Strategic Purchasing of Health Care Services in BotswanaHFG Project
The document discusses strategic purchasing of health care services in Botswana, noting that the majority of health funds are currently spent on secondary and tertiary care rather than primary care. It analyzes Botswana's health financing and expenditures, provider payment systems, and lessons that can be learned from international experience to reform primary health care financing through strategic purchasing. The recommendations aim to improve allocative efficiency and incentivize quality primary health care.
Public Financial Management, Health Governance, and Health SystemsHFG Project
While the importance of governance in a health system is well recognized, there is an overall lack of evidence and understanding of the dynamics of how improved governance can influence health system performance and health outcomes. There is still considerable debate on which governance interventions are appropriate for different contexts. This lack of evidence can result in avoidance of health governance efforts or an over-reliance on a limited set of governance interventions. As development partners and governments are increasing their emphasis on improving accountability and transparency of health systems and strengthening country policies and institutions to move towards universal health coverage (UHC), the need of this evidence is ever rising.
To address this evidence gap, the USAID’s Office of Health Systems (USAID/GH/OHS), the World Health Organization (WHO), and the Health Finance and Governance (HFG) Project launched an initiative in September 2016 to ‘Marshall the Evidence’ on how governance contributes to health system performance and improves health outcomes.
The overall objective of the initiative was to increase awareness and understanding of the evidence of what works and why in how governance contributes to health system performance, and how the field of health governance is evolving at the country level. This report provides a synthesis of the findings across the four themes. This report presents the findings of the Public Financial Management.
Modeling the impact of the health finance and governance projectHFG Project
Over its six-year life (2012-2018), the project worked with more than 40 partner countries to increase their domestic resources for health, manage resources more effectively, and reduce system bottlenecks in order to increase access to and use of priority health services and strengthen health systems overall. HFG provided state-of-the-art and country-specific technical assistance to remove obstacles that impede effective health system functioning and essential reforms. Recognizing the importance of measuring its impact, HFG quantified its return on investment for HFG health systems strengthening efforts.
HFG and its partner Avenir Health conducted a rigorous exercise to estimate the impact of the project’s health systems strengthening activities on its overall goal: increased use of priority health services. We used Spectrum, a suite of modeling tools developed by Avenir Health and partners, to quantify impact on mortality and morbidity based on changes in the coverage of specific priority health services due to the project’s activities aimed at improving access, quality, and use of health care. Given the diverse activities of HFG and the challenge of establishing a measurable causal link between project activities and coverage effects, we adopted a conservative approach and chose for this impact modeling exercise a subset of HFG activities for which a direct link was apparent. Based on these parameters, the exercise was conducted for eight country programs: Bangladesh, Cote d’Ivoire, Cameroon, Ethiopia, Haiti, Nigeria, Senegal, and Vietnam.
Using a methodical approach, we analyzed individual project activities in these countries and the expected effects on service coverage to estimate the impact on morbidity and mortality. We examined how our activities, including implementing strategies for improved human resources for health, operationalizing health insurance schemes, rolling out packages of health services, and using costed plans and packages to advocate for more financial resources, will increase access to health services, which in turn will lead to greater coverage of health services among targeted populations and ultimately to reduced morbidity and mortality. We modeled the impact of HFG’s activities by quantifying the number of deaths that were averted as a result of HFG-supported strategies and reforms.
The modeling results indicate that continued implementation of health systems strengthening strategies like those HFG supported would bring significant expansion of health care coverage and enhanced health outcomes.
This report presents country- and activity-specific results and the methodology for estimating coverage changes and impact. We hope this modeling exercise adds to the global understanding of how the impact of health systems strengthening can be measured. It provides powerful evidence on why investment and effort in strengthening health systems must continue.
Maximizing Human Capital by Aligning Investments in Health and EducationHFG Project
There is a strong evidence base that identifies strategic investments in health and education across the life course that can maximize human capital development. Key opportunities exist during prenatal development and the first 1000 days, early childhood, school-age years, and adolescence to deliver cost-effective interventions that improve both health and education outcomes. Current global investments are imbalanced and miss opportunities for synergies between sectors. Coordinating health and education efforts, especially during school-age years, could enhance returns on investments and help populations reach their full potential.
Landscape of Urban Health Financing and Governance in BangladeshHFG Project
The document provides an overview of urban health care delivery in Bangladesh. It finds that while urban local bodies are legally responsible for primary health care, they lack the infrastructure to provide these services. As a result, the urban population relies on a variety of alternative providers, including private clinics and hospitals, government secondary/tertiary hospitals, donor-funded projects like the Urban Primary Health Care Services Delivery Project and NGO Health Service Delivery Project, international NGOs, and local NGOs/CBOs. These institutions are financed through different mechanisms like user fees, government budgets, and donor funding. Governance also varies depending on the type of organization. The analysis concludes there are significant gaps in knowledge around urban health financing, delivery
Strengthening Primary Care Through Performance - Based Incentive SystemHFG Project
The document summarizes the findings from two cycles of research on Indonesia's primary care incentive system under its national health insurance program. The research found that:
1) Health workers' incomes come from various sources, including government salary, capitation payments, regional allowances, and private practice, but the capitation system does not adequately motivate individual performance.
2) There is wide variation in health workers' incomes between districts and facilities based on local policies and patient volumes.
3) While incentive systems exist, they are often based more on attendance and processes rather than quality metrics or achievement of health targets. Respondents recommended revising incentives and indicators to better promote quality primary care performance.
Strategic Purchasing of Health Care Services in BotswanaHFG Project
The document discusses strategic purchasing of health care services in Botswana, noting that the majority of health funds are currently spent on secondary and tertiary care rather than primary care. It analyzes Botswana's health financing and expenditures, provider payment systems, and lessons that can be learned from international experience to reform primary health care financing through strategic purchasing. The recommendations aim to improve allocative efficiency and incentivize quality primary health care.
Public Financial Management, Health Governance, and Health SystemsHFG Project
While the importance of governance in a health system is well recognized, there is an overall lack of evidence and understanding of the dynamics of how improved governance can influence health system performance and health outcomes. There is still considerable debate on which governance interventions are appropriate for different contexts. This lack of evidence can result in avoidance of health governance efforts or an over-reliance on a limited set of governance interventions. As development partners and governments are increasing their emphasis on improving accountability and transparency of health systems and strengthening country policies and institutions to move towards universal health coverage (UHC), the need of this evidence is ever rising.
To address this evidence gap, the USAID’s Office of Health Systems (USAID/GH/OHS), the World Health Organization (WHO), and the Health Finance and Governance (HFG) Project launched an initiative in September 2016 to ‘Marshall the Evidence’ on how governance contributes to health system performance and improves health outcomes.
The overall objective of the initiative was to increase awareness and understanding of the evidence of what works and why in how governance contributes to health system performance, and how the field of health governance is evolving at the country level. This report provides a synthesis of the findings across the four themes. This report presents the findings of the Public Financial Management.
Modeling the impact of the health finance and governance projectHFG Project
Over its six-year life (2012-2018), the project worked with more than 40 partner countries to increase their domestic resources for health, manage resources more effectively, and reduce system bottlenecks in order to increase access to and use of priority health services and strengthen health systems overall. HFG provided state-of-the-art and country-specific technical assistance to remove obstacles that impede effective health system functioning and essential reforms. Recognizing the importance of measuring its impact, HFG quantified its return on investment for HFG health systems strengthening efforts.
HFG and its partner Avenir Health conducted a rigorous exercise to estimate the impact of the project’s health systems strengthening activities on its overall goal: increased use of priority health services. We used Spectrum, a suite of modeling tools developed by Avenir Health and partners, to quantify impact on mortality and morbidity based on changes in the coverage of specific priority health services due to the project’s activities aimed at improving access, quality, and use of health care. Given the diverse activities of HFG and the challenge of establishing a measurable causal link between project activities and coverage effects, we adopted a conservative approach and chose for this impact modeling exercise a subset of HFG activities for which a direct link was apparent. Based on these parameters, the exercise was conducted for eight country programs: Bangladesh, Cote d’Ivoire, Cameroon, Ethiopia, Haiti, Nigeria, Senegal, and Vietnam.
Using a methodical approach, we analyzed individual project activities in these countries and the expected effects on service coverage to estimate the impact on morbidity and mortality. We examined how our activities, including implementing strategies for improved human resources for health, operationalizing health insurance schemes, rolling out packages of health services, and using costed plans and packages to advocate for more financial resources, will increase access to health services, which in turn will lead to greater coverage of health services among targeted populations and ultimately to reduced morbidity and mortality. We modeled the impact of HFG’s activities by quantifying the number of deaths that were averted as a result of HFG-supported strategies and reforms.
The modeling results indicate that continued implementation of health systems strengthening strategies like those HFG supported would bring significant expansion of health care coverage and enhanced health outcomes.
This report presents country- and activity-specific results and the methodology for estimating coverage changes and impact. We hope this modeling exercise adds to the global understanding of how the impact of health systems strengthening can be measured. It provides powerful evidence on why investment and effort in strengthening health systems must continue.
Maximizing Human Capital by Aligning Investments in Health and EducationHFG Project
There is a strong evidence base that identifies strategic investments in health and education across the life course that can maximize human capital development. Key opportunities exist during prenatal development and the first 1000 days, early childhood, school-age years, and adolescence to deliver cost-effective interventions that improve both health and education outcomes. Current global investments are imbalanced and miss opportunities for synergies between sectors. Coordinating health and education efforts, especially during school-age years, could enhance returns on investments and help populations reach their full potential.
