HP+ hosted an interactive, online policy forum on August 9, 2022, on how a stronger enabling environment for family planning can reduce contraceptive discontinuation. While much attention is given to reducing unmet need and the uptake of modern contraception, much less attention is given to helping women continue to use their methods once they start. Yet almost one in three new users of family planning discontinues within 12 months of starting for a variety of reasons. The event’s speakers, including Sara Stratton and Sandra Mapemba from HP+; Rahal Saeed from Palladium’s USAID-funded NPI EXPAND project; and Heidi Quinn from the International Planned Parenthood Federation, joined HP+’s Jay Gribble and 101 participants to discuss how program efforts can be strengthened to reduce discontinuation while helping women achieve their reproductive goals. Speakers offered examples from their work globally and in Kenya, Malawi, and Pakistan. The policy forum was the culmination of HP+’s blog series, “Rethinking Contraceptive Discontinuation: Are Solutions Being Overlooked?,” where a variety of authors detailed some of the emerging approaches, such as counseling and services, supply chain, self-care and digital solutions, financing, the development of new methods, and community norms, to address contraceptive discontinuation.
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.
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.
Government stakeholders collaborated with HP+ to reduce the resource need gap and ensure efficient and needs-based resource prioritization for the health sector. Using the OneHealth Tool and other classification methodologies, stakeholders reached consensus on the essential health programs, interventions, and inputs for the strategic plan. Presenting key challenges, lessons learned, and recommendations for the future, this brief can be used to advocate for increasing domestic resources for Madagascar’s health system and to inform the Malagasy government, as well as a wider audience beyond Madagascar, about best practices and potential pitfalls with the financial planning process for a health sector strategic plan.
On February 8, 2022, the Nurses and Midwives Council of Malawi (NMCM) held an event to roll out nursing standards developed and piloted with HP+ support in four facilities using a quality improvement (QI) approach. The technical standards for the provision of healthcare for children, adults, oncology, and breastfeeding will help ensure the delivery of high-quality care and accountability. At the event, Deborah Banda, a nursing officer representing Kamuzu Central Hospital, assured the other nurses that QI is doable, “When you implement those you achieve a great improvement and clients are satisfied.” The pilot brought forward champions for change, who pushed for support of the QI activities. NMCM expressed gratitude to USAID and HP+ and interest in continued support to develop standards in areas such as community health, midwifery, intensive care, neonatal health, accident, and emergency. A guide and presentation based on the Malawi pilot on how to rollout standards following a quality improvement approach is available.
Three years in the making, HP+-supported work has been published in the February edition of Global Health: Science and Practice. Co-authored by HP+ partner staff and in collaboration with colleagues from USAID, Harvard, Johns Hopkins University, and Save the Children, the article focuses on a study of “Global Research Priorities for Understanding and Improving Respectful Care for Newborns.” The study developed, for the first time, a prioritized list of research questions focusing exclusively on respectful care for newborns. It highlighted the absence of agreed-upon terminology and tools needed to advance both theoretical and practical efforts. This list should guide researchers and other stakeholders in developing further research.
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.
In September 2021, Guatemala’s Ministry of Health (MSPAS) adopted the Home Management of COVID-19 Patients: A Practical Guide for Healthcare Personnel as national guidance. HEP+ is using the guide—which was adapted from HP+’s 2020 COVID-19 Home-Based Quality Care guide—to train MSPAS healthcare workers on how to provide home-based care. Since September 30, 2021, 133 healthcare providers from Alta Verapaz, Quiché, San Marcos, and Metropolitan areas were trained; the next training will be held in Huehuetenango. The guide will be shared with those who have been trained, who will then share the information with health personnel in their health areas who did not receive the HEP+ training. While written for healthcare workers, the guide is equally useful for personal use or when caring for a household member with COVID-19.
Representatives from four district hospitals in Malawi where new nursing standards are being piloted came together this month to share experiences, challenges, and lessons learned. HP+ and the Nurses and Midwifery Council of Malawi (NMCM) developed new technical standards for nursing and midwifery practices for child and adult health, oncology care, and breastfeeding. The lack of specific standards for these key areas of practice has been an obstacle for nurses and midwives in delivering high-quality care and has prevented professional councils such as NMCM from assessing and assuring quality of care in service delivery. HP+ trained staff from NMCM and the Ministry of Health’s Quality Management Directorate as quality improvement coaches in rolling out the adult health standards in the four pilot sites. HP+ coached this team as members implemented the standards using a QI approach and facilitated the learning and review meeting. All four sites improved their compliance with the standards against the baseline assessment, despite having had only five months to adopt the concept, implement the standards, and undergo assessment. The pilot helped to identify gaps in the draft standards, which will now be revised, finalized, validated by the professional committee, and scaled up.
