Welcome to the USAID-funded Health Policy Plus (HP+) project website.
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A key component of successful advocacy is engaging media to promote issues relevant to a wide audience in order to build awareness of critical issues and garner support for change. To this end, HP+ conducted a training workshop for national journalists on the fundamentals of family planning and reproductive health (FP/RH) and their importance in underpinning the country’s development and future growth. The workshop, held November 12-14 in Antananarivo, brought together 11 national and local journalists from radio, television, and print media to learn about the importance of FP/RH and provided the opportunity to role play interviews with health workers and clients from primary healthcare centers. Moving forward, HP+ will serve as a bridge between journalists and experts on FP/RH in Madagascar, supporting journalists to network with and source their information from knowledgeable health personnel. As a follow up with a stipend from HP+, each journalist will undertake investigative reporting on topics such as early pregnancy, early marriage, barriers to family planning use, access to family planning services, and family planning for homeless people to be published in January and February. These stories on reproductive health will bolster advocacy efforts.
In Guatemala, HEP+ has been supporting the National Network on Indigenous Women Rights, or REDNAMI, to strengthen advocacy and policy dialogue strategies and promote the long-term sustainability of civil society networks in Guatemala. On November 18, in observance of the International Day of Non-Violence against Women, REDNAMI held an event to discuss sexual and reproductive violence against indigenous women in Guatemala, advocating for government commitment to honoring human rights and minimizing violence against girls, adolescents, and adult women, and increasing funding for health and education—specifically targeting prevention of adolescent pregnancy, maternal death, and chronic malnutrition. Silvia Xinico, Coordinator of the National Alliance of Indigenous Women’s Organizations for Reproductive Health, Nutrition, and Education, served as moderator of the event, and emphasized the importance of including indigenous women’s issues in national policy.
Since 2011, Malawi’s HIV clinical guidelines have recommended that providers proactively offer family planning to all clients at each ART visit to ensure no missed opportunity to support PLHIV’s reproductive intentions. This approach, called Provider-Initiated Family Planning (PFIP), calls for condoms and injectables to be available at the ART clinic, and referrals for other methods as needed. In 2015, the USAID-funded Health Policy Project assessed the extent of PFIP implementation in Malawi by collecting data at 41 health facilities (both public and NGO) through facility audits, provider interviews, client exit interviews, and mystery client visits. This study – discussed in a new article in Global Health Science and Practice Provider-Initiated Family Planning within HIV Services in Malawi: Did Policy Make It into Practice? – found that contrary to clinical protocols, only 14% of clients at the ART clinic reported being offered family planning during their visit that day. Furthermore, only 24% of providers had received training in FP-HIV integration, 21% had no family planning training at all, and only half of providers had information on where to refer clients for family planning. Only 24% of sites had both condoms and injectables on hand, and only 15% of ART clinics had a full range of FP available. Overwhelmingly most ART clients relied on condoms for FP, yet there was significant demand for family planning among the female ART clients, with about half wanting no more children. These findings suggest that although Malawi has been an early adopter of PFIP, this innovative policy is not being implemented in practice. The authors, Erin K. McGinn (Palladium) and Laili Irani (Population Council), conclude that the demand for integrated services and high unmet need for FP among PLHIV underscores the need for more focused efforts to fully implement PIFP in Malawi’s HIV services.
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.
In Nigeria, HP+ has been working to support implementation of the Basic Health Care Provision Fund (BHCPF)—a critical health reform aimed at improving and expanding high-quality, affordable, accessible primary healthcare services to all Nigerians. This month, the first-ever BHCPF scorecard, intended to showcase state-level readiness and initial implementation of one of the key sources of federal-level funding for the BHCPF, was rolled out. The evaluation revealed that, of all 24 states assessed, only three (Abia, Osun, and the Federal Capital Territory)—all of which were supported by HP+—met all of the requirements. A fourth HP+-supported state (Ebonyi) met all but one requirement. The scorecard assessed whether proper structures were put in place to accept federal-level funds for implementation, facility baseline assessments were conducted, and a significant cascade of facility-level trainings on BHCPF implementation were completed. HP+ support to this effort is critical, as the project has worked to improve institutional capacity and facility-level readiness to implement a ground-breaking health reform, that if successful, could significantly move the needle towards achieving universal health coverage goals in Nigeria.
