HP+ hosted a thought-provoking webinar discussion on June 30, 2022, on the development and application of the Legal and Policy Framework to Accountability approach in different country contexts. The speakers, including Dr. Charles Mwinuna, Provincial Health Director, Zambia and representatives from Samasha Medical Foundation, the Centre for Reproductive Health and Education in Zambia, and Women and Development in Law in Africa, joined Katie Peel from HP+ to discuss the current contextual constraints, the application of the approach, and preliminary ”wins” in the accountability space for family planning. The legal and policy accountability approach looks beyond family planning, providing a framework to engage a broad range of stakeholders, tackle challenges, and drive action forward. Dr. Charles Mwinuna of the Ministry of Health expressed his gratitude for the activity implementation and noted the strengthened capacity of Neighborhood Health Committee and Family Planning Technical Working Group members in the planning and budgeting process. Moses Muwonge and Charity Nagemi from the Samasha Medical Foundation shared how the integration of the approach with the Motion Tracker enhances collaboration with partners and helps address barriers to the achievement of FP2030 commitments by considering policy or legal challenges, developing strategies to address challenges, identifying opportunities for partnership, and informing accountability efforts.
The Kenya Ministry of Health, for the first time, published the National and County Health Budget Analysis, FY 2020/21 to its public website, demonstrating the importance of this report in providing evidence for the country’s health sector resource mobilization and health planning and budgeting efforts. HP+ supported Kenya’s Ministry of Health to develop the analysis report, which examines how public health sector financial resources were allocated for the 2020/21 fiscal year in comparison to the allocation patterns of the preceding two years. Findings show that while Kenya has not yet attained the recommended allocation to health contained in the Abuja Declaration, the government has made significant progress, increasing allocation to 11 percent of the total government budget in 2020/21, from 7.5 percent allocated in 2014/15. Continuing this trend will help Kenya progress toward achieving sustainable financing for health and reduce dependence on external assistance. Other findings show that county governments spend the majority of their funds on the payment of staff salaries, which can limit funds available for other key inputs such as drugs. Further, county governments allocate more funding to curative care than to preventive and promotive care. These and other findings in the report provide evidence for national and county policymakers and decisionmakers to inform public health budget allocation planning at both the national and county level. The report is also available on the HP+ website.
Health and Education Policy Plus (HEP+) in Guatemala marked its completion featuring advancements in health reform and civil society leadership with a hybrid event on June 14. Derek Sedlacek, USAID Guatemala Director of the Health and Education Office, highlighted the collaborative nature of HP+’s work: The results achieved respond to the priorities identified collaboratively with the Guatemalan government and the Ministry of Health.…We are sure that all of the positive achievements from this [project] period will be maximized to continue improving health outcome indicators for the Guatemalan population, especially in rural areas. Two breakout sessions presented themes of civil society engagement and governance and health sector reform, with a focus on the project’s response to COVID-19. During the civil society breakout session, representatives from ALIANMISAR, the Men’s Network, and OSAR described their strengthened capacity as a result of partnering with HEP+ and how this had supported their health service provision, quality monitoring, and advocacy. Both sessions emphasized that the project’s achievements were possible because of collaboration, trust, and partnerships struck between the project and its key partners—the Guatemalan government and civil society organizations.
Many health workers and patients are not aware of the rights guaranteed to them by Madagascar’s new reproductive health/family planning (RH/FP) law adopted in 2019, nor of the duties required of health workers regarding RH/FP care. To support broader dissemination, HP+ Madagascar worked with Madagascar’s Directorate of Family Health to develop a job aid highlighting health workers’ RH/FP rights and obligations, including excerpts of the law adapted into simpler language to aid comprehension. The intended impact of the job aids is twofold: (1) to enable health personnel to educate their patients on the RH/FP rights and benefits protected by the law, and (2) to remind health workers of their own rights and responsibilities as outlined in the law, as well as the penalties for neglecting their duties. The job aid will be disseminated throughout USAID’s 13 regions of intervention in Madagascar.
