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Tanzania recently launched its fifth five-year health plan, a TSh 47 trillion roadmap for saving more than 200,000 lives and reducing HIV incidence by 50 percent. The Five-Year Health Sector Strategic Plan (HSSP V) also lays out strategies for averting more than 400,000 disability-adjusted life years and reducing infant, neonatal, and maternal mortality. To estimate the cost of the strategy, equivalent to US$20.3 billion, HP+ used the OneHealth tool. HP+ also estimated the resources available for the health sector from all sources. The mission of the plan, which covers 2021 to 2026, is to provide sustainable health services with standards that are acceptable to all citizens without financial constraints, based on geographical and gender equity. In her address during the June 24 launch, Honorable Minister for Health, Community Development, Gender, Elderly and Children, Dr. Dorothy Gwajima said the plan will expand reach of primary health services and address the prevention and treatment of both communicable and non-communicable diseases.
In August, HP+ facilitated a virtual training for research institutions and government representatives in Kenya, Tanzania, and Uganda on applying the Activity-Based Costing and Management methodological approach to HIV services. HP+ strengthened the capacity of these institutions and participants to implement data collection; conduct analysis; develop research protocols and data collection instruments; secure ethical clearance; facilitate stakeholder consultations; and develop reports using the approach. Findings from the analysis can help policymakers and partners to more effectively allocate resources, improve monitoring efforts, optimize investments, and drive efficiencies through improved delivery of services.
Nigeria’s Abia State launched its social health insurance scheme on September 26, 2019, taking a major step forward in ensuring its citizens gain access to equitable, affordable, and quality health services. The launch comes after a year’s long engagement by Health Policy Plus (HP+), which provided technical support to the health insurance scheme that includes defining and costing of health benefit package, developing the mechanism for claims management and provider payments, and strengthening of the organizational capacity of the agency’s governing board, management, and staff. The launch event was attended by HP+ project director Suneeta Sharma and HP+ Nigeria deputy country director Gani Alabi and several high-level government officials, including the deputy Governor of Abia state, Dr Udeh Oko Chukwu and representative of Senator Orji Uzor Kalu, former governor of Abia state, who committed to enrolling vulnerable populations from his constituency through his eponymous foundation. The chairman of the House of Assembly’s committee on health also demonstrated political will reinforcing the legislatures’ commitment to policies and frameworks for universal access. The governor’s representative announced that disbursement of funds through the Basic Health Care Provision Fund would begin on October 1, flowing to the 292 accredited ward-level primary health centers. The event demonstrated community leadership and the importance of traditional leaders in overseeing the success of the health scheme at the local level. Moving forward, payroll deductions of formal sector employees will begin in October.
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On October 10, in Jakarta, HP+ disseminated cost results from its subnational HIV activity to an audience of more than 50, composed of attendees from the Indonesian government, civil society, and development partners. HP+ collected primary cost data from 19 civil society organizations and “puskesmas” (community health clinics) in Jakarta to identify the unit costs of delivering critical HIV interventions, disaggregated by key population reached and service delivery model. Detailed, updated unit costs are needed to improve estimates of the total resources required to meet provincial HIV targets and to explore the feasibility of increased financing of the HIV response through local government and greater integration into the Jaminan Kesehatan Nasional benefits package—the country's single-payer national health insurance scheme. As a result, the Provincial Health Office for Jakarta, which presented at the dissemination event, committed to using HP+ cost results in its annual budgeting and planning for HIV activities.
The Reproductive Health Supplies Coalition Advocacy and Accountability working group hosted a webinar, Expanding Access: Estimating the Impact of DMPA-SC Introduction, in December 2017. The webinar, now featured on their website, was led by Erin McGinn, Jim Rosen, and Michelle Weinberger of the USAID-funded Health Policy Plus (HP+) project, provided an overview of the HP+ Microsoft Excel-based model to project the potential contribution of DMPA-SC (also referred to as Sayana Press) to a national family planning program. This model covers both hypothetical public health impact and potential cost savings and returns on investment. Results of recent country applications in Nigeria and Cameroon were shared during the webinar. Read our brief for more information.
