HP+ West Africa held an end-of-project event June 24, 2022, in Lomé, Togo and virtually to highlight the impact of HP+ activities in Burkina Faso, Côte d’Ivoire, Niger, Togo, Benin, and Guinea. The event was attended by more than 100 leaders in the region, including representatives of Togo’s health ministry, the U.S. Embassy in Togo, the Ouagadougou Partnership, and the West African Health Organization. Four panel discussions focused on costed implementation plans, joint advocacy for policy change, domestic resource mobilization for family planning, and sustainability, and featured impactful results such as Burkina Faso's increased contraception rate from 18 percent to nearly 30 percent over the course of the project. “A partner like HP+ made it possible to substantially improve the enabling environment…that allowed us to advocate for the increase of domestic financing for the repositioning of family planning,” said Marie Ba of the Ouagadougou Partnership.
Indonesia’s Minister of Health approved a regulation for public-private partnerships (PPPs) in the health sector in mid-February 2022. HP+ supported the ministry’s Center for Health Financing and Decentralization Policy in spearheading the development, adoption, and sensitization process for the regulation. PPPs are helpful in mobilizing the private sector to address gaps in health services within the public health sector. This regulation, which focuses on non-infrastructure needs within the health sector, will allow private companies and organizations to address government health priorities through various contracting and partnership mechanisms. This is expected to contribute to sustainable and equitable scale-up of those services. Read our report on Building the Foundation for Public-Private Partnerships for Indonesia’s Health Sector.
HP+ experts showcased digital health solutions that promote sustainability, equity, and private sector engagement at the Global Digital Health Forum, held December 6–8, 2021, under the theme of Improving Health Through Digital Transformation. For HP+ Mozambique, Marcel Saraiva presented efforts to transition a digital planning and budgeting module to the government as part of a panel on “Cultivating Successful Transition of Digital Systems to Government for Long-term Sustainability,” which was moderated by HP+’s Allison Connolly. Presenting HP+ Indonesia’s work, Adhiatma Akosah was part of a session on “Making Healthcare Fairer and More Equitable,” in which he highlighted the unique challenges faced by a local technology company delivering maternal and newborn digital care tools in the COVID-19 context. Lastly, HP+’s Bryant Lee presented on “Using Blended Finance to Mobilize Private Capital for Digital Health Enterprises” to share recommendations and opportunities to leverage new financing for affordable health in lower- and middle-income countries
A sustainability approach by HP+ is to strengthen the capacity of in-country partners to navigate the complexities of effective policy development, implementation, financing, and governance aligned to country priorities. In Mali, this approach was undertaken partly through seconded staff at the ministry level. A series of three briefs—"Case Studies on Secondments: A Promising Approach to Government Sector Capacity Strengthening in Mali”—explain the process that was undertaken to second staff and strengthen capacity across ministerial-level departments and document lessons learned, recommendations, and future activities. This approach aims to improve the enabling environment for equitable and sustainable health services, supplies, and delivery systems.
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.
Achieving improved health outcomes through multisectoral actions was the focus of an online policy forum convened by Health Policy Plus on June 22, 2021. The session—A Multisectoral Endeavor Called Health: Working Across Sectors for Quality and Sustainability—delved into the importance of designing cross-sectoral interventions and building strong collaborations, such as networks that focus on common goals and bring success to all their members. Clive Mutunga of USAID opened the discussion and provided insights on how multisectoral approaches strengthen health policy and sustainability. Building on his remarks, lead authors from the HP+ blog series “A Multisectoral Endeavor Called Health” shared some lessons learned around youth, nutrition, public and private sector collaboration, and governance. In a panel discussion led by Jay Gribble, deputy director for HP+, panelists addressed challenges faced when coordinating across silos, the importance of understanding context, the need to have good communications, and the role of stakeholder engagement. Speakers addressed audience questions around adapting strategies for sustainability in response to the COVID-19 pandemic and how to work with global organizations to support countries in undertaking multisectoral action.
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.
The Kyrgyz Republic this month requested bids for US$57,000 in HIV services, increasing its HIV social contracting commitment by 35 percent over the previous tender in 2019. The Republican AIDS Center within the Kyrgyz government will secure grants with nongovernmental organizations for services to expand access to HIV treatment and retention in care, directly addressing the Joint United Nations Program on HIV/AIDS’ 95-95-95 goals. HP+ conducted a critical needs assessment in support of the project, collecting and analyzing NGO proposals and supplied technical assistance on the design of the new program. The Kyrgyz Republic Ministry of Health launched the initiative in December and HP+ will provide ongoing mentoring and technical assistance to the Republican AIDS Center in support of the program. Engaging local organizations to provide this critical work—and financing it—demonstrates the Kyrgyz Republic’s progress toward a sustainable and responsive HIV program.
