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.
For seven years, HP+ has worked with government and partners across Mali’s health system. Results and accomplishments were highlighted Thursday, June 9 with an end-of-project event in Bamako. Over the last two years, HP+ in Mali focused on health financing, health system strengthening, and health equity. Representatives of Mali’s National Health Insurance Fund and Devolution and Decentralization Support Team emphasized the importance of the in-depth health financing analyses HP+ conducted to support Mali’s health system. Analyses have focused on provider payment systems, health finance flows, and efficiency and equity at all levels, and were completed in collaboration with key partners. Also noted at the event was HP+’s role in advancing advocacy for community health worker (CHW) rights and legal status. These efforts led to the recent adoption of a decree enshrining the formal status and rights of CHWs, marking a transformative step toward making essential community healthcare sustainable and accessible for all Malians. In closing her remarks at the ceremony, Director of Health at USAID/Mali Julia Henn emphasized, “Although HP+ is coming to a close, we are still with you and will continue to support the Malian population.”
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+’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 Guatemalan Registry of Legal Entities on April 5, 2022, authorized the formal registration of three HEP+ civil society partners as nongovernmental organizations (NGOs). With NGO status, the National Alliance of Indigenous Women’s Organizations for Reproductive Health (ALIANMISAR), Network of Men for Health, Education, and Nutrition (REDHOSEN), and Young Artists for Social Justice (JAxJS) can gain stronger financial security through more fundraising channels. This will contribute to the sustainability of their networks and their work to continue advocating for improved access to health, education, and nutrition services in their communities. HEP+ has provided capacity development and financial support for the advocacy activities of its civil society partners for years, and over the past year has helped the organizations navigate the NGO-registration application process. You can read more about HEP+’s efforts to strengthen CSO capacity. in our brief.
President Uhuru Kenyatta launched the 2020–2030 Kenya Health Financing Strategy during the Annual Universal Healthcare Conference on February 7, 2022. The launch signals the government’s commitment to reform the health sector and achieve sustainable, high-quality services for all Kenyans. Among other priorities, the strategy recommends instituting mandatory pre-payment revenue generation from health insurance premiums, replacing out-of-pocket payment at the point of service, guided by fairness and affordability for different income levels. (This recommendation was adopted in a 2022 amendment to the National Health Insurance Fund Act, which has made membership in the fund mandatory for all Kenyans 18 years of age and above.) HP+ provided technical assistance to the Ministry of Health to develop and finalize the strategy, including facilitating stakeholder engagement and advocacy, generating evidence to inform policy priorities, and assisting with drafting the document. HP+ also supported the ministry to develop a communications and advocacy plan, an abridged version of the strategy, frequently asked questions, and a poster to facilitate dissemination. Read more about HP+’s support, lessons learned, and recommendations, including an interview with HP+ Kenya staff Stephen Muchiri and David Khaoya.
Effective advocacy to increase family planning budgets is an intricate and complex endeavor. A new brief introduces the HP+ budget advocacy approach and provides examples of the tools and approaches employed to support increased funding for family planning. The brief explains how HP+ and its predecessor projects have built on expertise in family planning advocacy to tackle budget advocacy using an approach that addresses underlying causes for budget shortfalls, advances systemic change, and strengthens the capacity of budget advocates to use evidence to make the case.
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.
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.
Community health workers provide essential healthcare at local levels, but their status and funding are uneven, often sitting outside official health systems. Momentum is building and the case is being made to formalize and fund these essential health service providers as part of national and subnational health systems throughout many low- and middle-resource countries. HP+ teams in Mali and the West Africa Regional office developed videos to support advocacy for formalization and greater investment for this important cadre of health worker. Interviews for The Place and Role of Community Health Workers in Achieving Universal Health Coverage took place during a high-level meeting of health officials hosted by HP+ West Africa in Lome, Togo in 2019, with participation from the World Health Organization, the West African Health Organization, the United Nations Population Fund, and USAID West Africa. In addition, Togolese community health workers provided testimonials on their work in the community. Mali’s video, The Importance of Investing in Essential Care Provided by Community Health Workers, was developed to support stakeholders to advocate for greater support and funding from the Malian government.