Landscape of Urban Health Financing and Governance in BangladeshHFG Project
The document provides an overview of urban health care delivery in Bangladesh. It finds that while urban local bodies are legally responsible for primary health care, they lack the infrastructure to provide these services. As a result, the urban population relies on a variety of alternative providers, including private clinics and hospitals, government secondary/tertiary hospitals, donor-funded projects like the Urban Primary Health Care Services Delivery Project and NGO Health Service Delivery Project, international NGOs, and local NGOs/CBOs. These institutions are financed through different mechanisms like user fees, government budgets, and donor funding. Governance also varies depending on the type of organization. The analysis concludes there are significant gaps in knowledge around urban health financing, delivery
Strengthening Primary Care Through Performance - Based Incentive SystemHFG Project
The document summarizes the findings from two cycles of research on Indonesia's primary care incentive system under its national health insurance program. The research found that:
1) Health workers' incomes come from various sources, including government salary, capitation payments, regional allowances, and private practice, but the capitation system does not adequately motivate individual performance.
2) There is wide variation in health workers' incomes between districts and facilities based on local policies and patient volumes.
3) While incentive systems exist, they are often based more on attendance and processes rather than quality metrics or achievement of health targets. Respondents recommended revising incentives and indicators to better promote quality primary care performance.
The Health Finance and Governance Briefing KitHFG Project
Resource Type: Brief
Authors: Megan Meline, Lisa Tarantino, Jeremy Kanthor, and Sharon Nakhimovsky
Published: September 2015
Resource Description: Getting access to affordable, quality health care is a universal story that touches virtually every family in the world. At the same time, providing quality health services and access to trained health professionals is a challenge for governments. The World Health Organization (WHO) estimates that 150 million people worldwide face “catastrophic expenditure” because of high costs of health care. In other words, they may have to forgo paying for basic needs, such as food, housing, or education to pay for medical treatment instead. These costs include transportation, doctors’ fees, medicine, hospitalization bills, and days lost from work.
Behind these sobering statistics lies a wealth of news and feature stories waiting for the media to investigate and share with national leaders and policymakers as well as civil society groups who can advocate for changes to health budgets and policies. At the heart of these stories are important questions about the financing of health care and the quality of governance that ensures responsive and effective management of those resources and services.
But writing health finance and governance stories can be challenging. Health finance is riddled with complex language, technical economic terms, and numbers – not necessarily a journalist’s comfort zone. The right sources for these stories can be difficult to identify and unwilling to talk. Data may be difficult to locate or to understand. And while corruption makes for splashy headlines, the broader systemic challenges of health governance are not widely understood — and yet they are important.
The Health Finance and Governance Briefing Kit is designed to help journalists and their editors uncover and tell these important health stories that affect people all around the world.
Guyana 2016 Health Accounts - Main ReportHFG Project
The document summarizes the key findings of Guyana's first Health Accounts exercise for fiscal year 2016. It found that total health expenditure was G$ 28.6 billion, with the government contributing 81% of funding. Household out-of-pocket spending accounted for 9% of total spending. Non-communicable diseases received the largest share of spending at 34%. The analysis aims to inform strategic health financing decisions and assess domestic resource mobilization as external donor funding declines. Recommendations include increasing prevention spending and strengthening financial commitment to HIV programs.
South Africa HIV and TB Expenditure Review 2014/15 - 2016/17. Executive SummaryHFG Project
The South African Government (SAG) and its development partners have mounted a formidable response to the world’s largest HIV epidemic and a persistent burden of tuberculosis (TB), the country’s leading killer. Nearly 4 million South Africans initiated antiretroviral therapy (ART) by the end of financial year 2016/17, helping to curtail new infections and reduce the number of annual HIV-related deaths. Mortality from TB has also declined thanks, in part, to improved treatment success.
Despite progress, challenges remain. Roughly 3 million people living with HIV (PLHIV) lack treatment, and each year more than a quarter million are newly infected. Moreover, nearly a half million South Africans contract TB every year, with an increasing share affected by drug-resistant strains.
To effectively plan and steward the health system, the SAG routinely monitors programmatic and financial performance of the response to HIV and TB, including by tracking expenditure. Analysis of spending, including trends in sources, levels, geographic and programmatic distribution and cost drivers can help policymakers to assess whether resources are reaching priority populations, interventions, and hotspot geographies; to identify potential opportunities to improve allocative and technical efficiency; and to stimulate more productive dialogue at multiple levels of the system.
This review of HIV and TB expenditure in South Africa is an input to policy, planning and management processes within and amongst spheres of government and between government and development partners. The data have been especially useful to national and provincial programme managers as they perform their oversight functions, leading to improved spending of available resources. With 52 annexes, it also serves as an authoritative reference document detailing levels and trends in HIV and TB spending by the three main funders of the disease responses: the SAG, the United States Government (USG), primarily via the President’s Emergency Plan for AIDS Relief (PEPFAR), and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund). The findings have informed South Africa’s report to the UNAIDS Global AIDS Monitor and the country’s forthcoming funding request to the Global Fund.
Guyana 2016 Health Accounts - Statistical ReportHFG Project
The document provides an overview of Guyana's 2016 Health Accounts methodology. It summarizes key aspects of the System of Health Accounts 2011 framework used, including boundaries, classifications, and definitions. Data was collected from government, households, NGOs, employers, insurers, and donors to track financial flows for health for 2016. The results help understand Guyana's health financing and answer questions on spending patterns.
Repositioning the Health Economics UnitHFG Project
The document summarizes a proposal to reposition the Health Economics Unit (HEU) of the Ministry of Health and Family Welfare in Bangladesh. It conducted interviews and a review to assess the HEU's current mandate, structure, staffing and activities. Key findings were that the HEU's mandate was too broad and staffing too limited to fulfill its mission effectively. The proposal is to rename it the Directorate General of Health Economics and Policy, refocus its work on health economics analysis, advocacy and policy guidance to support universal health coverage. It would have four specialized units and address recruitment and collaboration issues. The Quality Improvement Secretariat and parts of another unit would be relocated to allow the repositioned body to fulfill its revised
Repositioning the Health Economics UnitHFG Project
The document discusses a proposal to reposition the Health Economics Unit (HEU) within the Ministry of Health and Family Welfare in Bangladesh. The proposal aims to clarify and focus the HEU's mandate on supporting universal healthcare through health economics analysis and policy guidance. It recommends refocusing the HEU's activities, limiting its scope by relocating certain units, renaming it the Directorate General of Health Economics and Policy, and establishing four new technical units. It also addresses staffing limitations and the need to strengthen collaboration to effectively implement the proposed changes.
Budget matters for health: key formulation and classification issuesHFG Project
This policy brief aims to raise awareness on the role of public budgeting – specifically aspects of budget formulation – for non-PFM specialists working in health. As part of an overall WHO programme of work on Budgeting in Health, it will help clarify the characteristics and implications of various budgeting approaches for the health sector.
Guyana 2016 Health Accounts - Dissemination BriefHFG Project
The 2016 Guyana Health Accounts study found that:
1) Total health expenditure in Guyana was $28.6 billion (Guyanese dollars), with the government contributing 81% of funding.
2) The majority (71%) of health funds were spent on public health facilities like hospitals and clinics.
3) Most funds (64%) were spent on curative care services, while non-communicable diseases received the largest share (34%) of funds.
4) Government funding represents the largest source of financing for HIV/AIDS programs and services in Guyana, providing 62% of funds.
Do Better Laws and Regulations Promote Universal Health Coverage? A Review of...HFG Project
The importance of policies, laws, and regulations (referred to collectively below as “policy instances”) as instruments to support progress towards Universal Health Coverage (UHC) in low- and middle-income countries cannot be understated. However, there has been insufficient focus in the literature on the role of these instruments, leading to a lack of evidence as to what constitutes a supportive legal environment that can consistently provide a strong basis for UHC reform processes. In this review, we explore how policies implemented in different country contexts have had an impact on their achievement of UHC goals.
In order to better differentiate the effect of various policy instances on the achievement of UHC goals, we developed a typology for policy instances and then ascribed the different aspects of governance to the instances identified in the literature, based on how they were designed and implemented. Finally, we considered the success of each policy instance identified, in terms of achieving intended UHC-related outcomes.
Governments may have political and process constraints on the number of policy instances they can design and implement in a period leading up to and during health sector reform. In terms of which health system component to focus such change on, we have more evidence for policy instances focused on health financing, given that designing effective financing mechanisms can shape the entire health
sector. Following this, policy instances that address human resources for health and supply chain management should be prioritized as they appear to have key strengthening effects on the provision of healthcare by increasing efficiency, equity, and quality.
This review of the evidence to date of governments’ policy-making experience highlights the importance of effective policy design and implementation with a clear orientation towards better governance, and in particular increased responsiveness and accountability.
Integrating the HIV Response at the Systems LevelHFG Project
The global response to combat the acquired immunodeficiency syndrome (AIDS) epidemic scaled up considerably in the early 2000s with the establishment of key institutions, notably the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) (AIDS.gov 2018). In response to high global rates of AIDS-related morbidity and mortality, the internationally supported rapid scale-up of human immunodeficiency virus (HIV) prevention, testing, treatment, and drug development is widely credited with curtailing a global epidemic, thereby limiting the human and financial costs of the virus (Bekker et al. 2018). Still the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 1.8 million people were infected with HIV in 2017, and there are nearly 37 million people living with HIV (PLWHIV) worldwide (UNAIDS 2018a). In many countries, financing and governance of HIV services is transitioning from international donors to national governments.
