Welcome to the USAID-funded Health Policy Plus (HP+) project website.
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HP+ hosted an interactive, online policy forum on August 9, 2022, on how a stronger enabling environment for family planning can reduce contraceptive discontinuation. While much attention is given to reducing unmet need and the uptake of modern contraception, much less attention is given to helping women continue to use their methods once they start. Yet almost one in three new users of family planning discontinues within 12 months of starting for a variety of reasons. The event’s speakers, including Sara Stratton and Sandra Mapemba from HP+; Rahal Saeed from Palladium’s USAID-funded NPI EXPAND project; and Heidi Quinn from the International Planned Parenthood Federation, joined HP+’s Jay Gribble and 101 participants to discuss how program efforts can be strengthened to reduce discontinuation while helping women achieve their reproductive goals. Speakers offered examples from their work globally and in Kenya, Malawi, and Pakistan. The policy forum was the culmination of HP+’s blog series, “Rethinking Contraceptive Discontinuation: Are Solutions Being Overlooked?,” where a variety of authors detailed some of the emerging approaches, such as counseling and services, supply chain, self-care and digital solutions, financing, the development of new methods, and community norms, to address contraceptive discontinuation.
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 Through the training, providers learned that some of their approaches were outdated, such as offering family planning methods to women six weeks after delivery.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.
A new HP+ video tells the story of a cooperative partnership among national and local governments, private sector businesses, and civil society to open a maternity waiting home in Gowa District, South Sulawesi, Indonesia. Combining health expertise, educational outreach, and technical and practical resources from the private sector, the home provides a safe environment for pregnant women living far from modern health facilities and engages the women and the local community in classes on safe birth, mother and child nutrition, income generation, and healthy lifestyle practices.
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 participant at a recent HEP+ organized forum on female empowerment said that opposition from her own family is one of the obstacles women face in contributing to Guatemala’s civil society organizations. “[My family] told me that women only had to dedicate ourselves to having children, but I said no, that we also have to take advantage of the time we have and empower more women and support them,” said Amanda Baltazar, leader in a network in San Marcos. Amanda’s remarks were made at a virtual forum on March 12, one of two supported by HEP+ as part of International Women’s Day activities organized by REDMISAR, the JAxJS Network, and the Network of Men for Health, Education, and Nutrition of San Marcos. Participants in the discussion, "The Power of Women in Society,” described some of the challenges and opportunities that have motivated them to grow personally and professionally. The second forum, "Empowered Women," was organized by the Metropolitan JAxJS Network. Guest speakers shared their personal and professional challenges and explained how they have overcome them.
How best to improve maternal health access and quality in resource-constrained settings was the focus of an online policy forum convened by HP+ on March 23. The session—Quality v. Coverage: Is There a Trade-off in Financing Maternal Health?—highlighted the continued high level of maternal mortality despite increases in facility-based births. It explored the push and pull that policymakers must face when planning and allocating resources aimed at increasing access and quality. Led by Elena Ateva, HP+’s maternal health lead, the discussion featured Alison Morgan of the Global Financing Facility, Nana Twum-Danso of the Rockefeller Foundation, and Aparajita Gogoi of the White Ribbon Alliance/India. In addition, HP+’s Dorit Stein shared recommendations from a research study on strategic health purchasing reforms for maternal and neonatal health services and Aparajita Gogoi shared results from the What Women Want campaign and accompanying dashboard of women’s responses
HEP+ Guatemala and one of its long-standing civil society partners are among the co-authors on a recent article on the importance of encouraging partnerships during challenging times such as the COVID-19 pandemic. The paper draws on a 12-country study series on multisectoral collaboration for health and sustainable development in the context of the health and rights of women, children, and adolescents to incorporate sectoral analysis into multisectoral research methods, develop a core set of research questions, and identify shared indicators of success and failure across sectors. The article, “Specific Considerations for “Research on the Effectiveness of Multisectoral Collaboration: Methods and Lessons from 12 Country Case Studies,” appeared in BMC Globalization and Health. Among its co-authors are Susana Palma from HEP+ and Silvia Xinico from HEP+ the partner National Alliance of Indigenous Women’s Organizations for Reproductive Health.