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.
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.
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.
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.
Following an HP+ analysis that showed the potential impacts on maternal and neonatal deaths and stillbirths that could occur as a result of declining maternal health services due to diverted services and reduced coverage indirectly caused by the COVID-19 pandemic, HP+ partner the White Ribbon Alliance (WRA) developed and launched the “Safer Together” Respectful Maternity Care advocacy and communications campaign. The campaign is being used by WRA National Alliances and other stakeholders in USAID priority countries—including Pakistan, India, Malawi, and Indonesia—to convene stakeholders, advocate for joint action, and disseminate joint messages to women, communities, and providers.
In 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 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
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.
Nigeria’s Abia State government has formally approved the release of US$137,000 as take-off grant to be used for procuring technology infrastructure—a critical need that has delayed the rollout of the state insurance scheme since its official launch in September 2019. HP+ has supported Abia State Health Insurance Agency (ABSHIA) in multi-layered advocacy efforts that resulted in the release of the take-off grant. The release of the grant will enable an effective rollout of the ABSHIS toward providing health insurance for about 200,000 residents—a major leap forward in improving access to affordable and equitable quality healthcare in the state.
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.
As a result of HP+ advocacy support to Cambodia’s National AIDS Authority, the country’s Ministry of Economy and Finance (MEF) agreed to significantly increase funding for antiretroviral drugs (ARVs) over the next three years. The annual increases in funding—from the current allocation of US$1.5 million to US$5 million by 2023—will allow the Global Fund to reallocate resources to critical, underfunded HIV prevention activities. The MEF’s decision supports progress toward achieving the country’s national strategic plan directive that 50 percent of HIV response funding be derived from domestic sources by 2023 and sets a new contribution floor for government ARV funding.
In December 2019, Madagascar integrated a tax exemption for contraceptives into the country’s finance law. The exemption, which will remove the 20% value-added tax applied at customs, followed HP+ support to the Ministry of Public Health’s Family Health Directorate to write advocacy messages encouraging key decisionmakers to make contraceptives tax-exempt. This exemption will reduce purchase costs, contributing to operationalization of the new Reproductive Health and Family Planning Law (2018) that promises access to contraceptives for all, and encourage private sector engagement in family planning service delivery.
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.
Under the leadership of Senegal’s Ministry of Health and Social Action, HP+ West Africa organized an unprecedented family planning advocacy workshop in Dakar in August to secure support and financial commitments from the private sector. The workshop resulted in more than US$630,000 pledged for family planning funding. The International Management Group (IMG), a private company from Cote d'Ivoire that took part in the Dakar meeting disbursed funds for family planning advocacy and clinic services in December 2018. Their contribution provided access to contraceptive pills, injectables, implants and IUDs to 121 additional women on voluntary contraception. This is just a start. IMG expressed a commitment to sustain its engagement moving forward.
The Ministry of Public Health has announced it will more than triple its budget to procure contraceptives in 2019. The budget item jump, from 62 million FCFA in 2018 to 200 million FCFA in 2019 comes as result of USAID-supported advocacy by family planning groups and support from Health Policy Plus (HP+), and promises to vastly increase the country’s capacity to provide voluntary family planning to meet demand. HP+ assisted Nigeren family planning advocates in forming The Network of Champions in Advocacy for Adequate Health Financing (RCPFAS) and, with the Directorate of Maternal and Child Health, provided guidance to its members to make the case for the increase, which meets a pledge made by the government at the Family Planning Summit in London in 2017. HP+ also helped organized a series of meetings with civil society and key Ministry of Health and Ministry of Finance decision makers to secure the commitment and the sign off by the Secretary General Ranaou Abache on November 22, 2018. Read more in our news story.