The Health Policy Plus (HP+) project in Malawi celebrated almost seven years of accomplishments with an in-person and live-streamed event in Lilongwe April 28, showcasing three major pillars of achievement in improved policy implementation and monitoring, health governance and sustainable health systems, and multisectoral engagement to improve the lives and health of Malawians. Featured at the session was HP+ Malawi’s purposeful collaborative approach with the Malawian government and civil society. As Gerald Manthalo, deputy director of planning for the Ministry of Health, said: “The project was implemented government’s way. Supporting us to support ourselves was running throughout, and now we have strengthened ability to raise resources, better governance across all levels, and a holistic approach to health development.” Project Director, Suneeta Sharma, attended the event led by Country Director Olive Mtema. The more than 100 participants included the deputy speaker of Parliament and the chair of the Parliamentary Health Committee, development partners, faith leaders, youth, the media, and health ministry representatives from the planning unit, the Reproductive Health Directorate, the Family Health and Health Systems Strengthening Division, and USAID Malawi.
Under the leadership of the Ministry of Health, HP+ West Africa supported the development of a new costed implementation plan for 2021–2025. The operational plan details the program activities and costs associated with achieving national objectives, providing clear information at the program level on the resources needed to promote voluntary, safe, and affordable family planning and provide better access to family planning services for all. Adopted by family planning stakeholders in Niger in August 2021 and now being disseminated, the plan details targets, actions, and indicators for success and suggests redirecting funding to priority needs. The adoption of the plan translates Ouagadougou Partnership and FP2030 commitments into concrete actions and constitutes a genuine advocacy tool for the mobilization of resources for family planning.
HEP+ support came to fruition with the publication of two Guatemalan Ministry of Health (MSPAS) agreements that create new offices to support water, sanitation, and hygiene. In 2021, HEP+ provided technical assistance to an MSPAS team that assessed the flow of the water and sanitation project approval process and identified solutions through which to streamline project authorization. Following the assessment, HEP+ assisted MSPAS’s Integral Health Care Directorate with the technical, legal, and financial validation of two proposals before they were presented to MSPAS authorities. One establishes a Coordination Unit for Healthcare and Environment within MSPAS’s Integral Health Care Directorate. The other creates health authorization offices in each of the 29 health area directorates with the aim of streamlining the management of water, sanitation, and hygiene infrastructure projects in the country. With the creation of these new offices, approximately 400,000 Guatemalans from 22 different communities will have better access to potable drinking water and will benefit from future sanitation projects.
Herminia Reyes, Country Director for HP+ in Guatemala, discussed effective citizen participation approaches aimed at improving transparency and accountability in Guatemala at a December 7, 2021, virtual panel co-hosted by the PACE project, HP+, and USAID’s Office of Population and Reproductive Health (PRH) and the Center for Democracy, Human Rights, and Governance (DRG). The event—"Family Planning and Effective, Inclusive, and Accountable Governance"—highlighted the multisectoral benefits of investment in family planning and how it can support the long-term realization of effective governance and resilience. Reyes was joined by PACE’s Kenya Deputy Director, Chrysantus Shem, who provided a case study and Elizabeth Leahy Madsen who spoke about a new analysis showing the link between mature age structure, effective governance, and political stability. The panel was moderated by Lillian Benjamin of PRH and featured comments from David Jacobstein of the DRG Center. The webinar panel was held in the lead up to the Global Summit on Democracy, convened by the Biden Administration.
From November 16 to 18, 2021, HEP+ delivered a workshop to 21 participants to foster joint accountability among government and civil society on commitments outlined under Guatemala’s Law for Healthy Motherhood. This dynamic workshop gave civil society and government stakeholders the opportunity to discuss the accountability mechanisms and joint commitments related to improving maternal health in Guatemala, promoting transparency, and strengthening governance around adolescent pregnancy. Workshop participants prepared action plans to address adolescent pregnancy, which will begin with conducting qualitative research to learn more about gaps and opportunities for strengthening programs and approaches to prevent adolescent pregnancy. Applying what was taught at the workshop, participants plan to analyze the relevant health system actors, their accountability roles in the area of adolescent pregnancy, and the accountability relationships between relevant parties at the national and subnational levels. The networks will present results in March 2022.
