Welcome to the USAID-funded Health Policy Plus (HP+) project website.
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With HEP+ support, inter-institutional agreements that pave the way for the transfer of health functions to local health areas were signed on July 18 between Guatemala’s central government ministries and six municipalities. These agreements allow for improved coordination between central and local authorities and support capacity strengthening at the municipal level, empowering local health area directorates and municipal health districts to plan, operate, and monitor newly delegated responsibilities. With this increased monitoring at the local level, authorities can better monitor health outcomes according to the epidemiological profile of each municipality and thus, support the reduction of morbidity and mortality indicators. The newly delegated comprehensive healthcare approach is also anticipated to improve water and sanitation services for communities. HEP+ supported the Presidential Secretariat for Executive Coordination with designing a framework and methodology to collect input from stakeholders at all levels on the competencies to be delegated and provided input on the inter-institutional agreements.
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.”
Kenyans from national and county government, donor organizations, and stakeholders gathered in Nairobi and online May 24 to celebrate seven years of work by Health Policy Plus (HP+). The event marked the tangible results of the project in HIV and malaria response, family planning, maternal health, capacity building at the national and county levels, and sustaining work throughout the COVID-19 pandemic. Several speakers noted that HP+ helped Kenya adapt to the 2010 mandate that healthcare services and governance would shift from the national government to Kenya’s 47 county governments. David Khaoya, country director for HP+ in Kenya moderated the session that included invited dignitaries from USAID Kenya, the Ministry of Health, the Council of Governors, and the leadership of the County Executive Committee (CEC) health caucus, along with project director, Dr. Suneeta Sharma. Kisumu County assistant director of medical services, Dr. Kennedy Otieno, remarked that HP+ strengthened their capacity to analyze data to the extent that Treasury counterparts began requesting county guidance on financial analysis. “I really appreciate HP+ and the funders for this program, for democratizing esoteric information for so many technical officers…This reversal of roles has really enabled the county departments, especially Kisumu, to realize the potential of planning, especially financial planning, for service delivery.”
At the request of USAID, HEP+ presented to USAID Washington and members of the Bureau for Latin America and the Caribbean on November 23, 2021, on the case for health sector decentralization in Guatemala and the flagship decentralization successes of the project. Some of these decentralization successes include the enactment of the National Decentralization Agenda, 10 prioritized ministries producing their own decentralization plans, assessing municipal capacity to take on decentralization responsibilities through HEP+-developed information systems, and leading capacity development to support municipal ability to take on new responsibilities. Between 2016 and 2018, the number of municipalities deemed capable of implementing the newly delegated functions doubled to 14. Health sector decentralization is a priority for HEP+ and the Guatemalan Ministry of Health. In 2022 the project will be prioritizing further legal reform, the continuation of municipal capacity development, and a “territorial ordainment” tool that will help the project prioritize municipalities for decentralization.
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.
HP+ recently helped planners in Tanzania ensure that local family planning services systems reflect national-level guidance. HP+ provided technical support to update the National Package of Essential Family Planning Interventions for Comprehensive Council Plans and ensure that both it and the National Family Planning Costed Implementation Plan (NFPCIP) 2019-2023, are incorporated into revised guidelines for the local level decisionmakers and used as the key reference documents for subnational budgeting and planning for family planning. Integrating these family planning guidelines within council level plans—which previously contained no FP planning guidance—is expected to increase domestic resource mobilization for family planning and further support efforts to encourage sustainable family planning budget allocation and disbursement among local government areas. It is also anticipated to increase the effectiveness and speed of NFPCIP 2019-2023 implementation at all levels and increase uptake of modern contraceptives.
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.
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.
An analysis of Kenya’s national and county health budgets revealed that, while there has been a significant increase in resources allocated to health, gaps in implementation remain. HP+ conducted the study, which found that resources for health comprise just 9 percent of the total government budget; this falls short of the 15 percent recommended by the Abuja Declaration. Furthermore, county budgets continue to be dominated by recurrent expenditures—such as personnel salaries—raising concerns about resource allocation for effective and quality service delivery. The report provides evidence to support key recommendations for national and county governments to more effectively allocate resources to health.
In support of the Government of Cambodia’s implementation of a policy to decentralize health sector leadership to subnational and provincial levels, HP+ supported the National AIDS Authority (NAA) to facilitate an advocacy workshop in the province of Kampong Speu on August 31. Fifty participants—hailing from the provincial government, operational districts, NAA, and the National Center for HIV/AIDS, Dermatology, and STIs—reviewed policy measures and discussed implementation plans and roles. Decentralized implementation of this policy will enable the province to directly manage health resources and make decisions with regard to health planning, monitoring, and policy prioritization.