The Malawian Ministry of Health in January officially endorsed and adopted the updated Respectful Maternity Care (RMC) Charter: The Universal Rights of Women and Newborns, which sets an international standard for the rights and services women and newborns should receive when seeking care. The charter was updated in 2019 by USAID, HP+ partner White Ribbon Alliance, and other partners to ground the charter in widely accepted international and regional human rights instruments. To advocate for adoption of the charter, WRA Malawi coordinated with key nursing and midwifery institutions including, the Directorate of Nursing and Midwifery Services and the Kamuzu College of Nursing to present, provide feedback on, and approve the updated charter. The effort was buoyed by the What Women Want campaign, whose survey had found the top priority among women and girls was respectful and dignified care. WRA Malawi also introduced and advocated for adoption of the charter with key decisionmakers, such as the Safe Motherhood Technical Working Group and the Reproductive Health Directorate and hosted the official launch event where the MOH officially endorsed and adopted the charter. The MOH and nursing and midwifery training institutions will translate the document into Chichewa and update their curricula to be in alignment with it. WRA will support the Reproductive Health Directorate in distributing the charter to all health facilities in Malawi and will begin introducing the charter to women and health workers.
A recently drafted law against gender-based violence was the focus of Mali’s “16 Days of Activism” on GBV in November. HP+ Mali provided technical and financial support in the Koulikoro Region to two key organizations—Coordination of Women's Associations and Organizations and Malian Association for the Well-being of Women and Children. Two separate events to advocate for the adoption of law against GBV produced pledges to abandon the practice of female genital mutilation and commitments from the governor of Koulikoro, the mayor of Kati, and local decision makers to support and advocate for the adoption of the law. Youth from the NGO TAGNE (an organization working for the abandonment of GBV) in Kati challenged decisionmakers through a performance of Poetry Slam, requesting they accelerate government actions to support abandonment of GBV in Mali. Koulikoro is the second of seven regions with 15 percent of women reporting having experienced acts of sexual violence at some point in their life.
HP+ partner the White Ribbon Alliance launched a documentary highlighting women’s and girls’ challenges in accessing reproductive and maternal health services through the lens of the What Women Want campaign, which mobilized over 84,000 women and girls in Malawi to voice their requests for high-quality reproductive and maternal health services and outcomes. The documentary has had a wide reach thus far, including a snippet being viewed as part of the September 2020 Partnership for Maternal, Newborn, and Child Health Accountability Breakfast opening video during the UN General Assembly. The documentary will continue to serve as an advocacy tool to advance efforts to meet women’s and girls’ health needs in Malawi.
To take a closer look into women’s and girls’ self-articulated demands for their own healthcare, HP+ partner White Ribbon Alliance launched the Brave Voices, Bold Actions: Women’s Health, Rights & You podcast. Season one takes a deep dive into respectful maternity care through the lens of the Respectful Maternity Care Charter. Throughout 10 episodes, the podcast features the voices of brave women, girls, health professionals, and global leaders who discuss changes that should be made to improve sexual, reproductive, and maternal health outcomes, including during the COVID-19 pandemic.
The New Security Beat, a Wilson Center blog, published a piece by Sara Stratton, HP+ technical director for family planning and maternal and child health. Pandemic Preparedness: Strengthening Family Planning Policies Today to Secure Essential Services for Tomorrow discusses the COVID-19 response and threats to contraceptive access for women in low- and middle-income countries. It sets out policy recommendations to ensure essential services for women and girls are maintained during this and future pandemic responses, including policies on task sharing with private sector suppliers such as pharmacies; policies on self-injection of contraceptives; and gender-informed policies for a female-dominated healthcare workforce.
An HP+ webinar on May 28—Diagnosing Inequities in Family Planning Programs: A Case Study from Uganda—introduced a new, replicable approach for diagnosing inequities across family planning programming outputs and outcomes at both national and subnational levels. Presenters showcased results from its application to Uganda, focusing on the sub-regions, disadvantaged sub-groups, and family planning components for which inequities are most pervasive, and demonstrated its applicability to other countries. Use of the model is intended to increase the quality of family planning information and services for women.