This funding transition has major implications for the governance, management, and implementation of the HIV response. Governments undergoing funding transitions for the HIV response are integrating aspects of the response into systems and processes for governing, managing, financing, and delivering other essential
health services. But this phenomenon has not been systematically studied, and documentation on how governments achieve this is limited. Understanding how some governments are navigating an HIV funding transition may help other countries and the global health community to better design and plan future or ongoing efforts to transition national HIV responses to domestic resources for health. USAID’s HFG project is helping to fill this gap. In particular, this study helps build an evidence base by exploring whether and how four countries in the process of transitioning to greater domestic financing of their HIV response are integrating HIV programming with local systems and processes for other essential health services.
This study applies the concept of system integration to examine the alignment of rules, policies, and support systems to address HIV and other essential health services in four low and middle-income countries (LMICs). Specifically, the study explores the current extent of integration, the decisions faced by policymakers, and potential barriers/facilitators to integration in four countries. The analysis allows HFG to share lessons learned by each of these countries attempting to optimize rules, policy, and support systems for HIV and other essential health services.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to expand access to healthcare. It helps countries increase domestic health funding, manage resources effectively, and make wise purchasing decisions. The project provides technical assistance in over 40 countries on improving health financing, governance, management systems, and measuring universal health coverage progress.
The Next Frontier to Support Health Resource TrackingHFG Project
The document discusses challenges and opportunities for institutionalizing health resource tracking (HRT) in low- and middle-income countries. It identifies three key elements needed for institutionalization: strong demand for HRT data; sustainable local capacity to produce HRT data; and use of HRT results in policy and decision making. It outlines remaining challenges in each area and suggestions for future investments to address challenges, such as building understanding of HRT's value, maintaining local expertise, improving health information systems, and strengthening communication and use of HRT findings.
South Africa HIV and TB Expenditure Review 2014/15 - 2016/17 Full ReportHFG Project
The South African Government (SAG) and its development partners have mounted a formidable response to the world’s largest HIV epidemic and a persistent burden of tuberculosis (TB), the country’s leading killer. Nearly 4 million South Africans initiated antiretroviral therapy (ART) by the end of financial year 2016/17, helping to curtail new infections and reduce the number of annual HIV-related deaths. Mortality from TB has also declined thanks, in part, to improved treatment success.
Despite progress, challenges remain. Roughly 3 million people living with HIV (PLHIV) lack treatment, and each year more than a quarter million are newly infected. Moreover, nearly a half million South Africans contract TB every year, with an increasing share affected by drug-resistant strains.
To effectively plan and steward the health system, the SAG routinely monitors programmatic and financial performance of the response to HIV and TB, including by tracking expenditure. Analysis of spending, including trends in sources, levels, geographic and programmatic distribution and cost drivers can help policymakers to assess whether resources are reaching priority populations, interventions, and hotspot geographies; to identify potential opportunities to improve allocative and technical efficiency; and to stimulate more productive dialogue at multiple levels of the system.
This review of HIV and TB expenditure in South Africa is an input to policy, planning and management processes within and amongst spheres of government and between government and development partners. The data have been especially useful to national and provincial programme managers as they perform their oversight functions, leading to improved spending of available resources. With 52 annexes, it also serves as an authoritative reference document detailing levels and trends in HIV and TB spending by the three main funders of the disease responses: the SAG, the United States Government (USG), primarily via the President’s Emergency Plan for AIDS Relief (PEPFAR), and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund). The findings have informed South Africa’s report to the UNAIDS Global AIDS Monitor and the country’s forthcoming funding request to the Global Fund.
The Health Finance and Governance project in Ukraine worked to improve the country's health system through strategic purchasing approaches. It demonstrated the effectiveness of integrating HIV testing into primary care, improving efficiency of the TB hospital system by developing monitoring and simulation tools, and laying the groundwork for strategic purchasing reforms across the broader hospital sector. Key results included increasing HIV testing and detection rates while lowering costs, helping restructure TB hospitals based on data to improve care and achieve savings, and establishing cost accounting methods and a case-based payment system pilot to enhance the performance and efficiency of hospitals nationwide.
Capacity Building in Human Resources Management of the Ministry of Health in ...HFG Project
The Ministry of Health in Guinea recognized after the Ebola outbreak that it needed to rebuild and strengthen its health workforce. With support from HFG, the MOH established better governance structures including upgrading its Division of Human Resources to a Department of Human Resources with new services and establishing an inter-ministerial committee to coordinate health workforce issues. HFG also helped improve Guinea's human resources information system and develop a multi-year workforce training plan to improve health services through clinical coaching.
Entry Point Mapping: A Tool to Promote Civil Society Engagement on Health Fin...HFG Project
ivil society organizations (CSOs), particularly those working in the health sector, frequently seek opportunities to influence public health policy or share feedback on the quality or accessibility of health services. While these organizations may have important contributions to make, they often are not aware of the most effective and accessible entry points to use. Entry Point Mapping provides a methodology for systemic review and identification of mechanisms, forums and public platforms by which civil society organizations can participate in health sector policy formulation, program implementation, and oversight.
This paper presents an Entry Point Mapping Tool designed for CSOs with advocacy experience and public health officials seeking to expand civil society participation and contains a step-by-step guide for researching and analyzing legal entry points for civil society participation in governance of public health care facilities. Because CSOs have varied interests, the tool includes a series of steps for individual CSOs to determine the level of government at which to pursue their specific advocacy interest and the process of collecting targeted information on legally required points of entry for their civic engagement.
In addition, the Entry Point Mapping Tool offers guidance on analyzing the effectiveness on these entry points and coaches CSOs through the negotiation process of activating or expanding existing entry points, creating new ones, and winning overall collaboration with health officials on improving health policy and service delivery. This tool also documents the experience of CSOs implementing the entry point mapping methodology in Bangladesh and Cote d’Ivoire to demonstrate how the tool can promote increased civil society engagement on issues of health finance and governance.
A regulatory review assessing JKN implementation versus designHFG Project
The purpose of the regulatory review undertaken in late 2015 was to understand the effectiveness of existing regulations in implementing JKN, potential shortcomings and opportunities for revisions or clarifications, as well as how implementation deviated or aligned to the original design in the regulations. The regulatory review findings would in turn feed into IR for UHC national and subnational stakeholder engagement process and support the identification of the research questions for cycle 1 of implementation research.
Provision of care at the primary level is the backbone of JKN system and requires effective
regulation. Primary health care is provided in puskesmas (public health centers) and private
practices. The regulatory review focuses on five major features of JKN implementation in
primary health care (PHC) including: provider payment and incentives, service package,
utilization of capitation payment, referral within a multi-tiered system, and enrollment of the
poor and vulnerable. Such features were identified by stakeholders early in the IR for UHC process as important themes to untangle the major problems in the implementation of JKN.
Hence, the study team completed the regulatory review to understand the existing regulations
surrounding the five features and their potential shortcomings and opportunities. Each of the
five topics is addressed below. We first describe the background for each topic, what the
regulations say and then what happened during implementation.
Working Groups Report Out_CORE Group_10.17.13CORE Group
The document outlines the FY14 priorities and strategic plans for several working groups within CORE Group. Key points include:
- Monitoring long-lasting insecticide-treated nets and collaborating on social and behavior change strategies for malaria programs.
- Operationalizing frameworks for multisectoral collaboration on malaria and webinars on case management, prevention strategies, and insecticide resistance.
- Collaboration with various technical stakeholders on case management, community case management, and health communication.
- Integration of HIV/TB, early childhood development, and other initiatives for several working groups. Addressing strategic plans through learning, dialogue and collaborative action.
Strategic Review: Towards a Grand Convergence for Child Survival and HealthCORE Group
This document summarizes a strategic review of options for improving integrated management of newborn and childhood illness (IMNCI) going forward. The review draws on data from over 90 countries and hundreds of experts. Key findings are: 1) While IMNCI has helped transform child health services, interest and funding have declined and scale-up was rarely achieved; 2) To achieve ambitious new child mortality targets, health systems must be strengthened and universal health coverage ensured; 3) The review proposes renewing focus and action on IMNCI through a "Grand Convergence" to end preventable child deaths, supported by domestic and international financing. The goal is high quality care across home, community and health facilities as part of reproductive, maternal
The Health Finance and Governance Briefing KitHFG Project
Resource Type: Brief
Authors: Megan Meline, Lisa Tarantino, Jeremy Kanthor, and Sharon Nakhimovsky
Published: September 2015
Resource Description: Getting access to affordable, quality health care is a universal story that touches virtually every family in the world. At the same time, providing quality health services and access to trained health professionals is a challenge for governments. The World Health Organization (WHO) estimates that 150 million people worldwide face “catastrophic expenditure” because of high costs of health care. In other words, they may have to forgo paying for basic needs, such as food, housing, or education to pay for medical treatment instead. These costs include transportation, doctors’ fees, medicine, hospitalization bills, and days lost from work.
Behind these sobering statistics lies a wealth of news and feature stories waiting for the media to investigate and share with national leaders and policymakers as well as civil society groups who can advocate for changes to health budgets and policies. At the heart of these stories are important questions about the financing of health care and the quality of governance that ensures responsive and effective management of those resources and services.
But writing health finance and governance stories can be challenging. Health finance is riddled with complex language, technical economic terms, and numbers – not necessarily a journalist’s comfort zone. The right sources for these stories can be difficult to identify and unwilling to talk. Data may be difficult to locate or to understand. And while corruption makes for splashy headlines, the broader systemic challenges of health governance are not widely understood — and yet they are important.
The Health Finance and Governance Briefing Kit is designed to help journalists and their editors uncover and tell these important health stories that affect people all around the world.
Guyana 2016 Health Accounts - Main ReportHFG Project
The document summarizes the key findings of Guyana's first Health Accounts exercise for fiscal year 2016. It found that total health expenditure was G$ 28.6 billion, with the government contributing 81% of funding. Household out-of-pocket spending accounted for 9% of total spending. Non-communicable diseases received the largest share of spending at 34%. The analysis aims to inform strategic health financing decisions and assess domestic resource mobilization as external donor funding declines. Recommendations include increasing prevention spending and strengthening financial commitment to HIV programs.