Family planning strategies, policies, programs, and advocacy can be more effective if they are grounded in a comprehensive understanding of the accountability ecosystem for family planning. To help stakeholders better understand the accountability ecosystem, HP+ has published a Legal and Policy Framework to Accountability Approach, which was applied in Zambia in 2020. The framework document provides an overview of a 10-step process that can be used to guide organizations aiming to understand the higher-level legal and policy frameworks within their country and how these influence accountability relationships, structures, and mechanisms for family planning. With a solid understanding of the accountability ecosystem for family planning, stakeholders can design more strategic advocacy campaigns, establish connections with new partners, and address underlying systemic challenges to achieving family planning objectives in strategies and policies.
From 2017 to 2020, HP+ Cambodia delivered technical assistance and capacity development to advance universal health coverage and the sustainability of key Cambodian health programs. This included supporting the National Social Protection Council Secretariat to implement and monitor the National Social Protection Policy Framework 2016–2025, the government’s long-term roadmap to increase support for vulnerable populations and expand health insurance. The newly published Manual for the Social Protection Monitoring and Evaluation Mechanism, developed over three years of support from HP+, is a monitoring tool to ensure consistency, transparency, and accountability in the framework’s implementation. Approved by the National Social Protection Council in September 2020, the tool is now publicly available in English and Khmer on the GS-NPSC website. Cambodia’s Minister of Economy and Finance acknowledges USAID and HP+ support within the manual, stating, “As the chairman of the National Social Protection Council, I would like to deeply thank and acknowledge the contributions of the technical teams and all stakeholders, especially the Health Policy Plus (HP+) project supported by the United States Agency for International Development (USAID), as well as other development partners including UNICEF, for their active cooperation and valuable inputs to make this M&E mechanism happen.”
Madagascar’s Ministry of Public Health has published a final review of its 2016-2020 Costed Implementation Plan (CIP) in a new report available through HP+. The CIP is a five-year roadmap that identifies evidence-based strategies and approaches for improving family planning programs and estimates the costs of implementing those strategies. The final review report examines and details the CIP achievements using Organisation for Economic Co-operation and Development (OECD) criteria of effectiveness, efficiency, coherence, relevance, impact, and sustainability. The effort was part of the project’s commitment to help strengthen Malagasy capacity to develop, implement, and monitor health sector policies and strategies to improve equity and sustainability of health services. Information from the review report, which also includes perspectives of family planning stakeholders in-country and a literature review, will be used by Madagascar stakeholders as they develop the country’s next CIP and to improve the nation’s family planning program. HP+ had previously supported the government of Madagascar’s efforts to develop and implement the national costed implementation plan (CIP) for family planning (2016-2020).
Building digital solutions for health was the focus of a recent online policy forum convened by the Health and Education Policy Plus project (HEP+) in Guatemala. HEP+, with the Ministry of Health and Social Assistance (MSPAS) and the Office of Human Rights (PDH), delved into the importance of increasing information-sharing through digital platforms. The July 27 forum featured opening remarks by Yma Alfaro of USAID and Herminia Reyes, HEP+ Guatemala’s country director, which led into descriptions of three data dashboards that monitor health and education indicators. The panel discussion that followed focused on the experience of MSPAS and PDH in working with the HEP+ technical team and how HEP+ support helped bring solutions to the population. Claudia Maselli of PDH emphasized that “the support of USAID, HEP+, and Palladium has been hugely beneficial to the institution. This partnership and leadership [with HEP+ have] enabled us to build these tools that monitor and publish the results of our work. The technical assistance has been very valuable for our entire team.” The online policy forum was held in Spanish with live English interpretation.
With the support of HEP+, the Nutrition Institute of Central America and Panama (INCAP) has made significant progress in collecting baseline data for Guatemala’s Great National Crusade for Nutrition (GCNN), which aims to reduce malnutrition in the country. As of May 25, INCAP had visited 536 homes in Chimaltenango, Sacatepéquez, and the department of Guatemala as a part of an effort to identify municipalities most in need. Once baseline data collection is complete, the information will be used to monitor and evaluate the GCNN’s efforts, help the Guatemalan government better identify local health needs, and inform nutrition intervention delivery. In addition to preventing chronic malnutrition and anemia, the national strategy aims to reduce maternal and infant mortality and morbidity, promote food security and nutrition, strengthen food services, and prevent and infectious diseases. HEP+ support of the GCNN initiative includes creating systems for technical and operational analyses, a budget based on programmatic categories, and a strategy to define the resources and activities needed to strengthen the GCNN.