Frontline healthcare workers at Guatemala’s Ministry of Public Health and Social Assistance (MSPAS) recently completed an HEP+-created series of training sessions on COVID-19 care. “Improving the Quality and Hospital Care of Patients with COVID-19” covered epidemiology and management of COVID-19, COVID-19 therapy and therapeutic options, intubation, mechanical ventilation, nosocomial infections, anesthesia and management of delirium, ventilator weaning, and other topics. Thirty-nine doctors and 42 respiratory therapists and nursing staff completed the 26 hours of theoretical and practical training in June. A second training series in July and August covered mental health for health workers, the use of antibiotics in the patient with COVID-19, post-COVID-19 syndrome, and fungal infections in a COVID-19 patient. Health workers who have completed the course will train the staff under their charge on the same material. Thus far, a total number of 1,421 attendees have attended these additional sessions in July and August. HEP+ will provide technical assistance to update the infection prevention and control manuals in the coming weeks.
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.
Uganda has adapted an HP+-produced COVID-19 guide in support of the 75 percent of cases in the country that can benefit from home care. The document can guide health workers, village health teams, caregivers, patients, and family members on how to effectively implement home-based care activities and manage the disease. The adaptation was spearheaded by the USAID Uganda Health Systems Strengthening Activity and the USAID Social and Behavior Change Activity with the Uganda Ministry of Health.
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.
As part of the global effort to equitably supply vaccines to countries in need, HP+ convened academic and program implementation experts to share best practices, lessons learned, and tools to support rollout in low-resource countries. Under an accelerated effort, developing countries will be supported by the COVAX mechanism to immunize 20 percent of the population in 2021. The target group, scale, and intensity of this immunization campaign is significantly different than those handled by health ministries and immunization programs in the past. Joining the discussion to explore this were Ramon Soto of HP+’s COVID-19 response team in Honduras, Dr. Laila Woc-Colburn from Emory University’s School of Medicine, Dr. Edwin Asturias from the University of Colorado Denver, and Danielle Darrow de Mora of FHI 360. Key issues emerging from the discussion include strategies to deliver vaccines to hard-to-reach populations including migrants and indigenous populations and the need to include communities in rollout planning (microplanning). Panelists proposed effective strategies on the prevention, identification, and management of rare adverse events.
HP+ worked with the FP2020 Secretariat to develop new guidance on establishing strong “mutual accountability” approaches. The new guidance provides a “how-to” for governments to meaningfully engage civil society throughout the commitment process and how government and civil society can hold each other accountable for meeting 2030 commitments to family planning. The FP2020 Secretariat is rolling out the new guidance, and it will be officially launched in the coming weeks. The accountability guidance builds on HP+’s extensive experience supporting accountability for FP2020 commitments. It promotes including civil society throughout the commitment process—commitment-making, implementation, and tracking—and includes examples derived from an HP+ global review of existing social accountability mechanisms. FP2020 will disseminate this guidance through its country focal persons and other venues. Both the guidance and examples are available online.
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.
On November 12, HP+, in conjunction with USAID and Indonesia’s Ministry of Health’s Centre for Health Financing and Insurance (PPJK), hosted a global practice webinar. “Public-Private Partnerships (PPPs) for Health: Nuts and Bolts from Policy to Practice—Highlights from India” is the fourth webinar in a series focused on strengthening health sector stakeholders’ understanding of global best practices in scaling up high-quality health services through PPPs. With over 100 participants hailing from government, academia, and the private sector, the webinar explored the rationale and benefits for creating PPPs, approaches to identifying opportunities for collaboration, and the tools, resources, and institutions necessary to design and implement partnership approaches. Examples were taken from India’s experience in expanding private sector engagement and blended financing mechanisms in pursuit of better health outcomes, including the Utkrisht Development Impact Bond model applied to maternal and newborn health programs. Speakers, who included representatives from PPJK, the Gates Foundation, USAID/Washington, and USAID/Indonesia, inspired the audience to think beyond traditional corporate social responsibility, toward innovative ways to harness new collaborations between the public and private sectors.
In El Salvador, HP+ engaged 83 healthcare professionals in 20 facilities across six municipalities to adapt and disseminate evidence-based guidelines and pilot a training for clinical management of COVID-19. The guidelines and training, which cover diagnosis and treatment, as well as triage, hospital referral, home care management, and infection prevention and control, have strengthened COVID-19 response efforts within primary healthcare and household settings and improved patient perceptions of safety. Moving forward, the training will be expanded to include additional content for nurses and cascaded to enhance the capacity of healthcare professionals to engage effectively in the COVID-19 response in El Salvador.