After a decade of aid suspension, Gambia’s newly-elected President met with US government officials and a health assessment team to discuss the lifting of the country’s suspension and what it could mean for Gambia. Modibo Maiga and Pascal Saint-Firmin, representing the USAID-funded Health Policy Plus project’s West Africa program, attended the meeting, which also included the United States Ambassador, Eleonore Rabelahasa, and Rachel Cintron from USAID.
HP+ has demonstrated its value to USAID Eswatini in facilitating the transitioning of two local organizations from subs to primes. During March and April 2019, HP+ supported USAID Eswatini to assess the landscape of local organizations working in the HIV sector with regard to their institutional and technical capacity. HP+ conducted organizational capacity assessments (OCAs) with 11 local non-governmental organizations (NGOs) and faith-based organizations (FBOs) and provided recommendations to USAID on organizations exhibiting strong capacity that could be transitioned to primes with some further preparation. HP+ was recently notified of USAID Eswatini’s desire to transition two of the more highly ranked organizations to primes and will be drawing on HP+’s assessment findings and materials in lieu of doing NUPAS with the current subs. World Vision Eswatini is a current sub to Pact and has HIV expertise in OVC, economic strengthening, youth, key populations, and the HIV care continuum. Young Heroes is also a sub to Pact and is known for its work in OVC and youth, although it has expanded into additional HIV sub-areas as the organization has grown.
Health Policy Plus Cambodia received an appreciation award from Cambodia’s National AIDS Authority at its Annual Congress Meeting on November 6, 2019, in Phnom Penh. HP+ Cambodia engaged with the National AIDS Authority on evidence generation, capacity building, policy advocacy, and technical dialogue to drive policy change for a more sustainable and domestically financed HIV response. A success of the engagement has culminated in the prime minister approving a policy circular to increase allocation of resources for HIV. Read our brief for more information.
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.
Read additional background from local reporting
Abia State hosted a Legislatures Day Event on September 26, 2019, which featured a special session in the general chamber of the House of Assembly, an orientation focused on state health systems strengthening, and a launch among legislatures and HP+ visitors. The first-time special parliamentary session on universal health coverage at the House of Assembly coincided with the launch of the State Social Health Insurance Scheme and was designed to advance state government understanding and commitment for financing and oversight of the primary health care system. HP+ project director Suneeta Sharma addressed the legislature, where members of the Health & Women, Appropriations, and Public Private Partnership (PPP) committees as well as the speaker of the House expressed their commitment to universal health coverage and the strengthening of the state’s primary health service delivery. The PPP Committee chairman said: “The House will support the primary health care initiative, which will improve the economy of the State because when people are healthy, they can work.” The Abia Legislatures Day Event was an innovative way for HP+ to engage collectively with the House of Assembly on this important topic and to set a model approach for engagement with government leaders in other priority States. Get more background details.
A new blog -- Integrating Services Means Thinking Outside Silos -- published on Science Speaks, the global health blog of the Infectious Disease Society of America, addresses the need for greater integration of family planning and HIV service delivery. The commentary, by Health Policy Plus deputy director for family planning and reproductive health, Jay Gribble, and the project’s technical lead on stewardship, RTI’s Alyson Lipsky, discusses the complexity of integration and explores three policy approaches to support it. They conclude that, “To move forward, health system actors must identify the problem that integration is trying to fix and which approach to integration best addresses that underlying problem. Often, the biggest challenge is breaking down the health system silos and being open to finding new ways to respond to people’s health needs.”
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.