Malawi is developing guidelines on how to sustain youth-friendly health services (YFHS) as evidence shows that the COVID-19 pandemic has drastically decreased the use of such care. The use of YFHS declined by approximately one-third in April/May of 2020 compared to the same period in 2019, according to two 2020 assessments on COVID-19 and YFHS. In response, HP+ Malawi is working with government and other stakeholders to develop National Guidelines for Sustaining Provision of Youth-Friendly Health Services amidst the COVID-19 Pandemic. The guidelines, which are being developed by a multisectoral group of stakeholders, are intended for both governmental and nongovernmental entities that offer health information and services to young people. They are a framework to hold implementers accountable for offering services during the pandemic as well as a way to empower communities and youth themselves to better understand their right to access health services despite COVID-19-related restrictions or access barriers. The government of Malawi is further discussing how to expand the scope of the guidelines to address public health emergencies beyond COVID-19.
In March, HP+ convened and led a workshop that kicks off a six-month leadership development process in Malawi using the new model for building the capacity of health stewardship. The 23 participants are drawn from four districts and comprise district youth officers, family planning coordinators, youth development officers, youth-friendly health services coordinators, district nursing and midwifery officers. The curriculum combines in-person and virtual learning events with a virtual peer support group, a leadership assessment, one-on-one coaching and mentoring, and individual stewardship development plans that link leadership development daily professional responsibilities. Participants will be undergoing a leadership assessment in the coming weeks and begin preparing for a second learning event in June. This activity’s anticipated impact is a cohort of key actors in each of the select four districts with strengthened leadership and stewardship capacities to better address key challenges within the health system, with particular emphasis on family planning and youth-friendly health services.
HP+ has helped the Kenya Ministry of Health retain its current allocations for national HIV, malaria, and reproductive health programs into the next fiscal year even in the face of economic constraints due to COVID-19. HP+ provided technical assistance to the Ministry of Health program teams to develop budget justification memos that supported the need to continue to fund these programs. The memos were used during the sector performance review and resource sharing process, helping to ensure that each program is able to continue supporting its respective critical disease area. In preserving budget allocations despite a tightened fiscal space, the health programs established their continued importance among the nation’s priorities, allowing Kenya to maintain stewardship and accountability for funding these programs. The FY 2021/22 funding for HIV, malaria, and reproductive, maternal, newborn, adolescent, and child health programs is US$12 million, $8 million, and $8.63 million, respectively.
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Domestic Resource Mobilization
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.
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.
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.
On September 14, 2020, Cambodia’s National Social Protection Executive Committee approved the adoption of a new monitoring and evaluation (M&E) system, developed with HP+ support, to enable systematic oversight of social protection results and financing to manage its portfolio, improve accountability and transparency, and inform future investment priorities. HP+ supported the development of the system by creating a logical framework and identifying indicators; drafting an operational manual and legal framework; and providing customized trainings and ongoing coaching to build capacity of a new team with no previous M&E experience. Implementation of the system will support Cambodia’s policy goals of preventing and reducing poverty, vulnerability, and inequality.
In Cambodia, General Secretariat for the National Social Protection Council (GS-NSPC) leadership reached consensus on five actionable policy recommendations to ensure high-quality health services are delivered under national Universal Health Coverage schemes. The recommendations, which include adoption and optimization of a strategic purchasing approach as well as the integration of monitoring and key progress indicators into the annual performance-based budgeting process, were documented in a peer-reviewed article developed with HP+ input, Improving Health Service Quality in the Kingdom of Cambodia: A Policy Perspective, published in the Asia Pacific Journal of Public Health in September 2020.
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.
HP+ supported the development of a National Social Protection (NSPC) Monitoring and Evaluation system in Cambodia to facilitate the collection, analysis, and use of service and beneficiary statistics; budget and expenditure data; and payment and administrative information to monitor key performance indicators. HP+ trained NSPC staff on use of the system dashboard, which generates key performance metric visuals; a soft launch by September is planned. The monitoring system is expected to improve accountability and transparency between line ministries and the Ministry of Economy and Finance; strengthen social protection scheme management and decision making; inform the annual budget; and increase public transparency and accountability.