South Africa HIV and TB Expenditure Review 2014/15 - 2016/17. Executive SummaryHFG Project
The South African Government (SAG) and its development partners have mounted a formidable response to the world’s largest HIV epidemic and a persistent burden of tuberculosis (TB), the country’s leading killer. Nearly 4 million South Africans initiated antiretroviral therapy (ART) by the end of financial year 2016/17, helping to curtail new infections and reduce the number of annual HIV-related deaths. Mortality from TB has also declined thanks, in part, to improved treatment success.
Despite progress, challenges remain. Roughly 3 million people living with HIV (PLHIV) lack treatment, and each year more than a quarter million are newly infected. Moreover, nearly a half million South Africans contract TB every year, with an increasing share affected by drug-resistant strains.
To effectively plan and steward the health system, the SAG routinely monitors programmatic and financial performance of the response to HIV and TB, including by tracking expenditure. Analysis of spending, including trends in sources, levels, geographic and programmatic distribution and cost drivers can help policymakers to assess whether resources are reaching priority populations, interventions, and hotspot geographies; to identify potential opportunities to improve allocative and technical efficiency; and to stimulate more productive dialogue at multiple levels of the system.
This review of HIV and TB expenditure in South Africa is an input to policy, planning and management processes within and amongst spheres of government and between government and development partners. The data have been especially useful to national and provincial programme managers as they perform their oversight functions, leading to improved spending of available resources. With 52 annexes, it also serves as an authoritative reference document detailing levels and trends in HIV and TB spending by the three main funders of the disease responses: the SAG, the United States Government (USG), primarily via the President’s Emergency Plan for AIDS Relief (PEPFAR), and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund). The findings have informed South Africa’s report to the UNAIDS Global AIDS Monitor and the country’s forthcoming funding request to the Global Fund.
Guyana 2016 Health Accounts - Statistical ReportHFG Project
The document provides an overview of Guyana's 2016 Health Accounts methodology. It summarizes key aspects of the System of Health Accounts 2011 framework used, including boundaries, classifications, and definitions. Data was collected from government, households, NGOs, employers, insurers, and donors to track financial flows for health for 2016. The results help understand Guyana's health financing and answer questions on spending patterns.
Repositioning the Health Economics UnitHFG Project
The document summarizes a proposal to reposition the Health Economics Unit (HEU) of the Ministry of Health and Family Welfare in Bangladesh. It conducted interviews and a review to assess the HEU's current mandate, structure, staffing and activities. Key findings were that the HEU's mandate was too broad and staffing too limited to fulfill its mission effectively. The proposal is to rename it the Directorate General of Health Economics and Policy, refocus its work on health economics analysis, advocacy and policy guidance to support universal health coverage. It would have four specialized units and address recruitment and collaboration issues. The Quality Improvement Secretariat and parts of another unit would be relocated to allow the repositioned body to fulfill its revised
Repositioning the Health Economics UnitHFG Project
The document discusses a proposal to reposition the Health Economics Unit (HEU) within the Ministry of Health and Family Welfare in Bangladesh. The proposal aims to clarify and focus the HEU's mandate on supporting universal healthcare through health economics analysis and policy guidance. It recommends refocusing the HEU's activities, limiting its scope by relocating certain units, renaming it the Directorate General of Health Economics and Policy, and establishing four new technical units. It also addresses staffing limitations and the need to strengthen collaboration to effectively implement the proposed changes.
Budget matters for health: key formulation and classification issuesHFG Project
This policy brief aims to raise awareness on the role of public budgeting – specifically aspects of budget formulation – for non-PFM specialists working in health. As part of an overall WHO programme of work on Budgeting in Health, it will help clarify the characteristics and implications of various budgeting approaches for the health sector.
Guyana 2016 Health Accounts - Dissemination BriefHFG Project
The 2016 Guyana Health Accounts study found that:
1) Total health expenditure in Guyana was $28.6 billion (Guyanese dollars), with the government contributing 81% of funding.
2) The majority (71%) of health funds were spent on public health facilities like hospitals and clinics.
3) Most funds (64%) were spent on curative care services, while non-communicable diseases received the largest share (34%) of funds.
4) Government funding represents the largest source of financing for HIV/AIDS programs and services in Guyana, providing 62% of funds.
Do Better Laws and Regulations Promote Universal Health Coverage? A Review of...HFG Project
The importance of policies, laws, and regulations (referred to collectively below as “policy instances”) as instruments to support progress towards Universal Health Coverage (UHC) in low- and middle-income countries cannot be understated. However, there has been insufficient focus in the literature on the role of these instruments, leading to a lack of evidence as to what constitutes a supportive legal environment that can consistently provide a strong basis for UHC reform processes. In this review, we explore how policies implemented in different country contexts have had an impact on their achievement of UHC goals.
In order to better differentiate the effect of various policy instances on the achievement of UHC goals, we developed a typology for policy instances and then ascribed the different aspects of governance to the instances identified in the literature, based on how they were designed and implemented. Finally, we considered the success of each policy instance identified, in terms of achieving intended UHC-related outcomes.
Governments may have political and process constraints on the number of policy instances they can design and implement in a period leading up to and during health sector reform. In terms of which health system component to focus such change on, we have more evidence for policy instances focused on health financing, given that designing effective financing mechanisms can shape the entire health
sector. Following this, policy instances that address human resources for health and supply chain management should be prioritized as they appear to have key strengthening effects on the provision of healthcare by increasing efficiency, equity, and quality.
This review of the evidence to date of governments’ policy-making experience highlights the importance of effective policy design and implementation with a clear orientation towards better governance, and in particular increased responsiveness and accountability.
Integrating the HIV Response at the Systems LevelHFG Project
The global response to combat the acquired immunodeficiency syndrome (AIDS) epidemic scaled up considerably in the early 2000s with the establishment of key institutions, notably the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) (AIDS.gov 2018). In response to high global rates of AIDS-related morbidity and mortality, the internationally supported rapid scale-up of human immunodeficiency virus (HIV) prevention, testing, treatment, and drug development is widely credited with curtailing a global epidemic, thereby limiting the human and financial costs of the virus (Bekker et al. 2018). Still the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 1.8 million people were infected with HIV in 2017, and there are nearly 37 million people living with HIV (PLWHIV) worldwide (UNAIDS 2018a). In many countries, financing and governance of HIV services is transitioning from international donors to national governments.
This funding transition has major implications for the governance, management, and implementation of the HIV response. Governments undergoing funding transitions for the HIV response are integrating aspects of the response into systems and processes for governing, managing, financing, and delivering other essential
health services. But this phenomenon has not been systematically studied, and documentation on how governments achieve this is limited. Understanding how some governments are navigating an HIV funding transition may help other countries and the global health community to better design and plan future or ongoing efforts to transition national HIV responses to domestic resources for health. USAID’s HFG project is helping to fill this gap. In particular, this study helps build an evidence base by exploring whether and how four countries in the process of transitioning to greater domestic financing of their HIV response are integrating HIV programming with local systems and processes for other essential health services.
This study applies the concept of system integration to examine the alignment of rules, policies, and support systems to address HIV and other essential health services in four low and middle-income countries (LMICs). Specifically, the study explores the current extent of integration, the decisions faced by policymakers, and potential barriers/facilitators to integration in four countries. The analysis allows HFG to share lessons learned by each of these countries attempting to optimize rules, policy, and support systems for HIV and other essential health services.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to expand access to healthcare. It helps countries increase domestic health funding, manage resources effectively, and make wise purchasing decisions. The project provides technical assistance in over 40 countries on improving health financing, governance, management systems, and measuring universal health coverage progress.
The Next Frontier to Support Health Resource TrackingHFG Project
The document discusses challenges and opportunities for institutionalizing health resource tracking (HRT) in low- and middle-income countries. It identifies three key elements needed for institutionalization: strong demand for HRT data; sustainable local capacity to produce HRT data; and use of HRT results in policy and decision making. It outlines remaining challenges in each area and suggestions for future investments to address challenges, such as building understanding of HRT's value, maintaining local expertise, improving health information systems, and strengthening communication and use of HRT findings.
South Africa HIV and TB Expenditure Review 2014/15 - 2016/17 Full ReportHFG Project
The South African Government (SAG) and its development partners have mounted a formidable response to the world’s largest HIV epidemic and a persistent burden of tuberculosis (TB), the country’s leading killer. Nearly 4 million South Africans initiated antiretroviral therapy (ART) by the end of financial year 2016/17, helping to curtail new infections and reduce the number of annual HIV-related deaths. Mortality from TB has also declined thanks, in part, to improved treatment success.
Despite progress, challenges remain. Roughly 3 million people living with HIV (PLHIV) lack treatment, and each year more than a quarter million are newly infected. Moreover, nearly a half million South Africans contract TB every year, with an increasing share affected by drug-resistant strains.
To effectively plan and steward the health system, the SAG routinely monitors programmatic and financial performance of the response to HIV and TB, including by tracking expenditure. Analysis of spending, including trends in sources, levels, geographic and programmatic distribution and cost drivers can help policymakers to assess whether resources are reaching priority populations, interventions, and hotspot geographies; to identify potential opportunities to improve allocative and technical efficiency; and to stimulate more productive dialogue at multiple levels of the system.
