPT.2. At the conference, USAID’s Emmanuel Njeuhmeli presented estimates that medical male circumcision performed between 2005 and 2015 in South Africa will save more than $790 million in treatment costs by 2030; and that male circumcisions in South Africa will avert 218,000 HIV infections by 2030. Referencing the research, Ministers of Health from South Africa, Lesotho and Swaziland called on policymakers to maintain high levels of male circumcision coverage and for endemic countries to commit domestic funding in an Op Ed published July 21st on Bhekisisa the health site of South Africa’s Mail & Guardian newspaper.