HP+ is supporting Cambodia’s General Secretariat for National Social Protection Council (GS-NSPC) to implement integrated systems to enable social health insurance reforms. Following an April launch by the Prime Minister of an inter-Ministerial Technical Working Group to oversee linking of health insurance reimbursement systems, HP+ is collaborating with the GS-NSPC and the Asian Development Bank to design an interoperability demonstration project to support harmonization. These efforts to boost effectiveness, transparency, and accountability will improve the operation and effectiveness of the Health Equity Fund, which includes long-acting reversible and permanent contraceptive methods, and National Social Security Fund schemes that cover nearly 5 million beneficiaries.
An HP+ webinar delivered by Christine Lasway and Laura Hurley on May 14 – What’s Measured Matters: Monitoring Family Planning Costed Implementation Plans – presented an overview of the CIP Performance Dashboard, a data management tool to track CIP performance targets. The discussion included case studies from Madagascar and Ghana, countries using it to monitor execution of their CIPs. The CIP Performance Dashboard, available in Excel and now as an online tool, was developed based on DHIS2. This webinar is ideal for stakeholders looking for a strategic planning performance monitoring tool.
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
On December 19, the Pharmaceutical and Other Health Technologies Policy was approved by ministerial decree in the presence of authorities from the Ministry of Public Health (MSPAS), the Guatemalan Institute of Social Security (IGSS), over 70 health sector public officials, and representatives of international cooperation agencies. The event where the policy was approved was led by the Minister of Health. The policy represents a strategic mechanism that guides, directs, and implements comprehensive actions with national reach. It strengthens health sector governance by establishing criteria and strategies to define roles and responsibilities in the management of medicines and other health technologies. It also unifies guidelines for health and public sector institutions to guarantee access to medicines to all Guatemalans. During the event, IGSS committed to adhere to the policy and collaborate with MSPAS to achieve its full implementation. The MSPAS Logistics Management Unit Director acknowledged the technical assistance received by the Pan American Health Organization, World Health Organization, and USAID/HEP+ during the design, development, validation, and approval process of the policy.
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A blog published by Health Policy Plus in the lead up to Universal Health Coverage Day December 12th, considers a governance angle on Universal Health Coverage and identifies three areas that are particularly critical: 1) politically aware and savvy champions committed to inclusive processes; 2) leadership and management that fosters a culture of accountability; and 3) more data on the costs of effective management and administration of UHC programs. The authors, Jay Gribble, the deputy director for family planning and reproductive health and Alyson Lipsky, the project’s lead on governance and stewardship, draw on results from HP+ Nigeria and other case studies as they argue that these governance, stewardship, and accountability elements will be key to reaching UHC goals.
The Indigenous Women’s National Alliance for Reproductive Health, Education, and Nutrition (ALIANMISAR)—a Guatemalan civil society network supported by USAID through HEP+—signed a letter of understanding on July 2, with Acción Ciudadana (“Citizen Action”) with the aim of contributing to establishing the conditions and guidelines of cooperation for the promotion of transparency, anti-corruption legal assistance, training, and prioritization of social auditing. Acción Ciudadana is an entity that aims to promote the establishment of transparency mechanisms and processes to contribute to the achievement of a strong culture of democracy and the rule of law. In the future, Acción Ciudadana will conduct face-to-face activities for technical support in social auditing and cooperation through ALIANMISAR’s many activities, contributing to long-term sustainability.
HP+ worked with Uganda-based Samasha Medical Foundation to scale-up its Motion Tracker—a locally-produced, civil society led tool that strengthens accountability and helps countries make progress toward their FP2020 commitments. HP+ supported its scale up from Uganda to Tanzania and Zambia, which resulted in broader community and stakeholder involvement and stronger FP2020 commitments in both countries that can be tracked and monitored. HP+’s work with Samasha helped cement the Motion Tracker as a sustainable, locally-grown approach to strengthening self-reliance and joint accountability, with Samasha receiving additional funding from the World Health Organization and the New Venture Fund to continue their work in Uganda, Zambia, and Tanzania, and further expand to Nigeria.