This review of HIV and TB expenditure in South Africa is an input to policy, planning and management processes within and amongst spheres of government and between government and development partners. The data have been especially useful to national and provincial programme managers as they perform their oversight functions, leading to improved spending of available resources. With 52 annexes, it also serves as an authoritative reference document detailing levels and trends in HIV and TB spending by the three main funders of the disease responses: the SAG, the United States Government (USG), primarily via the President’s Emergency Plan for AIDS Relief (PEPFAR), and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund). The findings have informed South Africa’s report to the UNAIDS Global AIDS Monitor and the country’s forthcoming funding request to the Global Fund.
The Health Finance and Governance project in Ukraine worked to improve the country's health system through strategic purchasing approaches. It demonstrated the effectiveness of integrating HIV testing into primary care, improving efficiency of the TB hospital system by developing monitoring and simulation tools, and laying the groundwork for strategic purchasing reforms across the broader hospital sector. Key results included increasing HIV testing and detection rates while lowering costs, helping restructure TB hospitals based on data to improve care and achieve savings, and establishing cost accounting methods and a case-based payment system pilot to enhance the performance and efficiency of hospitals nationwide.
Capacity Building in Human Resources Management of the Ministry of Health in ...HFG Project
The Ministry of Health in Guinea recognized after the Ebola outbreak that it needed to rebuild and strengthen its health workforce. With support from HFG, the MOH established better governance structures including upgrading its Division of Human Resources to a Department of Human Resources with new services and establishing an inter-ministerial committee to coordinate health workforce issues. HFG also helped improve Guinea's human resources information system and develop a multi-year workforce training plan to improve health services through clinical coaching.
Entry Point Mapping: A Tool to Promote Civil Society Engagement on Health Fin...HFG Project
ivil society organizations (CSOs), particularly those working in the health sector, frequently seek opportunities to influence public health policy or share feedback on the quality or accessibility of health services. While these organizations may have important contributions to make, they often are not aware of the most effective and accessible entry points to use. Entry Point Mapping provides a methodology for systemic review and identification of mechanisms, forums and public platforms by which civil society organizations can participate in health sector policy formulation, program implementation, and oversight.
This paper presents an Entry Point Mapping Tool designed for CSOs with advocacy experience and public health officials seeking to expand civil society participation and contains a step-by-step guide for researching and analyzing legal entry points for civil society participation in governance of public health care facilities. Because CSOs have varied interests, the tool includes a series of steps for individual CSOs to determine the level of government at which to pursue their specific advocacy interest and the process of collecting targeted information on legally required points of entry for their civic engagement.
In addition, the Entry Point Mapping Tool offers guidance on analyzing the effectiveness on these entry points and coaches CSOs through the negotiation process of activating or expanding existing entry points, creating new ones, and winning overall collaboration with health officials on improving health policy and service delivery. This tool also documents the experience of CSOs implementing the entry point mapping methodology in Bangladesh and Cote d’Ivoire to demonstrate how the tool can promote increased civil society engagement on issues of health finance and governance.
A regulatory review assessing JKN implementation versus designHFG Project
The purpose of the regulatory review undertaken in late 2015 was to understand the effectiveness of existing regulations in implementing JKN, potential shortcomings and opportunities for revisions or clarifications, as well as how implementation deviated or aligned to the original design in the regulations. The regulatory review findings would in turn feed into IR for UHC national and subnational stakeholder engagement process and support the identification of the research questions for cycle 1 of implementation research.
Provision of care at the primary level is the backbone of JKN system and requires effective
regulation. Primary health care is provided in puskesmas (public health centers) and private
practices. The regulatory review focuses on five major features of JKN implementation in
primary health care (PHC) including: provider payment and incentives, service package,
utilization of capitation payment, referral within a multi-tiered system, and enrollment of the
poor and vulnerable. Such features were identified by stakeholders early in the IR for UHC process as important themes to untangle the major problems in the implementation of JKN.
Hence, the study team completed the regulatory review to understand the existing regulations
surrounding the five features and their potential shortcomings and opportunities. Each of the
five topics is addressed below. We first describe the background for each topic, what the
regulations say and then what happened during implementation.
Working Groups Report Out_CORE Group_10.17.13CORE Group
The document outlines the FY14 priorities and strategic plans for several working groups within CORE Group. Key points include:
- Monitoring long-lasting insecticide-treated nets and collaborating on social and behavior change strategies for malaria programs.
- Operationalizing frameworks for multisectoral collaboration on malaria and webinars on case management, prevention strategies, and insecticide resistance.
- Collaboration with various technical stakeholders on case management, community case management, and health communication.
- Integration of HIV/TB, early childhood development, and other initiatives for several working groups. Addressing strategic plans through learning, dialogue and collaborative action.
Strategic Review: Towards a Grand Convergence for Child Survival and HealthCORE Group
This document summarizes a strategic review of options for improving integrated management of newborn and childhood illness (IMNCI) going forward. The review draws on data from over 90 countries and hundreds of experts. Key findings are: 1) While IMNCI has helped transform child health services, interest and funding have declined and scale-up was rarely achieved; 2) To achieve ambitious new child mortality targets, health systems must be strengthened and universal health coverage ensured; 3) The review proposes renewing focus and action on IMNCI through a "Grand Convergence" to end preventable child deaths, supported by domestic and international financing. The goal is high quality care across home, community and health facilities as part of reproductive, maternal
Dr Ehiemere - Chanelling Public Health Nursing EducationGbolade Ogunfowote
This document summarizes a paper presented on channeling public health nursing education towards improving preventive healthcare services in Nigeria. It defines key terms like public health nursing education and preventive healthcare services. It briefly reviews the history of public health nursing education in Nigeria and the United States. It discusses objectives to define terms, review the way forward, and discuss a brief history. It proposes recommendations like regular curriculum reviews, leadership opportunities for nurses, and international collaboration to improve services. The conclusion states that effective education will empower nurses and communities to make healthy lifestyle changes, improving health and development.
HFG Project Brief - Improving Health Finance and Governance Expands Access to...HFG Project
The USAID Health Finance and Governance Project works in over 25 countries to improve health systems financing and governance, expand access to essential services like maternal and child health care, and progress toward universal health coverage. In Burundi, the project strengthened the management and organizational capacity of the National HIV/AIDS Program. In Cote d'Ivoire, the project helped develop the country's first post-conflict strategic plan to address health workforce issues and better support HIV care. The project also piloted an integrated HIV service delivery model in Ukraine.
This presentation covers the USAID Office of Maternal, Child Health and Nutrition; the Office of Health Systems; Office of Population and Reproductive Health; and the Center for Innovation and Impact.
Community-based programs for children aim to promote optimal child growth and development. Key programs include Home-Based Newborn Care (HBNC), Mothers Absolute Affection (MAA) program, POSHAN Abhiyaan, and Home-Based Care for Young Child (HBYC). As part of HBNC, ASHAs conduct home visits for newborns to provide essential care and identify issues. HBYC involves additional home visits by ASHAs after 42 days to monitor nutrition, health, development and hygiene. The CHO plays an important role in supporting these programs through supervision, identification of high-risk children, counseling mothers, and ensuring treatment and referrals for sick children.
GoI supports various initiatives to promote optimal infant and young child feeding (IYCF) practices in India, including the Maternal and Child Health Care program, nutrition support through schemes like SNP and THR, and the VHSND platform. Key programs implemented are the MAA program launched in 2016 to promote breastfeeding, and the HBNC and HBYC programs launched in 2011 and 2012 respectively, which include home visits to support exclusive breastfeeding. Other initiatives include celebrating breastfeeding weeks, appointing IYCF counselors, and using tools like the MCP card and Poshan/ICDS program for counseling and awareness generation on optimal IYCF practices.
The USAID Health Finance and Governance project, led by Abt Associates, works with developing countries to expand access to healthcare. It helps countries increase domestic health funding, manage resources effectively, and make wise purchasing decisions. The project provides technical assistance to improve financing, governance, management systems, and universal health coverage monitoring. In Botswana specifically, the project worked with the Ministry of Health and Wellness to develop a new health financing strategy, update the universal health benefits package, create a blueprint for national health insurance, increase hospital outsourcing efficiencies, analyze HIV treatment costs, and design a framework for setting healthcare service prices.
Supporting the Scale-Up of HIV Care and Treatment through Human Resources for...HFG Project
The document discusses issues with Cote d'Ivoire's health workforce that are barriers to scaling up HIV treatment. Only 50% of HIV positive people receive antiretroviral therapy due to inadequate and unevenly distributed health workers. In response, USAID's Health Finance & Governance project helped develop Cote d'Ivoire's first national strategic plan to address health workforce challenges and expand access to HIV services, especially in northern regions where prevalence is rising. The plan aims to improve production and competencies of midwives and nurses to meet maternal and newborn health needs and support national health reform.
Maximizing the Impact Of Global Fund Investments by Improving the Health of W...theglobalfight
Dr. Viviana Mangiaterra, Senior Technical Coordinator for Maternal, Newborn and Child Health and Health Systems Strengthening at the Global Fund to Fight AIDS, Tuberculosis and Malaria, discusses service delivery integration for the three diseases, Global Fund partnerships and strengthened training and representation of women in Country Coordinating Mechanisms.
Nigeria National Social and behavior Change Strategy for infant and young chi...Dominique Thaly
This document presents Nigeria's National Social and Behavioural Change Communication Strategy for Infant and Young Child Feeding (IYCF) from 2016-2020. It aims to improve IYCF practices like early initiation of breastfeeding, exclusive breastfeeding for six months, and appropriate complementary feeding, in order to reduce chronic malnutrition among young children. The strategy was developed through stakeholder workshops and emphasizes community participation, capacity building, communication, social mobilization and advocacy to promote recommended IYCF behaviors. It outlines strategic approaches, roles and an operational plan to guide implementation over five years.