The World Bank approved the equivalent of US$105 million in non-reimbursable grants for the Government of Mozambique’s Primary Health Care Strengthening Program‐for‐Results—US$25 million from the Global Finance Facility (GFF) and US$80 million from the International Development Association (IDA). This announcement is due in part as a result of efforts by the USAID-funded Health Policy Plus project. HP+ had assisted the Mozambican government to develop an “investment case” to demonstrate the potential benefits of reproductive, maternal, neonatal, child, and adolescent health investment for the country. The investment case is the result of consultations about priority interventions to help increase service effectiveness, stimulate user demand, and strengthen the health system—initiatives that are needed to improve maternal and neonatal mortality rates while sustaining progress on reducing infant mortality in Mozambique. Read the World Bank Press release.
USAID and PEPFAR, through HP+ is providing technical support to Guyana’s national AIDS program secretariat to plan for the country’s transition from external to domestic financing of HIV programs and services. This support includes the development mechanisms the government can use to directly support civil society through new “social contracting” measures. A meeting held in mid-November resulted in consensus among nearly 50 civil society, private sector, and government stakeholders and donors to move forward with a social contracting model. In addition to implementation of the model, HP+ will provide additional support to Guyana’s mobilization of domestic resources for HIV programs, including developing costing of civil society-led services and programs and technical assistance to Guyana’s high-level HIV Transition and Sustainability Steering Committee.
Ministry of Health (MoH) Kenya engaged stakeholders’ preparation of the grant for securing Global Fund resources for HIV/AIDS, Tuberculosis and Malaria. The grant making process which took more than a month involved review of program interventions and targets, costs and cash forecast for the next three and half years. As a result, Kenya application of US$ 356 million is expected to go to full GFATM Board for approval in November 2017. HP+ supported MoH to cost the proposed intervention and in realignment of the grant distribution so as to facilitate the absorption capacity of the grant over the 3.5 years for the three diseases.
An article published in the Pacific Standard (Malawi’s Secret Weapon Against HIV: Male Circumcision, September 8, 2016) highlights the impact of USAID's Voluntary Male Medical Circumcision modeling study conducted by the Health Policy Project. The study recommends that Malawi focus on recruiting men and boys between the ages of 10 and 34 and to prioritize urban areas. The recommendation led the government of Malawi to shift its VMMC focus with an aim to have 60 percent of males between the ages of 10 and 34 in 14 of Malawi’s 28 districts circumcised by 2025. If Malawi reaches this goal the study calculates a potential total savings of $344 million.
The Government of Malawi adjusted its VMMC programming based on recommendations presented in a study authored by the USAID-supported Health Policy Plus project. The study models the impact and cost of focusing Malawi’s VMMC program by client age and geography. It recommends that Malawi focus on recruiting men and boys between the ages of 10 and 34 and to prioritize urban areas. In response to recommendations, the Government of Malawi is shifting its VMMC focus to aim to have 60 percent of males between the ages of 10 and 34 in 14 of Malawi’s 28 districts circumcised by 2025. If Malawi reaches this goal the study calculates a potential total savings of $344 million. The Health Policy Project’s study and its influence on programming in Malawi was featured in a Pacific Standard article on September 8, 2016 (Malawi’s Secret Weapon Against HIV: Male Circumcision).
Palladium’s Catherine (Barker) Cantelmo and Thomas Fagan presented work conducted under the Health Policy Project at an oral session on health financing chaired by Michael Ruffner (PEPFAR) and David Wilson (World Bank) at the International AIDS Conference. One of the presentations was on a study published in Plos Medicine. This 97-country study estimates that the facility-level ART resource needs for test-and-start from 2016 to 2020 exceed the projected funding available, assuming flat external support yet ambitious domestic resource contribution, and that the five-year funding gap could be as large as $21 billion. The results of the study were cited in a Washington Post article that underscores the need for additional donor funding for HIV, including a fully-funded Global Fund, to sustain the progress made over the last 16 years.