HEP + supported the municipalities of Sacapulas (Quiché) and San Rafael Pie de la Cuesta (San Marcos), to develop and formalize the Food Security and Nutrition (SAN) Policies of each municipality, based on the "Guide to Elaborate the Municipal Investment Plan" also developed by HEP+. These municipal policies are based on four pillars: 1) Food consumption, 2) Biological use of food, 3) Availability and access to food, and 4) Institutional strengthening, and are in alignment with Guatemala’s National Development Plan, K’atun 2032. These policies make it possible to allocate municipal resources transparently and manage resources with other organizations that work on food security and nutrition. The municipality of San Rafael Pie de la Cuesta has already allocated funds in its annual budget to operationalize said policy. The implementation of these policies at the municipal level will aim to improve food and nutrition conditions and reduce chronic malnutrition in the municipality. HEP+ monitors the implementation of these policies and advocates with other municipalities to develop similar policies.
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.”
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.
On January 17, two Nigerian states, Ebonyi and Abia, inaugurated the governing boards of their respective state health insurance agencies—an important step in making quality healthcare available and accessible to all Nigerians. This milestone follows an advocacy visit paid the previous day to the State Commissioner of Health, Hon. Dr. Daniel Umezurike, by HP+ Nigeria Country Director Onoriode Ezire, alongside officials from the country’s National Health Insurance Scheme (NHIS). The group discussed the need to establish state health insurance agencies and comply with the requirements of the Primary Health Care Under One Roof policy, prerequisites for accessing the Basic Health Care Provision Fund meant to improve access to quality and affordable healthcare for the poor. Moving forward, HP+ will continue to support efforts to increase quality and reduce the cost of healthcare services throughout the country.
The Office of the Human Rights Ombudsman (PDH) in Guatemala announced a commitment to expand its strategic alliance with ALIANMISAR, a local civil society organization, to assume the responsibility of monitoring the educational quality in the five education departments prioritized USAID and expand the program to schools in all 22 departments of the country starting on February 1, 2019. This commitment is a direct result of HP+’s efforts to build capacity within civil society networks and track progress on the program’s influence on the educational system; in the years since the program’s monitoring began in 2013, these networks have leveraged over US$3.8 million to improve 138 schools. Based on these positive responses to these results, the PDH and ALIANMISAR designed six questionnaires aimed at students, parents, teachers, and directors to collect demographic and institution-specific data that will provide a baseline for future educational interventions in the region. Additionally, the PDH has developed an online app to track and review the answers provided in these questionnaires, highlighting the visibility and accessibility of the data. The strategic alliance marks an important milestone for HP+’s efforts to achieve sustainable results that will have lasting effects in Guatemala as the PDH will accompany civil society networks to advocate for positive changes in the quality of educational services and will actively monitor future cases of human rights violations reported by students and educators.
In recent weeks, Guatemala’s Ministry of Education (MINEDUC) officially established the National Workforce Training System (SINAFOL) for school and extracurricular education systems. SINAFOL—a system that has been supported by HEP+ for over a year—is the structure that manages and coordinates the government, private sector, and social agents to define and implement policies and strategies that guide education and technical occupational training in the country. It incorporates standardization processes, training, evaluation and certification of labor skills, entrepreneurship, and citizenship in a permanent learning context. In addition to establishing the system in early November by ministerial degree, on January 3, MINEDUC published two additional decrees to (1) support the creation of six new careers in order to expand opportunities for young people in the education system, and (2) create a system of skill certification. HEP+ will continue to support the operation of SINAFOL and the skill certification system in coming months. Read the press coverage.
In late 2018, Nigeria’s Federal Capital Territory (FCT) Health Insurance Scheme broke new ground, holding its first ever stakeholders’ meeting—a move which led to the eventual release of nearly US$1.4 million in stalled funds and new political commitments by some of the FCT’s top leaders. In November 2018, the USAID-funded Health Policy Plus project and Nigeria’s FCT Health Insurance Scheme co-convened a stakeholder’s meeting to examine the implementation of the FCT Health Insurance Scheme since its roll-out in 2011 and generate lessons learned to improve the scheme’s implementation and expand access to high-quality healthcare. The meeting concluded with a list of recommendations, including a call for the government to ensure the prompt release of funds. Three days after the meeting, the FCT Director of Treasury released 350 million Naira (US$972,000) for payment of outstanding capitation to healthcare providers; the original request had been made six months prior. Additionally, 150 million Naira (US$417,000) was approved by the FCT Minister for payment of fee-for-service payments owed to providers since 2017. The government also committed to settling all remaining overdue payments by the end of 2018 and paying all first quarter 2019 payments in advance. HP+ Nigeria and partners are hard at work monitoring the progress of these commitments. Read the full news article.