HP+ is supporting FP2030, the next iteration of the FP2020 global effort to enable 120 million more women and girls to use contraceptives. Participating in the new family planning commitment-making process, HP+ health financing experts will provide feedback on country commitments and act as a one-on-one resource for country focal points. A number of reports and briefs developed under HP+ are included in FP2030’s Incorporating Domestic Financing in Commitments brief as part of the FP2030 Commitments Resource Kit developed for countries to use as they develop their family planning financing commitments. The kit includes HP+ documents on legal, regulatory, and financing considerations of universal health coverage, health insurance, catalytic investments for family planning, and the Family Planning Financing Roadmap.
Guatemala's government last month launched a technical working group charged with streamlining public services related to education, health, citizen security, infrastructure, and the environment with an emphasis on the country’s inland regions. The group, the Decentralization Process Bureau (METPRODES) is the initiative of Guatemala President Alejandro Giammattei and Presidential Secretary for Executive Coordination (SCEP) Álvaro Díaz. The plan for decentralization will allow ministries to transfer functions and resources to the local level, improving quality of, and increasing access to, public services across communities. HEP+ has worked closely with the SCEP since 2016 to launch and implement the national strategy for decentralization and will continue to do so in support of METPRODES.
A new blog published on the Wilson Center’s New Security Beat by HP+’s Dara Carr -- Reducing the Risk of Pandemic Disease Threats Through Multisectoral Action -- looks past our current “war time” footing on COVID-19 to the importance of sustaining and strengthening multisectoral collaboration to address future shocks. She discusses barriers to multisectoral collaboration and makes the case that existing policy assessment and advocacy approaches, including evidence-generating policy models, can be readily adapted to help address these barriers. The blog is part of a series edited by HP+’s deputy director for family planning, Jay Gribble, titled A Multisectoral Endeavor Called Health. The series examines the benefits of multisectoral actions in responding to the complex environment in which we live and explores the interrelationships between health and other sectors. Other topics in the series discuss the need for multisectoral collaboration to achieve health outcomes; the link between the health and nutrition sectors; the need for a creative and flexible policy and financing environment for effective planning across sectors.
On October 23, 75 participants joined a virtual watch party and panel discussion organized by HP+ to screen the short film “Why Policy Matters: Reforms Lead to a Healthy Outlook for Nigerians.” The most successful social media post promoting the event resulted in 83 video views and, due to successful outreach to partners, had a potential reach of over 28,000. The Commissioner for Health from Osun State, Nigeria, who joined the watch party and discussion, recognized the work of HP+ and USAID in his state to successfully implement national health reforms and expand access to care.
HP+ explores links between food insecurity, poverty, and poor health outcomes and the need to address underlying causes such as malnutrition with a multisectoral approach. In a new blog in its series, A Multisectoral Endeavor Called Health, co-authors Jay Gribble and Joni Waldron of USAID’s Feed the Future Ag Diversification Activity showcase efforts in Malawi where project design and implementation are linking agriculture to food security, economic growth, and health for long-term, sustainable change. Read the blog, “Reducing Malnutrition: A Multisectoral Approach to Addressing Underlying Causes.
On May 6, representatives from Kenya’s health leadership at the county level adopted a prototype of a new County Health Planning Unit (CHPU) for each county, created to address gaps in planning and advocating for budget allocations for strategic programs such as HIV, family planning, and malaria. HP+ supported the establishment of the CHPU through multisectoral collaboration with individual counties, the Ministry of Health, the Council of Governors, and the National Treasury. Moving forward, HP+ will support CHPU capacity strengthening and mentorship to institutionalize planning and budgeting at the county level, underscoring long-term sustainability on Kenya’s journey to self-reliance.
In Cambodia, HP+ supported the Ministry of Economy and Finance and the National Social Protection Council (NSPC) to develop a monitoring and evaluation (M&E) operations manual and indicators to monitor progress on social protection in Cambodia. Included is an indicator on rates of contraceptive prevalence. Due to COVID-19-related social distancing measures, HP+ has facilitated rapid transition of this activity to an online platform to validate indicators with 11 line ministries. In addition, HP+ developed an online course catalogue that offers 27 free, online social protection courses for colleagues to pursue self-study while working remotely.