At the 2016 CCIH Annual Conference, Dr. Tonny Tumwesigye of the Uganda Protestant Medical Bureau discusses how UPMB incorporated fertility awareness methods into its Family Planning services to expand options for families.
The Central Adelaide and Hills Medicare Local identified overweight and obesity as a key concern through population health profiling in 2012. They developed a healthy weight strategy using stakeholder engagement and community consultation methods. This included workshops, programs, and communication strategies. The strategy aimed to clarify care pathways for general practices and inform future management of overweight and obesity. It resulted in two documents: a monograph summarizing obesity trends, recommendations, and general practice support, and a pathway document to guide practices in managing overweight and obesity patients.
Public private partnership in safemotherhood program in NepalBidhya Basnet
The document discusses public private partnerships in Nepal's Safemotherhood program. It provides definitions of key terms, describes the status and activities of the program, and outlines various PPP models used. The program aims to reduce maternal and neonatal mortality by improving access to antenatal care, skilled birth attendance, emergency obstetric care, and postnatal care. It partners with various organizations to implement activities like community mobilization, ultrasound programs, and expanding emergency referral services. However, partnerships face limitations like unclear policies, weak coordination, and a lack of regulatory frameworks and research on the private health sector.
Community Based Management of Acute Malnutrition according UNICEF and WHO standards Implementation in Oromia Region, Ethiopia WIth Pablo Horstmann Foundation and Alegria Sin Fronteras
Digital health tools are being used across Tanzania, Malawi, Kenya, and Uganda to support community case management (CCM) programs. While the specific tools and approaches vary by country, there are significant opportunities to share lessons and harmonize tools. All four countries utilize frontline health workers like community health workers (CHWs) to provide CCM services in communities. Key CHW roles include registering clients, checking for danger signs, counseling, and making referrals. The three priority commodities - amoxicillin, oral rehydration salts, and zinc - are distributed at similar levels across health systems, though stockouts vary. Existing digital implementations focus on areas like commodity management, data reporting, behavior change, and decision
national health progrmmes for children.pptxpayalgakhar
This document summarizes several national health programs in India for children, including the Reproductive and Child Health Program, Universal Immunization Program, Integrated Child Development Services, School Health Program, and nutritional programs. It provides details on the objectives, services provided, implementation, and strategies of these programs, which aim to improve child health, reduce mortality and malnutrition, and make health services more accessible to children and mothers across India.
National Childhood Cancer Comprehensive Management Policy- DraftAVINASH THUMALLAPALLI
This document proposes a draft national childhood cancer comprehensive management policy for India. It recommends early diagnosis of childhood cancers through the Rashtriya Bal Swasthya Karyakram program and a shared care model integrating palliative care services. It also calls for a platform for civil society participation. Key elements include training community health workers and doctors in early diagnosis and palliative care, sharing data between stakeholders, and facilitating NGO involvement to provide holistic support from diagnosis through treatment and follow up. The goal is to improve access to equitable cancer care for children throughout India as mandated by national policies and children's rights.
The document summarizes Nepal's Safe Motherhood program. It describes the program's goals of reducing maternal and neonatal mortality and improving health. Major activities include promoting birth preparedness and emergency funds, expanding skilled birth attendants and emergency obstetric care, managing reproductive health issues, expanding service sites, and programs like Aama that provide incentives for institutional delivery. The program aims to make quality maternal care accessible to all women through these various community-based and facility-based strategies.
Similar to Moving Towards Universal Health Coverage Through Implementation of Operational Plan Activities Moving (20)
This document outlines a training manual for a hospital costing workshop. It provides an agenda for the 3-day workshop covering topics like the fundamentals of costing, the MASH costing tool, and calculating unit costs. The workshop aims to teach participants how to conduct costing exercises to understand their hospital's costs and improve management. Sessions include introductions, an overview of costing concepts, the costing process, and a demonstration of the MASH tool which is an Excel-based framework for tracking and analyzing hospital resources, services, and costs.
Trinidad and Tobago 2015 Health Accounts - Main ReportHFG Project
This document summarizes the key findings of the 2015 health accounts report for Trinidad and Tobago. It finds that total health expenditure was 4.5 billion TT dollars in 2015, equivalent to 4.1% of GDP. The government financed 41% of health spending, while households financed 35% through direct out-of-pocket payments. Noncommunicable diseases accounted for the largest share of recurrent health spending at 42%. Out-of-pocket payments remain high, comprising over a third of total health expenditure. The report recommends strengthening government commitment to health financing, increasing risk pooling to reduce out-of-pocket spending, improving access to services, and institutionalizing ongoing health accounts estimations.
Rivers State has a population of over 7 million people from various ethnic groups. The main occupations are fishing, farming, and trading. The state has high rates of tuberculosis, neonatal and under-5 mortality, and HIV prevalence. Key stakeholders in health include the Ministry of Health, Ministry of Finance, and various agencies. The USAID Health Finance and Governance project worked to increase domestic health financing through advocacy, establishing a health insurance scheme, and capacity building. These efforts led to increased health budgets, establishment of healthcare financing units, and improved sustainability of health financing in Rivers State.
ASSESSMENT OF RMNCH FUNCTIONALITY IN HEALTH FACILITIES IN BAUCHI STATE, NIGERIAHFG Project
This document summarizes an assessment of reproductive, maternal, newborn and child health (RMNCH) services in health facilities in Bauchi State, Nigeria. It found that infrastructure like electricity, water and toilets were lacking in many facilities. There were also shortages of skilled healthcare workers, especially midwives, and staff training. While many facilities offered antenatal care and immunizations, availability of emergency obstetric and newborn care and services like postnatal care and post-abortion care were more limited. Supplies of essential medicines, equipment and guidelines were also often inadequate. Community outreach was provided by some facilities but could be expanded.
BAUCHI STATE, NIGERIA PUBLIC EXPENDITURE REVIEW 2012-2016 HFG Project
This document summarizes a public expenditure review of health spending in Bauchi State, Nigeria from 2012 to 2016. It finds that while Bauchi State's health budget increased over this period, actual health spending lagged behind budgeted amounts. Specifically, health spending accounted for a small and declining share of the state's total budget and expenditure. The review recommends that Bauchi State increase and better target public health funding to improve health outcomes and progress toward universal health coverage goals.
HEALTH INSURANCE: PRICING REPORT FOR MINIMUM HEALTH BENEFITS PACKAGE, RIVERS ...HFG Project
This document provides a pricing report for a Minimum Health Benefit Package (MHBP) being developed by Rivers State government in Nigeria. It analyzes the cost of 6 scenarios for the package, including individual and household premiums, based on medical claims data from hospitals in Rivers State from 2014-2017. The recommended annual premiums range from N14,026 to N111,734 for individuals and N79,946 to N636,882 for households, depending on the benefits included and the percentage of the state's population covered. The report provides context on data sources and actuarial assumptions used to determine the premiums.
The document is an actuarial report for Kano State's contributory healthcare benefit package in Nigeria. It analyzes 4 scenarios for the package - a basic minimum package alone or plus HIV/AIDS, tuberculosis, or family planning services. The report finds that the estimated annual premium per individual would be between N12,180-N12,600 depending on the scenario, while the estimated annual premium per household of 6 would be between N73,081-N75,595. It provides these estimates by analyzing the state's population data, healthcare facilities, utilization rates, and costs to determine the risk premiums, administrative costs, marketing costs, and contingency margins for each scenario. The report recommends rounding the premium estimates and includes
Supplementary Actuarial Analysis of Tuberculosis, LAGOS STATE, NIGERIA HEALTH...HFG Project
This document provides an actuarial analysis of including tuberculosis (TB) coverage in the Lagos State Health Scheme in Nigeria. It analyzes 3 different TB treatment regimens and estimates the additional premium required. Based on historical TB case data from 2013-2016, it projects the number of cases and costs for the next 3 years. The analysis finds the additional premium to be 488.79 Naira on average per person to cover TB screening tests and the 3 treatment regimens. It acknowledges limitations in the source data and outlines key assumptions made in the projections.
Supplementary Actuarial Analysis of HIV/AIDS in Lagos State, NigeriaHFG Project
This document provides a supplementary actuarial analysis of including HIV/AIDS coverage in the Lagos State Health Scheme benefit package in Nigeria. It estimates the total additional medical cost to cover HIV/AIDS services would be 209.40 Naira per person per year, broken down into costs for HIV testing and counseling (13.60), antiretroviral therapy (133.05), and preventing mother-to-child transmission (15.96). The analysis is based on HIV service data from 2012-2016 and projected population and drug cost data from the Lagos State Ministry of Health. It assumes a 90% continuation and conversion rate for antiretroviral therapy and a 6.5% annual medical cost trend.
Assessment Of RMNCH Functionality In Health Facilities in Osun State, NigeriaHFG Project
This document summarizes an assessment of reproductive, maternal, newborn and child health functionality in health facilities in Osun State, Nigeria. It was conducted by Abt Associates in collaboration with other organizations as part of the USAID Health Finance and Governance Project. The assessment aimed to determine service delivery readiness in primary health centers for the Basic Health Care Provision Fund pilot. Key findings included inadequate health facility infrastructure, shortages of health workers and equipment, and gaps in administrative and referral systems. The results provide baseline data on capacity for implementing health financing reforms in Osun State under the National Health Act.
OSUN STATE, NIGERIA FISCAL SPACE ANALYSIS FOR HEALTH SECTORHFG Project
This document analyzes fiscal space for health in Osun State, Nigeria. It examines options for increasing fiscal space such as prioritizing health spending, earmarking taxes for health, and improving efficiency. The analysis finds that covering the state's population under the Osun State Health Insurance Scheme at a premium of N7,660 per person annually would cost over N30 billion, exceeding currently available resources. Additional funding sources or subsidies for vulnerable groups would be required to achieve universal health coverage in Osun State.