A blog post co-authored by HP+’s Director for Family Planning and Reproductive Health, Jay Gribble, and gender adviser Beth Rottach discussing the importance of gender considerations amid the COVID-19 pandemic response was published by the Infectious Diseases Society of America’s ScienceSpeaks blog. The article was also cross-posted to the International Conference for Family Planning 2021’s COVID and Reproductive Health blog. These platforms reach a wide audience of infectious disease and family planning experts, offering recommendations to ensure that the ongoing health needs of women and the people who care for them are positioned at the forefront in the global response to the pandemic.
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 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 Guatemala, HEP+ has been supporting the National Network on Indigenous Women Rights, or REDNAMI, to strengthen advocacy and policy dialogue strategies and promote the long-term sustainability of civil society networks in Guatemala. On November 18, in observance of the International Day of Non-Violence against Women, REDNAMI held an event to discuss sexual and reproductive violence against indigenous women in Guatemala, advocating for government commitment to honoring human rights and minimizing violence against girls, adolescents, and adult women, and increasing funding for health and education—specifically targeting prevention of adolescent pregnancy, maternal death, and chronic malnutrition. Silvia Xinico, Coordinator of the National Alliance of Indigenous Women’s Organizations for Reproductive Health, Nutrition, and Education, served as moderator of the event, and emphasized the importance of including indigenous women’s issues in national policy.
Since 2011, Malawi’s HIV clinical guidelines have recommended that providers proactively offer family planning to all clients at each ART visit to ensure no missed opportunity to support PLHIV’s reproductive intentions. This approach, called Provider-Initiated Family Planning (PFIP), calls for condoms and injectables to be available at the ART clinic, and referrals for other methods as needed. In 2015, the USAID-funded Health Policy Project assessed the extent of PFIP implementation in Malawi by collecting data at 41 health facilities (both public and NGO) through facility audits, provider interviews, client exit interviews, and mystery client visits. This study – discussed in a new article in Global Health Science and Practice Provider-Initiated Family Planning within HIV Services in Malawi: Did Policy Make It into Practice? – found that contrary to clinical protocols, only 14% of clients at the ART clinic reported being offered family planning during their visit that day. Furthermore, only 24% of providers had received training in FP-HIV integration, 21% had no family planning training at all, and only half of providers had information on where to refer clients for family planning. Only 24% of sites had both condoms and injectables on hand, and only 15% of ART clinics had a full range of FP available. Overwhelmingly most ART clients relied on condoms for FP, yet there was significant demand for family planning among the female ART clients, with about half wanting no more children. These findings suggest that although Malawi has been an early adopter of PFIP, this innovative policy is not being implemented in practice. The authors, Erin K. McGinn (Palladium) and Laili Irani (Population Council), conclude that the demand for integrated services and high unmet need for FP among PLHIV underscores the need for more focused efforts to fully implement PIFP in Malawi’s HIV services.
After many months of consultation with leading corporations and NGOs on boosting women’s health and empowerment in the workplace, the United Nations Foundation publicly released the Framework for Corporate Action on Workplace Women’s Health and Empowerment at a UN General Assembly side event on September 23. The framework, which offers a roadmap for gender-responsive policies, practices, and programs with health as the centerpiece of women’s empowerment, was developed by Meridian International—a non-profit, public diplomacy organization supported by HP+. In addition to providing concrete action steps for corporations and global supply chains to support these initiatives, the framework features publicly available tools and resources that can help companies to implement workplace interventions. At a consultation workshop during the Women Deliver conference in June, Meridian’s David Wofford presented the framework’s policy and systems change component that included information drawn from the HP+ Family Planning-Sustainable Development Goals (FP-SDGs) model. The final framework addresses workplace women’s health, gender-based violence, and professional advancement, with a priority placed on expanding access to services.
Malawi's population is one of the fastest-growing in Africa, placing great strain on its health system, environment, and economy—hindering the country's ability to meet its development goals. To address unmet need for family planning services and the needs of adolescent girls and young women at all levels, HP+ is coordinating across multiple sectors including engaging traditional and religious leaders and communities. Christian Connections for International Health (CCIH) published a story this week about a family in Malawi helped by the Evangelical Association of Malawi, under an HP+ supported activity. The account of a family receiving marriage and birth-spacing counseling after a family tragedy, demonstrates how engagement with community leaders on family planning messaging helped on family mend and achieve financial security.