HP+ led a webinar on January 30th to discuss how countries -- with examples from Botswana, Nigeria, Tanzania, Kenya and Indonesia -- have met PEPFAR’s minimum program requirements for policies and practices essential for success. With special guest Sylvain Bowra of the State Department in Botswana, HP+ contributors shared a new resource illustrating the status of each of the minimum requirements across all PEFPAR countries.
Malawi reached a key milestone in decentralization of the health sector at the end of 2019 with the establishment of district-level condom coordination committees to enhance distribution and access in all 28 districts. The District Condom Coordination Committees (DCCCs), oversight groups with clearly defined roles and responsibilities for accountability, were outlined as a priority in Malawi’s National Condom Strategy (2015-2020), which was developed with USAID support. Initially, HP+ helped to establish the coordinating committees in five priority districts and shared the approach with PSI to reach an additional three districts. HP+ scaled it up further in two more districts and then leveraged funding from UNFPA through the Family Planning Association of Malawi to set up committees in the remaining 18 districts to establish a Comprehensive Condom Program in every district. During the set-up process, HP+ oriented district staff and community partners on reporting tools for the community and facilities to improve distribution and prevent stockouts. Malawi’s National Condom Strategy was launched in 2017 by the Ministry of Health and Population’s Department of HIV/AIDS to improve availability of and access to male and female condoms and condom compatible commodities, for the purpose of preventing unintended pregnancies, HIV, and other sexually transmitted infections. Read local coverage
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.
A new blog -- Integrating Services Means Thinking Outside Silos -- published on Science Speaks, the global health blog of the Infectious Disease Society of America, addresses the need for greater integration of family planning and HIV service delivery. The commentary, by Health Policy Plus deputy director for family planning and reproductive health, Jay Gribble, and the project’s technical lead on stewardship, RTI’s Alyson Lipsky, discusses the complexity of integration and explores three policy approaches to support it. They conclude that, “To move forward, health system actors must identify the problem that integration is trying to fix and which approach to integration best addresses that underlying problem. Often, the biggest challenge is breaking down the health system silos and being open to finding new ways to respond to people’s health needs.”
In Madagascar, HP+ has been working to support efforts to harness the demographic dividend as the country’s age structure shifts toward a larger workforce, boosting economic growth. On September 12, the Ministry of Economy and Finance, with support from HP+ and UNFPA, organized the official launch of the country’s Demographic Dividend Roadmap at an event in Antananarivo. The event, which brought together stakeholders involved in coordination of activities aimed at achieving the demographic dividend, was attended by the Minister of Economy and Finance Richard Randriamandrato and actors from the public and private sectors, civil society, and technical and financial partners. At the launch, Randriamandrato formally validated the roadmap and discussed the importance of considering the country’s family planning/reproductive health law in efforts geared toward achieving the demographic dividend. At the end of September, HP+ is supporting the Ministry of Economy and Finance to finalize a follow-up plan, including details on monitoring and evaluation, budgeting, and resource mobilization for key activities.
Government and civil society health leaders from nine Francophone countries of West Africa called for the integration of community health workers into their nations’ health systems at a ground-breaking meeting in Lomé, Togo. The three-day workshop, held from September 16 – 19, gathered health officials and implementing partners, and local community health workers, who shared their perspectives. Senior officials from Togo’s Ministry of Health, WAHO and WHO’s West Africa office, along with U.S. Ambassador, Eric Stromayer joined a high-level opening ceremony. Eleonore Rabelahasa, the Senior Health Systems Strengthening and Policy Advisor in USAID’s regional health office, also participated in the three-day workshop. Five Togolese CHWs, who deliver a range of family planning, malaria and health consultations interventions, discussed the challenges and opportunities they face as front-line health workers and their perspectives to improve their capacity to improve equitable access to health services. The delegates developed action plans for each country with a goal to convene key stakeholders and put in place a plan of action by June 30, 2020.