A national youth conference on HIV/AIDS and sexual reproductive health and rights, organized by the National Youth Council of Malawi (NYCOM) and supported by the Global Fund, was held June 28, 2018, in Lilongwe. The conference provided a venue for youth, government, and civil society leaders to exchange best practices and recommendations in sexual and reproductive health, HIV, and other issues that impact youth under the theme is “Reflect and Act for Improved Youth Participation and Leadership.” USAID through the Health Policy Plus (HP+), supported the participation of five youth champions and five district Youth Friendly Health Services coordinators and held capacity building and leadership strengthening sessions for the youth leaders. As a result of advocacy led by youth at the conference, the U.S. Embassy revised its criteria for youth organization eligibility for PEPFAR’s Small Grants Program and NYCOM announced on July 1, 2018, its new board of directors, which until then had several vacancies in critical leadership positions.
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.
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.
With the support of the USAID-funded HP+ Guatemala (HEP+) and the successful advocacy of local networks since 2015, the Congress of Guatemala on August 17, 2017, approved a revision to the civil code to prohibit the marriage of minors, with no exceptions. A previous 2015 law established 18 years as the legal age of marriage, but judges could rule on exceptions, leading to marriage for 4,743 minors (13 and 17 years old) between 2015 and 2016. The revised civil code eliminates the loophole. Local organizations, including the National Alliance of Indigenous Women's Organizations for Reproductive Health (ALIANMISAR) and the National Men's Network (la Red Nacional de Hombres), with support from HEP+, used multi-faceted advocacy strategies to bring an end to child marriage. The elimination of the exception in the civil code means a brighter future for girls in Guatemala as it breaks the vicious cycle of "children raising children." The advocacy groups working closely with HEP+ continue to conduct outreach to local judges to monitor enforcement. Check our news article for links to local coverage.
With the support of the USAID-funded HP+ Guatemala (HEP+) and the successful advocacy of local networks, the Congress of Guatemala on August 17th approved a revision to the civil code to prohibit the marriage of minors, with no exceptions. A previous 2015 law established 18 years as the legal age of marriage, but judges could rule on exceptions, leading to marriage for 4,743 minors (13 and 17 years old) between 2015 and 2016. The revised civil code eliminates the loophole. Local organizations National Alliance of Organizations for Reproductive Health of Indigenous Women of Guatemala (ALIANMISAR) and the National Network of Men (la Red Nacional de Hombres), with support from HEP+, used multi-faceted advocacy strategies to bring an end to child marriage. The elimination of the exception in the civil code means a brighter future for girls in Guatemala as it breaks the vicious cycle of “children raising children.” The advocacy groups will continue to conduct outreach to local judges to monitor enforcement.
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Côte d'Ivoire’s Ministry of Health and Public Hygiene in April 2017 issue new guidance scaling up post-partum family planning to increase women's access to family planning services. The new guidance directs health facilities and qualified service providers to inform new mothers of the full range of family planning methods to ensure free and informed choice of options immediately following delivery. This comes as a result of advocacy efforts by a range of stakeholders. The USAID-funded Health Policy Plus (HP+) provided guidance and capacity development for advocates using the AFP SMART advocacy tool.
Full implementation of the Task Sharing Policy and Funding for Family Planning Costed Implementation Plan (CIP) in all States were among the key issues Family Planning Advocates identified as priorities that need urgent attention to scale up access to voluntary safe and quality Family Planning services in Nigeria. These issues were addressed earlier this month when the Federal Ministry of Health (FMoH) and the USAID-funded Health Policy Plus (HP+) project hosted a high-level Family Planning (FP) Advocates’ workshop in Abuja that highlighted the urgency and importance of Nigeria’s investment in expanding coverage and uptake of FP services. The event brought together prominent Nigerians from a wide variety of backgrounds to explore the challenges facing Family Planning and to commit to specific actions advocating for increased resources for FP intervention. Participants included religious leaders, elected officials, journalists, and leaders of business associations. Budget allocation; donor dependence; state-level service delivery; and data generation and management were identified as key advocacy issues to prioritize moving forward.