ANALYZING FISCAL SPACE FOR HEALTH IN NASARAWA STATE, NIGERIAHFG Project
This document analyzes potential fiscal space for health in Nasarawa State, Nigeria. It identifies several options for increasing funding available for the health sector, including leveraging conducive macroeconomic conditions, increasing the priority of health in sectoral budget allocations, earmarking portions of taxes and fees for health, obtaining external grants, and improving efficiency. Collectively, these options could provide tens of millions of additional naira annually that could be directed towards expanding health coverage and services. The document recommends that Nasarawa State prioritize these funding avenues and implement reforms to fully capitalize on the fiscal space available.
PUBLIC FINANCIAL ASSESSMENT OF HIV SPENDING: NASARAWA STATE, NIGERIAHFG Project
This document assesses public financial management of HIV spending in Nasarawa State, Nigeria. It identifies several bottlenecks in the planning, budgeting, and budget execution processes. Bottlenecks include highly centralized decision making, lack of cohesive planning, and absence of evidence-based advocacy. It also notes differences in priorities between government officials and program managers. Recommendations include advocating for HIV program needs, preparing medium-term sector strategies, making budgets and revenue forecasts more realistic, and building capacity of HIV agencies to improve financial management processes.
NASARAWA STATE, NIGERIA 2012-2016 PUBLIC EXPENDITURE REVIEWHFG Project
The document summarizes a public expenditure review of Nasarawa State from 2012-2016. It finds that while the state's health budget increased over this period, it still represents a low share of the total budget. The state's population health outcomes lag behind other states and access to health services remains limited. The review recommends that Nasarawa State increase and better target health spending to improve health system performance and progress toward universal health coverage.
KEBBI STATE, NIGERIA FISCAL SPACE ANALYSIS FOR HEALTH SECTORHFG Project
This document analyzes fiscal space for health in Kebbi State, Nigeria. It finds that while Kebbi State needs more resources for its health sector, there are several options to increase fiscal space. These include improving macroeconomic conditions, reprioritizing a greater share of the budget to health above the Abuja Declaration target of 15%, earmarking funds such as through the Contributory Health Scheme, mobilizing external resources, and improving health sector efficiency. The analysis models a scenario of the Kebbi State Contributory Health Scheme at a premium of N7,660 per person. It finds that even with coverage increases, efficiency gains, and utilization of options to raise funds, there remains a funding gap that
Indira awas yojana housing scheme renamed as PMAYnarinav14
Indira Awas Yojana (IAY) played a significant role in addressing rural housing needs in India. It emerged as a comprehensive program for affordable housing solutions in rural areas, predating the government’s broader focus on mass housing initiatives.
Contributi dei parlamentari del PD - Contributi L. 3/2019Partito democratico
DI SEGUITO SONO PUBBLICATI, AI SENSI DELL'ART. 11 DELLA LEGGE N. 3/2019, GLI IMPORTI RICEVUTI DALL'ENTRATA IN VIGORE DELLA SUDDETTA NORMA (31/01/2019) E FINO AL MESE SOLARE ANTECEDENTE QUELLO DELLA PUBBLICAZIONE SUL PRESENTE SITO
This report explores the significance of border towns and spaces for strengthening responses to young people on the move. In particular it explores the linkages of young people to local service centres with the aim of further developing service, protection, and support strategies for migrant children in border areas across the region. The report is based on a small-scale fieldwork study in the border towns of Chipata and Katete in Zambia conducted in July 2023. Border towns and spaces provide a rich source of information about issues related to the informal or irregular movement of young people across borders, including smuggling and trafficking. They can help build a picture of the nature and scope of the type of movement young migrants undertake and also the forms of protection available to them. Border towns and spaces also provide a lens through which we can better understand the vulnerabilities of young people on the move and, critically, the strategies they use to navigate challenges and access support.
The findings in this report highlight some of the key factors shaping the experiences and vulnerabilities of young people on the move – particularly their proximity to border spaces and how this affects the risks that they face. The report describes strategies that young people on the move employ to remain below the radar of visibility to state and non-state actors due to fear of arrest, detention, and deportation while also trying to keep themselves safe and access support in border towns. These strategies of (in)visibility provide a way to protect themselves yet at the same time also heighten some of the risks young people face as their vulnerabilities are not always recognised by those who could offer support.
In this report we show that the realities and challenges of life and migration in this region and in Zambia need to be better understood for support to be strengthened and tuned to meet the specific needs of young people on the move. This includes understanding the role of state and non-state stakeholders, the impact of laws and policies and, critically, the experiences of the young people themselves. We provide recommendations for immediate action, recommendations for programming to support young people on the move in the two towns that would reduce risk for young people in this area, and recommendations for longer term policy advocacy.
Bharat Mata - History of Indian culture.pdfBharat Mata
Bharat Mata Channel is an initiative towards keeping the culture of this country alive. Our effort is to spread the knowledge of Indian history, culture, religion and Vedas to the masses.
Combined Illegal, Unregulated and Unreported (IUU) Vessel List.Christina Parmionova
The best available, up-to-date information on all fishing and related vessels that appear on the illegal, unregulated, and unreported (IUU) fishing vessel lists published by Regional Fisheries Management Organisations (RFMOs) and related organisations. The aim of the site is to improve the effectiveness of the original IUU lists as a tool for a wide variety of stakeholders to better understand and combat illegal fishing and broader fisheries crime.
To date, the following regional organisations maintain or share lists of vessels that have been found to carry out or support IUU fishing within their own or adjacent convention areas and/or species of competence:
Commission for the Conservation of Antarctic Marine Living Resources (CCAMLR)
Commission for the Conservation of Southern Bluefin Tuna (CCSBT)
General Fisheries Commission for the Mediterranean (GFCM)
Inter-American Tropical Tuna Commission (IATTC)
International Commission for the Conservation of Atlantic Tunas (ICCAT)
Indian Ocean Tuna Commission (IOTC)
Northwest Atlantic Fisheries Organisation (NAFO)
North East Atlantic Fisheries Commission (NEAFC)
North Pacific Fisheries Commission (NPFC)
South East Atlantic Fisheries Organisation (SEAFO)
South Pacific Regional Fisheries Management Organisation (SPRFMO)
Southern Indian Ocean Fisheries Agreement (SIOFA)
Western and Central Pacific Fisheries Commission (WCPFC)
The Combined IUU Fishing Vessel List merges all these sources into one list that provides a single reference point to identify whether a vessel is currently IUU listed. Vessels that have been IUU listed in the past and subsequently delisted (for example because of a change in ownership, or because the vessel is no longer in service) are also retained on the site, so that the site contains a full historic record of IUU listed fishing vessels.
Unlike the IUU lists published on individual RFMO websites, which may update vessel details infrequently or not at all, the Combined IUU Fishing Vessel List is kept up to date with the best available information regarding changes to vessel identity, flag state, ownership, location, and operations.
karnataka housing board schemes . all schemesnarinav14
The Karnataka government, along with the central government’s Pradhan Mantri Awas Yojana (PMAY), offers various housing schemes to cater to the diverse needs of citizens across the state. This article provides a comprehensive overview of the major housing schemes available in the Karnataka housing board for both urban and rural areas in 2024.
Moving Towards Universal Health Coverage Through Implementation of Operational Plan Activities Moving
1. BANGLADESH UHC SESSIONS WITH OPERATIONAL PLANS
Moving Towards Universal Health Coverage
Through Implementation of Operational Plan Activities
MovingTowards Universal
Health Coverage
The movement towards Universal Health Coverage (UHC)
is gaining momentum in Bangladesh, especially following
approval of the Sustainable Development Goals (SDGs)
with a clear mandate for UHC (through Goal 3), and
strong political commitment from the highest echelons
of government. Key initiatives, such as the Health Care
Financing Strategy (2012-32), Bangladesh Health Workforce
Strategy (2015), National Social Security Strategy
(2015), Bangladesh Essential Service Package (ESP), and
Communication Strategy for UHC (2014-16) demonstrate
this commitment.
In 2015, the United States Agency for International
Development (USAID) undertook a Health Financing
Assessment and identified the need to “increase
awareness of and demand for UHC among a broad
range of stakeholders.”1
This was in line with the UHC
communication strategy of the Ministry of Health and
Family Welfare (MOHFW). USAID’s Health Finance and
Governance project (HFG) started working towards
“Building awareness on Universal Health Coverage:
Advancing the agenda in Bangladesh” in 2016.The objective
was to raise awareness of and advocate for UHC, including
its core concepts in health financing, so that a critical mass of
stakeholders could advance the UHC agenda in Bangladesh.
UHC is still a new concept for many health managers who
are not yet thoroughly conversant in or have internalized its
different dimensions. However, there is tremendous potential
for MOHFW Operational Plan (OP) managers (consisting
of Line Directors, Program Managers, and Deputy Program
Managers) to support progress on different aspects of UHC
as they implement OP activities.
1
Karen Cavanaugh, Mursaleena Islam, Sweta Saxena, Muhammod Abdus Sabur,
and Niaz Chowdhury. 2015. Universal Health Coverage and Health Financing in
Bangladesh: Situational Assessment and Way Forward.Washington, DC: USAID.
June 2018
Technical Note on
Working Sessions with Operational Plans
I have heard about UHC before, but this is the first
time for me to attend a formal workshop.
- Participant of working session with
National Nutrition Services OP
2. 2 BANGLADESH UHC SESSIONS WITH OPERATIONAL PLANS
To capitalize on this potential – and advance progress towards UHC – OP managers need support as they plan activities.