The Kyrgyz Republic has been advancing efforts to ensure sustainability of its HIV programming by developing mechanisms to provide government funding to NGOs to deliver services, or social contracting. HP+ is supporting the Ministry of Health and Republican AIDS Center to develop the regulations and mechanisms required to implement social contracting across the health sector. On September 2-3, in Bishkek, HP+ supported the Republican AIDS Center to conduct a grant launch meeting for the first round of social contracting in the health sector. The meeting, which brought together the grantor and organizations awarded approximately $43,000 to deliver services to people living with HIV – the Republican AIDS Center and six NGOs, respectively – focused on the processes and procedures of social contracting, as well as programmatic and financial reporting requirements. With HP+ facilitation, the participants developed tools and forms required for implementation of social contracting, such as an indicator matrix, an implementation action plan, a draft memorandum on interaction between regional AIDS centers and awarded NGOs, and draft reporting forms. Looking forward, HP+ will continue to support the process of implementation of social contracting in the Kyrgyz Republic through direct technical assistance and mentoring to the Republican AIDS Centers, the Ministry of Health, and grant recipients. HP+ is also supporting the national TB, oncology, and psychiatry program to advocate for funding and establish required regulatory documents for social contracting.
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."
The impending completion of the USAID-funded High Impact Services (SSGI) project threatens to leave 799 community health workers (CHWs) in the regions of Kayes and Sikasso without funding. Community health workers are an important lever for increasing access to quality health services in Mali whose work is essential to be sustained, so HP + worked with partners at the national and local levels to mobilize local resources to fill the gap until the nation’s new health reforms go into effect in 2022. As a result of the work done by HP+ and partners, the Decentralization Support Cell of the Ministry of Health and Social Affairs sent a memo at the beginning of August 2019 to the Minister of Health to transfer funds gained from replacing oil refrigerators with those that are solar powered to finance the community health worker program. This commitment and resource gap filling came as a result of meetings with regional and administrative authorities in these regions who identified the cold chain petrol budget line item as an opportunity. HP+ has also garnered support for better CHW job accountability and security by implementing employment contracts between mayors and health workers – as of July 2019, 105 community health workers have signed contracts across 26 municipalities in Sikasso and 105 health workers have done so across 43 municipalities in Kayes.
An event hosted by HP+ on June 4, 2019, showcased the synergies between stewardship of country health systems and the objectives of USAID’s journey to self-reliance in building countries' capacity to address their own development challenges. The event, which launched a special issue of the journal Public Administration and Development, “Stewardship and Health Systems Strengthening,” explored the concept of stewardship and its underlying six key functions, as outlined by WHO. The journal special issue was co-edited by HP+ colleagues, Derick Brinkerhoff of RTI and Harry Cross of Palladium. In addition to the co-editors and authors, who delivered their papers, speakers included David Jacobstein, a democracy specialist in USAID’s DRG office and HP+ AOR Linda Cahaelen. In a concluding discussion, moderated by Palladium’s Jay Gribble, Harry Cross summarized that “the road to self-reliance is dependent on the health system…it’s the road to sustainability. By improving stewardship functions, countries can achieve self-reliance.”
HP+ supported Kenya’s National Malaria Control Programme to develop the next iteration of its national malaria strategy—one that includes, for the first time, a financial sustainability plan. The resulting costed Kenya Malaria Strategy (KMS) 2019-2023 guides the country’s malaria control strategy for the next five years and informs the Ministry of Health’s planning and prioritization of key malaria interventions. The financial sustainability plan outlines resource needs, resource availability, and funding opportunities to help close the identified Ksh 24 billion funding gap. The Kenyan government estimates that three-quarters of its population is at risk for malaria and, through the KMS, aims to reduce malaria incidence and death by at least 75% (of 2016 levels) by 2023.
USAID and PEPFAR, through HP+ is providing technical support to Guyana’s national AIDS program secretariat to plan for the country’s transition from external to domestic financing of HIV programs and services. This support includes the development mechanisms the government can use to directly support civil society through new “social contracting” measures. A meeting held in mid-November resulted in consensus among nearly 50 civil society, private sector, and government stakeholders and donors to move forward with a social contracting model. In addition to implementation of the model, HP+ will provide additional support to Guyana’s mobilization of domestic resources for HIV programs, including developing costing of civil society-led services and programs and technical assistance to Guyana’s high-level HIV Transition and Sustainability Steering Committee.
The Government of Tanzania has committed 5.5 billion Tanzanian shillings (US $2.42 million) to the country's AIDS Trust Fund (ATF) for fiscal year 2016/17. This injection of funds, alongside the appointment of an independent board of governors to manage the ATF, represent important milestones in the trust fund's development. Once fully operational, the ATF could significantly reduce the country's dependence on external funders and promote the sustainability of Tanzania's HIV response. The ATF’s recent progress is due in part to support from USAID through the Health Policy Project, which provided technical assistance to the Tanzania Commission for AIDS starting in May 2015.