For World AIDS Day, HP+ participated in PEPFAR’s thunderclap and published an online #EndAIDS photo album, promoted via and e-postcard and on social media. The photos and accompanying quotes answered the question, “How does your work promote transparency, accountability, and partnerships to #EndAIDS?"
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?
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.
The Kenya Health Act, 2017 mandates provision of a range of health services, ensures free maternity care and immunizations for children five and under, and formalizes collaboration between county and national governments. To further regulate and reorganize Kenya’s health sector, the Health Act, 2017 establishes the Human Resources for Health Advisory Council and the Kenya Health Professions Oversight Authority. To safeguard health workers’ welfare, the advisory council will review and advise on policies, norms, and standards related to the deployment of healthcare staff. The authority oversees healthcare professionals and regulatory bodies, including complaint resolution and the professional conduct of health staff. The USAID-funded Health Policy Project (HPP), the Health Policy Plus (HP+) project’s predecessor, provided extensive technical assistance to Kenya’s Ministry of Health in the development of this law, facilitating advocacy and consensus-building efforts and providing guidance on linking the law with the Kenya Health Policy. Under HP+, our team continues to support implementation of other aspects of the Health Act, including implementation of the Linda Mama Boresha program, which provides free maternity, neonatal, and infant care for Kenyan women and children. Read our full article.
Participants in the USAID-funded Health Policy Plus (HP+) project’s Women's Leadership initiative in Pakistan have had tremendous success, directly contributing to policy and other efforts aimed at expanding outreach and access to family planning services for youth. Collectively, the women successfully advocated for the inclusion of youth-specific indicators to monitor the country's costed implementation plan and developed youth-specific guidelines for Pakistan's Manual of Standards for Family Planning Services. They provided recommendations to Sindh province's FP2020 working group and to the government—the latter of which ensured the funding and operationalizing of critical youth-friendly activities.
These wins come on the heels of three HP+ Women's Leadership for Family Planning workshops focused on increasing the women's confidence, capacity, and connections to achieve health policy and governance outcomes. HP+ initiated the Women's Leadership program in Pakistan late last year. The last of the three workshops was held in April.
Now, HP+ is continuing to support the women in their advocacy efforts and tracking their successes in our unfolding story on their progress.
Progress toward universal health coverage that reaches marginalized groups requires a multi-pronged approach that includes health insurance as well as demand-side interventions to improve service utilization; empowered communities demanding accountability; and, mechanisms to identify, reach, cover, and empower neglected or stigmatized populations. These recommendations were made at a USAID-hosted meeting - Extending Coverage to Marginalized Groups - at the Prince Mahidol Award Conference, in Bangkok, Thailand, on January 29th, which featured dynamic conversations among health economists and health reform experts. USAID representatives included Jennifer Adams, acting assistant administrator in the Bureau for Global Health; Margaret Reeves, senior family planning policy advisor; Jodi Charles, senior health systems advisor; and Josef Tayag, senior private sector financing advisor. The meeting was organized in collaboration with USAID-funded projects Health Policy Plus (HP+), Health Finance and Governance (HFG), and Sustaining Health Outcomes through the Private Sector Plus (SHOPS+).
Representatives from Guatemala’s Ministry of Education (MINEDUC) launched EscuelAPP, a new mobile application designed to enhance civil society’s role in holding the national government accountable for high-quality education. The application was developed by the USAID-funded Health and Education Policy Plus (HEP+) and is linked to a database created and maintained by HEP+ and its predecessor policy projects. EscuelAPP is available to the general public and to local and national MINEDUC staff. It offers easy, real-time access to school-level information on teachers, school performance, and delivery of benefits. Ministry staff and civil society use the app to monitor performance and change and make comparisons across schools and communities.