Members of the U.S. House of Representatives Foreign Affairs committee were briefed on US-funded health programs in Burkina Faso on October 4, 2019, during the delegation’s visit to Ouagadougou. The delegation of Karen Bass and Representative Sheila Jackson-Lee joined U.S. Ambassador Andrew Young, staff of the Centers for Disease Control and Prevention and USAID partners to share successes in health support and discuss challenges related to the ongoing strike of health professionals, security, and support for internally displaced people. Modibo Maiga, HP+ country director, and other implementing partners highlighted the strong collaboration between the US and Burkina Faso and the important role that community leaders, including religious leaders and youth, have played in mobilizing domestic resources for health and catalyzing policy change in support of family planning, adolescent reproductive health, and HIV/AIDS. Maiga also briefed the delegation on efforts by the Ministry of Health to integrate community health workers into its health workforce and stressed that the formalization of this cadre of workers at the community level will reduce the impact of the striking health professionals and will help defuse security tensions in communities.
In Madagascar, HP+ has been working to support efforts to harness the demographic dividend as the country’s age structure shifts toward a larger workforce, boosting economic growth. On September 12, the Ministry of Economy and Finance, with support from HP+ and UNFPA, organized the official launch of the country’s Demographic Dividend Roadmap at an event in Antananarivo. The event, which brought together stakeholders involved in coordination of activities aimed at achieving the demographic dividend, was attended by the Minister of Economy and Finance Richard Randriamandrato and actors from the public and private sectors, civil society, and technical and financial partners. At the launch, Randriamandrato formally validated the roadmap and discussed the importance of considering the country’s family planning/reproductive health law in efforts geared toward achieving the demographic dividend. At the end of September, HP+ is supporting the Ministry of Economy and Finance to finalize a follow-up plan, including details on monitoring and evaluation, budgeting, and resource mobilization for key activities.
Across two USAID priority states—Lagos and Kano—and at the national level, HP+ is supporting the implementation of a series of activities aimed at achieving sustainable financing for HIV and tuberculosis (TB) programs in Nigeria. At a workshop on September 3, organized by the Kano State Ministry of Health in collaboration with HP+, the Kano State TB Domestic resource mobilization (Domestic resource mobilization) Committee was reactivated following a gap in donor funding and HIV/AIDS programming integrated into the committee’s mandate. The Domestic resource mobilization Committee’s aim is to improve local domestic resource funding for TB and HIV/AIDS control programs in the state, promote public-private partnerships, and ensure effective and efficient appropriation, release, utilization, and management of funds for TB and HIV. The workshop was attended by members of the Kano State Domestic resource mobilization Committee for TB/HIV, including representatives of development partners such as USAID’s Sustaining Health Outcomes through the Private Sector (SHOPS) Plus project, KNCV Tuberculosis Foundation, and FHI360. The workshop resulted in commitments made to develop a roadmap for integration of TB/HIV into national programs, advocacy kits for stakeholder engagement, and improved awareness efforts.
After many months of consultation with leading corporations and NGOs on boosting women’s health and empowerment in the workplace, the United Nations Foundation publicly released the Framework for Corporate Action on Workplace Women’s Health and Empowerment at a UN General Assembly side event on September 23. The framework, which offers a roadmap for gender-responsive policies, practices, and programs with health as the centerpiece of women’s empowerment, was developed by Meridian International—a non-profit, public diplomacy organization supported by HP+. In addition to providing concrete action steps for corporations and global supply chains to support these initiatives, the framework features publicly available tools and resources that can help companies to implement workplace interventions. At a consultation workshop during the Women Deliver conference in June, Meridian’s David Wofford presented the framework’s policy and systems change component that included information drawn from the HP+ Family Planning-Sustainable Development Goals (FP-SDGs) model. The final framework addresses workplace women’s health, gender-based violence, and professional advancement, with a priority placed on expanding access to services.
The Kyrgyz Republic has been advancing efforts to ensure sustainability of its HIV programming by developing mechanisms to provide government funding to NGOs to deliver services, or social contracting. HP+ is supporting the Ministry of Health and Republican AIDS Center to develop the regulations and mechanisms required to implement social contracting across the health sector. On September 2-3, in Bishkek, HP+ supported the Republican AIDS Center to conduct a grant launch meeting for the first round of social contracting in the health sector. The meeting, which brought together the grantor and organizations awarded approximately $43,000 to deliver services to people living with HIV – the Republican AIDS Center and six NGOs, respectively – focused on the processes and procedures of social contracting, as well as programmatic and financial reporting requirements. With HP+ facilitation, the participants developed tools and forms required for implementation of social contracting, such as an indicator matrix, an implementation action plan, a draft memorandum on interaction between regional AIDS centers and awarded NGOs, and draft reporting forms. Looking forward, HP+ will continue to support the process of implementation of social contracting in the Kyrgyz Republic through direct technical assistance and mentoring to the Republican AIDS Centers, the Ministry of Health, and grant recipients. HP+ is also supporting the national TB, oncology, and psychiatry program to advocate for funding and establish required regulatory documents for social contracting.