Why do countries decide to decentralize their health sectors? What challenges do they face in assigning functions appropriately and agreeing on stewardship roles? Does financing follow function? An HP+ webinar on July 29 tackled these complex questions and more. Featuring the experiences of two countries that have engaged in large-scale attempts at decentralization of health sector financing and governance—Kenya and Indonesia—“Health Sector Decentralization: Can it Still Deliver?” focused on the essential question of whether decentralization can accelerate countries’ journeys to self-reliance. Among the presenters was Meral Karan, a Senior Governance Adviser at the Center of Excellence on Democracy, Human Rights, and Governance.
Kenya’s Public Financial Management Act requires that all funds collected at health facilities be channeled to a country revenue fund, blocking local health departments from control of revenue and compromising quality of care as a result. To address this challenge, HP+ supported the Kilifi Department of Health to assess the legal and policy environment and identify a strategy to redirect US$1.25 million in user fees back to the health sector to support purchase of commodities and cover operational costs. Returning control of domestic resources for health to the health sector is expected to improve quality of care and accessibility of commodities at health facilities.
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
Guatemala’s government leadership extolled the country’s progress and ongoing commitment to decentralization at the first-ever congressional session on decentralization and at a related meeting held days apart in early October. With acknowledgement of the USAID-funded Health and Education Policy Plus (HEP+) for its support of the government’s efforts, outgoing President Jimmy Morales and incoming political leaders both reiterated their commitment to decentralization of primary health care and education to the municipal level and the expected positive impact on health, education, and economic development of Guatemalans at all levels of society. Guatemala’s commitment to decentralizing primary health service delivery and education is enshrined in legal and regulatory statutes but implementation had lagged for several years. The congressional gathering comes at a time of political transition and was remarkable for the commitment to continue the effort by both outgoing and incoming leaders. The progress in implementing the country’s decentralization policy is at a pivotal time and comes after many years of effort by USAID and HEP+ to develop guidelines for implementation; support for civil society networks that demand accountability and monitor implementation; and for the development of an information system that supports decentralization. The SIPRODES information system, developed with support from HEP+, is an important data visualization tool that tracks the capacity and readiness of each municipality to take on newly devolved responsibilities; identifies and highlights areas for capacity development within the municipality; and establishes a communication path from the municipalities to the central government to signal readiness and evaluate how the municipalities are doing.
February 1 marked the first meeting of the year of Guatemala’s National Council of Rural and Urban Development (CONADUR). Representatives from the Ministry of Health, the Ministry of Finance, the Executive Coordination Secretariat of the President's Office, and the General Planning Office submitted proposals and progress updates related to the country’s ongoing process of government decentralization—an initiative supported by HEP+. As a result of the meeting, presided over by Guatemalan President Jimmy Morales, the council approved a regulatory framework for the administration of financial resources, planning, and implementation processes of programs and projects that will facilitate and increase transparency. HEP+ will continue to support the decentralization process by providing technical assistance to the Guatemalan government and other stakeholders.
The HEP+ team in Guatemala continues their work to support the government’s health sector reform and to put in place a strong, decentralized system of governance and public service provision. In September, President Jimmy Morales reaffirmed his commitments to decentralization at a meeting of the National Urban and Rural Development Council and announced the launch of the HEP+-supported National Decentralization Agenda. Members of the HEP+/HP+ team were on hand to capture the President’s remarks and authored a blog, asking: Will decentralization achieve Guatemala’s promise of accountable, inclusive democracy?
Since October 2016, the USAID-funded Health and Education Policy Plus (HEP+) has supported Guatemala’s Secretary of Executive Coordination of the President (SCEP) to promote decentralization in the national policy agenda. With HEP+ support, a National Decentralization Plan was approved by President Jimmy Morales in February 2017. On July 21, 2017, with President Morales in attendance, SCEP signed agreements with the Municipal Association of Los Altos in the Quetzaltenango Department to launch pilot decentralization programs in three municipalities. HEP+ will continue to support the implementation of these pilots through technical support for a National Decentralization Agenda (to be launched in September 2017) and the creation of operational and monitoring and evaluation plans. A local radio station covered the launch event twitter: https://twitter.com/RadioPuntoGT/status/888398025747509248