A journal article authored by HP+ project staff in collaboration with local partners was published this month in a special issue of AIDS. The article, which describes the development and implementation of a three-stage approach to reducing HIV stigma in health facilities, features the approach that HP+ implemented in Ghana and Tanzania. It is an evidence-based, adaptable, scalable approach that has proven successful in generalized and concentrated epidemic settings and can be used to address stigma toward any population. Results of endline evaluations in both countries demonstrate the intervention’s effectiveness, showing significant reduction in drivers and manifestations of stigma and discrimination among facility staff.
HP+ launches a new blog series today, A Multisectoral Endeavor Called Health: Working Across Sectors for Quality and Sustainability. The series will tackle a range of health development challenges and examine how multisectoral actions can help address complex, interrelated issues. Focusing on high-level objectives, such as achieving universal health coverage and reducing malnutrition, the blog series considers how multisectoral actions contribute to better health status of populations and play a role in achieving economic growth and other development goals. Read the first blog by Jay Gribble, Nicole Judice, and Suneeta Sharma, Unity is Strength: Improving Health is a Multisectoral Endeavor.
A new HP+ blog post shares key lessons to advance universal access to family planning from 16 francophone countries. The lessons emerged from discussions among representatives from 15 francophone countries and Haiti—comprising government, civil society, development partners, and youth—convened by Family Planning 2020. Recommendations from the meeting included the establishment of a legal framework to include family planning in reforms aimed at achieving universal health coverage; using evidence and advocacy to make the case for including family planning in health insurance benefits packages; and strengthening stakeholder capacity to understand and manage health financing schemes.
The HP+ “total facility approach” to reducing stigma and discrimination in health facility settings is being featured on the PEPFAR solutions website. This showcases the work carried out by HP+ in Tanzania and Ghana as an important solution for the HIV response. PEPFAR Solutions are impactful, data-proven approaches intended to guide others in program design and implementation. U.S. government staff and partners around the world use the solutions website as a resource for HIV program design. Having the stigma-reduction approach featured also makes it accessible to mission staff around the world as they embark on their COP20 planning processes.
Two district hospitals in Malawi were recently certified as “baby-friendly,” meaning that they meet World Health Organization standards under the Baby-Friendly Hospital Initiative, bringing the total number of baby-friendly district hospitals in the country to seven. This achievement comes as Malawi is witnessing stagnating improvements in child survival rates. A baby-friendly hospital encourages and assists mothers to exclusively breastfeed until six months of age, which contributes to improving these survival rates. Since 2018, HP+ has been training, mentoring, and coaching district hospitals on exclusive breastfeeding. The Malawian Ministry of Health intends to achieve baby-friendly certification for all hospitals that provide maternity and antenatal care services; HP+ will continue to support these critical efforts to improve child survival rates in Malawi. Read more about recent progress.
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.
The US President’s Emergency Plan for AIDS Relief (PEPFAR’s) Annual Report to Congress features the Gender and Sexual Diversity (GSD) blended learning package. The training package is designed to help PEPFAR improve its effectiveness at serving its most vulnerable populations with a focus on staff training. Health Policy Plus and PEPFAR built on the success of a series of in-country trainings to develop the GSD blended learning package, which includes online and in-person training components. All PEPFAR field and headquarters staff are required to spend 90 minutes participating in the online interactive curriculum. All staff must also join an in-person panel discussion with local gender and sexual minority representatives around HIV, human rights, and meaningful engagement of GSD in PEPFAR programming. Thus far, more than 400 PEPFAR field and headquarters staff have taken the online training.
USAID and PEPFAR, through the Health Policy Project’s (HPP) follow-on, Health Policy Plus (HP+), shared best practices, resources, and the project’s current work to reduce HIV-related stigma in health facilities during a recent webinar. The HPP/HP+ stigma-reduction package is comprised of a series of tools (assess, train, and sustain); includes a total-facility approach to reducing stigma and discrimination; and is based on a globally validated measurement tool, participatory training materials, and experiences from Africa, the Caribbean, and South and Southeast Asia. The stigma-reduction package has been implemented globally, with work ongoing in Ghana, Tanzania, and Jamaica. During the webinar, Suzie Jacinthe of USAID/Ghana commented, “We’ve never been able to quantify [stigma-reduction activities] in a way to show that what we’re doing is measurable change. With this activity, the beauty about it is that we…do questionnaires for the health facility as well as questionnaires from the PLHIV perspective of their experiences with those facilities to: gauge both [perspectives], come up with interventions out of the findings of the assessment, pilot them…and measure that change.” Jacinthe went on to say that HP+’s current effort to also cost these interventions, a first, will help governments demonstrate the real costs, alongside the measurable benefits, of implementing and replicating stigma-reduction interventions.
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+).