Government and civil society health leaders from nine Francophone countries of West Africa called for the integration of community health workers into their nations’ health systems at a ground-breaking meeting in Lomé, Togo. The three-day workshop, held from September 16 – 19, gathered health officials and implementing partners, and local community health workers, who shared their perspectives. Senior officials from Togo’s Ministry of Health, WAHO and WHO’s West Africa office, along with U.S. Ambassador, Eric Stromayer joined a high-level opening ceremony. Eleonore Rabelahasa, the Senior Health Systems Strengthening and Policy Advisor in USAID’s regional health office, also participated in the three-day workshop. Five Togolese CHWs, who deliver a range of family planning, malaria and health consultations interventions, discussed the challenges and opportunities they face as front-line health workers and their perspectives to improve their capacity to improve equitable access to health services. The delegates developed action plans for each country with a goal to convene key stakeholders and put in place a plan of action by June 30, 2020.
Malawi's population is one of the fastest-growing in Africa, placing great strain on its health system, environment, and economy—hindering the country's ability to meet its development goals. To address unmet need for family planning services and the needs of adolescent girls and young women at all levels, HP+ is coordinating across multiple sectors including engaging traditional and religious leaders and communities. Christian Connections for International Health (CCIH) published a story this week about a family in Malawi helped by the Evangelical Association of Malawi, under an HP+ supported activity. The account of a family receiving marriage and birth-spacing counseling after a family tragedy, demonstrates how engagement with community leaders on family planning messaging helped on family mend and achieve financial security.
The National Reproductive Health Program, as coordinator of the National Contraceptive Assurance Commission, held the Contraceptive Assurance Sub-Committees Meeting on August 8 and 9, to implement Ministry of Health and Social Welfare guidelines requiring that each health area form its own contraceptive assurance subcommittee. The sub-committees, integrated with the support of HEP+, submitted their findings and challenges and exchanged experiences with representatives of the health areas and other organizations that will be part of future sub-committees. USAID representative Vikki Stein, who attended the meeting, said "I want to specially recognize the Ministry of Health as the governing entity, because it has taken a very important decision to extend the sub-committees to all health areas. This action is helping improve the lives of women by preventing maternal and infant mortality."
In late June, HP+ held a three-day training workshop in Mbabane on the oral pre-exposure prophylaxis implementation, planning, monitoring, and evaluation tool (PrEP-it) for 33 Ministry of Health officials, representatives of implementing partners, USAID, and other stakeholders including the World Health Organization and UNAIDS. The pilot workshop, which took place from June 24-27, gave participants hands-on experience in the five modules of the tool: PrEP cascade, capacity, target-setting, costing, and impact. Meanwhile, the development team garnered valuable feedback on the usability and functionality of the tool. The Ministry of Health utilized the segment on target-setting to set their actual national targets for PrEP scale-up based on desired coverage of eSwatini’s PrEP priority populations. As a result of the workshop, the eSwatini government was able to establish and set PrEP targets for the next five years—the first country to do so—by capitalizing on the participation and concurrence of stakeholders at the training. Version 1.0 of PrEP-it is scheduled for release in September 2019.
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.