The National Reproductive Health Program, as coordinator of the National Contraceptive Assurance Commission, held the Contraceptive Assurance Sub-Committees Meeting on August 8 and 9, to implement Ministry of Health and Social Welfare guidelines requiring that each health area form its own contraceptive assurance subcommittee. The sub-committees, integrated with the support of HEP+, submitted their findings and challenges and exchanged experiences with representatives of the health areas and other organizations that will be part of future sub-committees. USAID representative Vikki Stein, who attended the meeting, said "I want to specially recognize the Ministry of Health as the governing entity, because it has taken a very important decision to extend the sub-committees to all health areas. This action is helping improve the lives of women by preventing maternal and infant mortality."
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.
The government of Mauritania, on International Women’s Day (March 8, 2018), signed a regulatory decree to implement a new reproductive health law in focus counties. The law was originally passed in January 2017. With the signing of this new regulatory guidance, there is now approval for community health workers to provide birth control pills and injectables. Nurses are now allowed to provide IUDs and implants. This policy advance, which promises to bring efficiency and scale to contraceptive use, comes as a result of advocacy efforts led by USAID and supported by the HP+, FP2020, AgirPF, Stop Sida, UNFPA, and local partners.
USAID’s Health Evaluation and Applied Research Development (HEARD) project is shining a spotlight on HP+ partner the White Ribbon Alliance and their work under HP+ and its predecessor, the Health Policy Project, to build a movement for respectful maternity care. The White Ribbon Alliance—as an integral part of the Health Policy Project and now Health Policy Plus project—has grown the multi-sectoral Global Respectful Maternity Care Advisory Council and continues to support the role of midwives and women’s right to high-quality respectful maternity care by mobilizing civil society to advocate for accountability for respectful maternity care and advocating for the inclusion of women’s voices within global maternal health dialogues.
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 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.
Two participants in the USAID-funded HP+ women leadership workshops held in Malawi — Nissily Mushani and Elizabeth Nailantei Kileku — are winners of the 120 under 40 award celebrating the next generation of family planning champions. In support of their nominations, HP+ shared voting information widely through an outreach campaign. Nissaly is a knowledge translation officer at the African Institute for Development and Policy and Elizabeth Nailantie Kileku is a nurse based in Kisumu, Kenya, working for the ministry of health. Winners will each receive $1,000 grant to continue their work in family planning or to jump start new initiatives. The award is organized by the Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, with sponsorship from Bayer.
Kenya’s free maternity care program was first introduced in 2013. Since then, facility deliveries rose from 44 percent before the policy was in place to 66 percent in FY 2012/13. The maternal death rate also declined by 7.9 percent. After several months of intensive work, Kenya has launched Linda Mama—a revamped free maternity services program that expands the types of services available to mothers and babies and access. The program will be offered at all public health facilities and a combined 2,700 private sector and faith-based facilities. USAID, through the Health Policy Plus project, supported Kenya’s Ministry of Health and National Health Insurance Fund to redesign the program; cost the program’s benefits package; determine the resources required for implementation; ensure adequate government allocations; inform the program’s reimbursement rates; and prepare technical, implementation, and funding policy documents. The new program will reach an estimated 700,000 women each year.
Mauritania’s Council of Ministers, on October 6, 2016, approved the text of a new Reproductive Health Law, which explicitly states that the right to reproductive health care is a universal right guaranteed to all throughout the course of their lives and prohibits forms of violence against women, including female genital mutilation. The law, submitted by the Minister of Health, brings Mauritania’s national policies into alignment with those of other countries of the Ouagadougou Partnership pursuing commitments on family planning outlined in FP2020 goals. This comes as a result of nearly a decade of unceasing effort by USAID and its policy advocacy partners, including UNFPA, Health Policy Plus and its predecessor projects, which helped draft an early version of the law for FP2020 advocacy efforts across West Africa. The bill will be presented to Parliament for passage in the coming months.