The impending completion of the USAID-funded High Impact Services (SSGI) project threatens to leave 799 community health workers (CHWs) in the regions of Kayes and Sikasso without funding. Community health workers are an important lever for increasing access to quality health services in Mali whose work is essential to be sustained, so HP + worked with partners at the national and local levels to mobilize local resources to fill the gap until the nation’s new health reforms go into effect in 2022. As a result of the work done by HP+ and partners, the Decentralization Support Cell of the Ministry of Health and Social Affairs sent a memo at the beginning of August 2019 to the Minister of Health to transfer funds gained from replacing oil refrigerators with those that are solar powered to finance the community health worker program. This commitment and resource gap filling came as a result of meetings with regional and administrative authorities in these regions who identified the cold chain petrol budget line item as an opportunity. HP+ has also garnered support for better CHW job accountability and security by implementing employment contracts between mayors and health workers – as of July 2019, 105 community health workers have signed contracts across 26 municipalities in Sikasso and 105 health workers have done so across 43 municipalities in Kayes.
Mali’s new Minister of Health Michel Hamala Sidibe launched the country’s costed implementation plan (CIP) in Bamako on July 16th, at an event featuring the USAID family planning advisor Patrick Coulibaly and the UNFPA country representative Josiane Yaguibou. Capitalizing on the growth in modern contraceptive prevalence rate between 2012/13 and 2018 (9.9%-18%), the CIP goal is to reach 30 percent by 2023. The CIP was developed with support by USAID through the Health Policy Project, which worked closely with Technical Advisor of the Minister, Dr. Mohamed Berthé, who is also the FP2020 focal point, and who ensured Ministry of Health and Social Affairs leadership throughout the process. Local news coverage of the event featured HP+ policy and advocacy advisor, Rokia Sissoko, who emphasized the collective effort of many stakeholders. Shanda Steimer, the USAID Mali health team lead, also attended the event.
Mali's National Network of Key Population Associations (RENAPOC), which advocates for its members to seek health services, prioritized addressing the barrier of stigma and discrimination to increase health access to HIV prevention and treatment services. All 36 members from Bamako, Kayes, Koulikoro, Sikasso, Ségou and Mopti came together to discuss and approve the contents of the strategic plan and on March 2, 2019, with technical and financial support from HP+ Mali, finalized and adopted a strategic plan. The RENAPOC strategic plan is now accepted as the validated strategic plan of the various key population associations and will allow RENAPOC to operate with a stronger structure and strengthened autonomy. This strategic plan will serve as a reference tool, both for internal and external partners, for the next 5 years.
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.”
On April 29 and 30, a caravan of Ouagadougou Partnership donors visited Mali to view progress that has been made in achieving family planning objectives and to understand existing challenges to these efforts. Since February, HP+ Mali has led the process of finalizing the country’s second generation costed implementation plan for family planning (CIP) that includes plans to accelerate modern contraceptive prevalence in the country from 16 percent in 2019 to 30 percent by 2023. The donor caravan deemed the CIP process to be “inclusive” of all necessary actors, highlighting the success of HP+ Mali in convening and executing the planning process. The project is in the process of finalizing the CIP in line with final recommendations from the pilot committee and aims to launch the plan in June 2019.
On May 3, Osun State—one of three states supported by HP+ in Nigeria—became the first state in the country to begin enrollment of clients into the national Basic Health Care Provision Fund (BHCPF), the federal government’s initiative to provide the rural poor with a basic package of health services. Along with the achievement of this milestone, the state will receive approximately US$2.5 million over the next nine months—delivered directly to selected primary healthcare facilities to support the delivery of high-quality health services. HP+ has supported Osun State to pilot the BHCPF for the last three months in preparation for the scheme’s statewide roll-out. “The learning from the pilot program will influence what will happen moving forward,” said HP+ Nigeria Country Director Onoriode Ezire to government officials at the launch. “We hope that, beyond the launch, access will be improved, and we will continue to address maternal and infant mortality in the state,” he added.
On May 22, 2019, two key health reform bills secured concurrence by Nigeria’s House of Representatives, the final step before the bills move forward for presidential authorization. The Federal Capital Territory’s (FCT’s) State Health Insurance and Primary Health Care Board bills, which were passed last month by Nigeria’s Senate, promise to improve access to primary healthcare and relieve financial barriers, particularly among the poor. Once signed into law, the bills will allow the FCT to access the country’s Basic Health Care Provision Fund—a national- and state-level mechanism that aims to extend health insurance coverage and provide a range of free services to the country’s most vulnerable groups.
HP+ supported Kenya’s National Malaria Control Programme to develop the next iteration of its national malaria strategy—one that includes, for the first time, a financial sustainability plan. The resulting costed Kenya Malaria Strategy (KMS) 2019-2023 guides the country’s malaria control strategy for the next five years and informs the Ministry of Health’s planning and prioritization of key malaria interventions. The financial sustainability plan outlines resource needs, resource availability, and funding opportunities to help close the identified Ksh 24 billion funding gap. The Kenyan government estimates that three-quarters of its population is at risk for malaria and, through the KMS, aims to reduce malaria incidence and death by at least 75% (of 2016 levels) by 2023.
Nigeria’s Federal Capitol Territory (FCT) is a major step closer to accessing resources for primary health care with the passage of a previously stymied law. Bolstered with evidence gathered with support from USAID through the Health Policy Plus project and capacity development of advocates and FCT leadership, the FCT secured sponsorship of the health insurance and primary health care board bills at the National Assembly and have been able to advance the bills through the stages of the legislative process. Concurrence and presidential assent, the final stages of the process, will open the door for the FCT to access the Basic Health Care Provision Fund (BHCPF), a national and state-level mechanism that will extend health insurance coverage, and a range of free services, not only to those in the public and formal private sector, but also to the vulnerable – pregnant women, children under 5-years old, persons with disabilities, and the elderly – and those in the informal sector, for whom access and the ability to pay for primary health care was a barrier. State-by-state health reform has been advancing to secure the systems and legal backing needed to access the BHCPF, while the FCT had been delayed until now. With this advancement, access to the fund is expected to reduce maternal and under-5 mortality rates and reduce financial hardship resulting from medical costs. Momentum around the BHCPF in Nigeria increased significantly last year with approved funding under the 2018 national budget. HP+ supported FCT leadership through each step of the legislative process, which it will continue to provide as the bill moves forward for concurrence and authorization by the President of Nigeria.
Developing Radio Partners (DRP), has leveraged its HP+ work with PRB in Malawi to garner more funding that is significantly expanding the listening audience for a community radio project broadcasting messages about youth-friendly health services. With HP+ support, DRP has trained and mentored teams of teenagers over the past two years to produce weekly programs that are aired by community radio stations in three districts in Central and Southern Malawi. Last year, it added two more stations, raising the project’s audience to more than 3 million. Building on the success, DRP has received $30,000 from the Conservation, Food & Health Foundation, based in Boston, to fund similar activities at two more stations through September 2019. Mzati Radio in Mulanje in southern Malawi and the Voice of Livingstonia in Mzuzu in the north were chosen in part because their listening areas have high rates of HIV, and early marriage is prevalent in Mzuzu. DRP is working with teams at the two new stations to produce weekly programs. This includes instruction on technical production as well as information about the National Youth-Friendly Health Services Strategy so the young journalists can accurately spread word via their radio programs to their peers about the services they are entitled to receive.
On January 25, at a meeting of parliamentarians convened by HP+ partner the White Ribbon Alliance for Safe Motherhood (WRA) Malawi, a representative from the Department of Human Resources Management and Development reported that 925 midwives were recruited and 303 midwives were promoted during fiscal year 2018/2019. This success—which goes even further than the government’s initial commitment to hiring 800 midwives—is in large part due to WRA Malawi’s Bedside Midwives report that highlighted a shortage of 20,000 midwives and has been a key advocacy tool since the campaign began in 2017. At the meeting, WRA Malawi praised the government’s progress to date and asked for continued support through approval of an increased budget to recruit, train, and retain more midwives, and the creation of a district-level nursing and midwifery pathway.
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 2017 and 2018, HP+ began developing tools and approaches to advance public financing for non-governmental organizations working in HIV and other health related areas. HP+ supported the Global Fund for AIDS, Tuberculosis and Malaria (the Global Fund) efforts to prioritize public financing to civil society organizations (CSOs) and non-governmental organizations (NGOs) as a critical factor in all countries’ paths to sustaining and financing their HIV, TB and Malaria programs. This included support to develop the social contracting diagnostic tool, and setting standards for analyzing the legal/regulatory factors inhibiting or enabling this government health system reform. The tools and approaches are now being used around the world by the Global Fund, HP+, and other technical assistance providers to support the uptake of social contracting. HP+ developed a policy brief to summarize the importance of advancing public financing for NGOs/CSOs/private sector as critical to HIV services and epidemic control. The brief outlines the key competencies and capacities needed to advance social contracting into government health systems. In Guyana, HP+ worked with government and other country stakeholders to identify the legal and regulatory barriers for public financing of CSO-led HIV services. In Kyrgyzstan, HP+ supported the Ministry of Health to develop regulations and protocols to implement public financing contracts to non-governmental organizations. In 2018, the government allocated funding to the mechanism.
This year’s annual national campaign for the promotion of family planning in Mali, "Multisectoral commitment to achieving the objectives of sustainable development through family planning," was launched on December 17 under sponsorship of the First Lady of Mali, Keita Aminata Maiga. For the second year in a row, HP+ was recognized by the Minister of Health and Social Affairs as the recipient of a Certificate of Acknowledgement of Family Planning Champions for its technical assistance efforts to provide the country with a consensus-driven costed implementation plan. This campaign is one of the key priorities of the Ministry of Health and Social Affairs aimed at reducing maternal and infant mortality nationwide.
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.
In December, USAID, through the Health Policy Plus (HP+) project convened a special plenary at the 5th Nigeria Family Planning Conference in Abuja. The session, “Financing Family Planning in Nigeria within the Context of the Basic Health Care Provision Fund and State Health Insurance,” featured panelists from USAID and Palladium—the prime implementer of the HP+ project—and discussants from the private sector and government. Dr. Kolade Oluwatosin, director of the private-sector firm Health Systems Consult Ltd., said during the meeting, “Best practices from countries like Kenya [another HP+-supported country] have shown that insurance can be used to address issues in family planning, but stakeholders—from donors, insurance bodies, civil society organizations, and government—must come together to agree on robust benefit packages.” From the meeting, a list of recommendations was generated for how Nigeria’s government could improve access to family planning while strengthening standards of care.
Under the leadership of Senegal’s Ministry of Health and Social Action, HP+ West Africa organized an unprecedented family planning advocacy workshop in Dakar in August to secure support and financial commitments from the private sector. The workshop resulted in more than US$630,000 pledged for family planning funding. The International Management Group (IMG), a private company from Cote d'Ivoire that took part in the Dakar meeting disbursed funds for family planning advocacy and clinic services in December 2018. Their contribution provided access to contraceptive pills, injectables, implants and IUDs to 121 additional women on voluntary contraception. This is just a start. IMG expressed a commitment to sustain its engagement moving forward.
The Ministry of Public Health has announced it will more than triple its budget to procure contraceptives in 2019. The budget item jump, from 62 million FCFA in 2018 to 200 million FCFA in 2019 comes as result of USAID-supported advocacy by family planning groups and support from Health Policy Plus (HP+), and promises to vastly increase the country’s capacity to provide voluntary family planning to meet demand. HP+ assisted Nigeren family planning advocates in forming The Network of Champions in Advocacy for Adequate Health Financing (RCPFAS) and, with the Directorate of Maternal and Child Health, provided guidance to its members to make the case for the increase, which meets a pledge made by the government at the Family Planning Summit in London in 2017. HP+ also helped organized a series of meetings with civil society and key Ministry of Health and Ministry of Finance decision makers to secure the commitment and the sign off by the Secretary General Ranaou Abache on November 22, 2018. Read more in our news story.
In October, 2018, the government of Nepal passed the Safe Motherhood and Reproductive Health Rights Act. The act ensures that important aspects of respectful maternity care such as privacy, confidentiality, and consent are well defined and protected in public as well as private healthcare facilities. This comes as the result of decades of advocacy work by Health Policy Plus partner, White Ribbon Alliance Nepal, supported by USAID under successive health policy projects, to ensure high-quality, respectful care for women and babies in Nepal. Read the WRA news story.