The USAID-funded HFG project organized and facilitated half-day working sessions with selected OP managers to not
only strengthen understanding about UHC, but also provide practical ways to take forward the UHC agenda while
implementing OP activities.
This technical note summarizes highlights from the
working sessions and also provides guidance and a
framework for incorporating UHC concepts in OP
implementation.
Objectives of the Working Sessions
yy Advance the UHC agenda through OP implementation.
yy Generate ideas and input on how planned OP activities could be implemented with an additional focus on UHC.
Approach for the Working Sessions
A half-day working session was chosen as OP mangers were unable
to participate for a longer time-period, and this modality provided
opportunity for maximum participation by OP personnel.
Bangladesh’s 4th
Health, Population and Nutrition Sector Program
(HPNSP, 2017-2022) has 29 OPs, of which 14 relate to service delivery.
Due to time constraints, eight OPs were selected covering priority
service delivery areas, and addressed through five working sessions – see Table 1.
Each session included a short video on UHC; an introduction to UHC by the Health Economics Unit (HEU) of MOHFW;
an overview of each OP by respective OP personnel; discussions with examples of specific OP activities to demonstrate
and generate ideas about implementation with a specific focus on UHC (see Table 2 for a summary); and finally a wrap-up
and way forward.
Professor Mohammad Abul Faiz and Dr. Muhammod Abdus Sabur facilitated the sessions.
It would be helpful to have some written guidance
or a handbook that explains how to implement OP
activities with a UHC perspective;
then all OP personnel could act accordingly.
- Participant of working session with
Non-Communicable Disease (NCD) Control OP
Activities in the MNCAH OP relating to UHC
are really time-demanding but are much
needed.All the discussions were really good.
Participant of working session with Maternal, Neonatal,
Child, and Adolescent Health (MNCAH) OP
Table 1: Summary of the Working Sessions
OPs Covered Date and Venue No. of Participants
Maternal, Neonatal, Child, and Adolescent
Health (MNCAH)
5th
December 2017
Integrated Management of Childhood Illnesses (IMCI)
Conference Room, Expanded Program on Immunization
(EPI) Building, Mohakhali, Dhaka
33
Maternal, Child, Reproductive, and Adolescent
Health
8th
January 2018
Meeting Room, Maternal and Child Health Services Unit,
Directorate General of Family Planning (DGFP), Dhaka
24
Clinical Contraception Services Delivery
Program
Community Based Health Care(CBHC)
18th
March 2018
CBHC Conference Room, Bangladesh Medical Research
Council Building, Mohakhali, Dhaka
18
National Nutrition Services 21st
March 2018
Institute of Public Health Nutrition Conference Room,
Mohakhali, Dhaka
19
Lifestyle & Health Education and Promotion
Hospital Services Management 17th
April 2018
Conference Room, Hospital and Clinic Section,
Directorate General of Health Services (DGHS) New
Building, Mohakhali, Dhaka
20
Non-Communicable Disease (NCD) Control
3. 3 BANGLADESH UHC SESSIONS WITH OPERATIONAL PLANS
Table 2: Key Discussions
Maternal, Neonatal, Child and Adolescent Health OP
OP Components
and Activities
OP Implementation and UHC Considerations
Maternal health
Increase safety of deliveries,
including through provision of
Emergency Obstetrical Care
As 67 percent of deliveries take place at home (Bangladesh Demographic and Health Survey
[BDHS] 2014), provision of skilled birth attendants is needed to make deliveries safer. Current
efforts to train female Health Assistants (HAs) and Community Health Care Providers (CHCPs),
along with Family Welfare Assistants (FWAs), should be strengthened. There is also need to
increase the number of private Community Skilled Birth Attendances (CSBAs) through proper
training, as is being done by many non-governmental organizations (NGOs), as well as through
other initiatives. CSBAs need to compete with existing traditional birth attendants (dais).
Therefore, an increase in both government and private CSBA numbers may increase safe deliveries
if combined with proper promotion. In addition, quality of CSBA care can be ensured if supervised
by Family Welfare Visitors (FWVs), as demonstrated by a pilot initiative.
Provision of comprehensive Emergency Obstetrical Care through the upazila health complex not
only improves coverage, but also provides protection against financial risk. While experiences to
date are not yet promising, both the obstetrician and anesthesiologist should be retained at the
upazila health complex to achieve UHC.
EPI
Increase and sustain routine
EPI
Although current EPI coverage at 82.5 percent is a success, there is a remaining gap of 17.5
percent. Improved micro-planning is needed to increase coverage, along with strengthened efforts
in counseling, promotion, and follow-up to reduce drop-outs. Since EPI sessions are free and are
conducted close to where people live, there are no financial hardship implications.
EPI in urban areas poses a challenge. Neither field workers (e.g., HAs or FWAs), nor networks
of facilities (e.g., Community Clinic [CC], Union Health and Family Welfare Center [UH&FWC]/
Union Sub Centre) exist. Service delivery is the responsibility of the respective municipality
or city corporation, but they have inadequate capacity, including inadequate human resources.
Through the Urban Primary Health Care project in selected municipalities and city corporations,
services are provided by contracted NGOs or NGO networks (e.g., Smiling Sun or Marie Stopes).
However, most NGOs charge a fee for EPI, which may be a barrier to access. In addition, coverage
by NGOs is not comprehensive, as some areas are overcrowded while others are not covered. To
achieve UHC, municipalities and city corporation authorities need support to map existing EPI sites
run by NGOs, to request new sites or relocate existing sites, and to negotiate for exemption for
the poor for charges.
National Newborn Health
Program
Promote birth preparedness,
newborn care preparedness,
and proper care seeking
through a comprehensive
social and behavior change
communication approach
All pregnant women and their family members, particularly decision-makers, need to be aware
of the different components of and reasons for birth preparedness. Sometimes an individual may
be unable to address all aspects of birth preparedness, such as transport or blood requirements,
or money for a caesarean section. A community approach is therefore required, such as CC
community support groups. Likewise for newborn care preparedness and proper care seeking,
pregnant women and family members, as well as existing birth attendants (whether skilled or
traditional), need to be oriented, particularly on existing harmful practices. To achieve UHC, all
pregnant women should be birth-prepared, and all newborns should receive essential newborn
care.
Adolescent health
Provide adolescent-friendly
sexual and reproductive
health services through
health facilities
Improved access to free, quality sexual and reproductive health services for adolescents through
government facilities will help in achieving UHC. Robust training for service providers from
different health facilities (e.g., upazila health complex, Union Sub-Center/H&FWC, and CC) is
needed to provide quality services, covering counseling and communication, as well as technical
aspects of service delivery.
4. 4 BANGLADESH UHC SESSIONS WITH OPERATIONAL PLANS
Maternal, Child, Reproductive, and Adolescent Health OP (Cont.)
OP Components
and Activities
OP Implementation and UHC Considerations
Maternal health
Provide four antenatal
care (ANC) sessions with
counseling for pregnant
women and their families
covering birth preparedness
and complication readiness
ANC uptake is low – only 31 percent of pregnant women completed four or more ANC visits
(BDHS 2014). Although 78 percent women undertake at least one ANC visit, only 64 percent
of deliveries are by medically trained providers (BDHS 2014). In order to ensure quality and
comprehensive service provision, there is need to increase ANC uptake to four or more visits,
with services delivered by medically trained providers. Providing services closer to where people
live reduces the potential for financial hardship – ANC should also be provided during domiciliary
visits by CSBAs, or through satellite clinics, CCs, or UH&FWCs.
Birth preparedness and complication readiness counseling should cover all pregnant women and
their families, particularly decision-makers, with particular attention to those who are usually
excluded (e.g., hard-to-reach communities, marginalized and minority populations, and the
disabled). Mother’s Bank is a good example of birth preparedness. Other components include
identifying more than one skilled birth attendant; identifying the facility where both comprehensive
and basic emergency obstetrics care are available; and identifying proper transport in case of need
so that delays in reaching the appropriate facility can be avoided.
To reduce maternal mortality, proper ANC visits delivery by skilled attendants (at home or in
the facility), and access to comprehensive and basic emergency obstetrics care in case of need
are crucial. In order to achieve UHC, the health system needs to be ready to provide required
services.
National Newborn Health
Program
Provide sick newborn
management services at
UH&FWCs by developing
the capacity of service
providers, ensuring the
supply of commodities and
drugs, and emphasizing
referral linkages as per
national guideline with
simplified antibiotic regimen
Managing sick newborns at the UH&FWC would be a step towards UHC. This requires robust
capacity development of service providers to ensure quality of care, along with ensuring the supply
of required commodities. UH&FWCs are located in close proximity to rural populations and
services are provided for free, which reduces potential for financial hardship. Effective referrals
can improve coverage and quality, and to some extent financial hardship, if the referral facility pays
proper attention to patients.
Child healthcare services
Provide proper counseling on
appropriate feeding practices,
including exclusive breast
feeding
Fifty-five percent of infants under six months are exclusively breastfed (BDHS 2014), which
represents a drop since the 2011 BDHS (64 percent). Given the importance of exclusive
breastfeeding for the child’s nutritional status, and this downward trend, effort is needed to
increase rates. All domiciliary and facility-based providers should promote exclusive breastfeeding
at every encounter, particularly among pregnant women and their family members.
5. 5 BANGLADESH UHC SESSIONS WITH OPERATIONAL PLANS
Clinical Contraception Services Delivery Program OP
OP Components
and Activities
OP Implementation and UHC Considerations
Strengthening long-acting
reversible contraceptive
and permanent method
(LARC&PM) services
Target young married
couples aged up to 24 years
to reduce unmet need;
introduce peer activities such
as counseling, promotion,
and group discussion to
increase referrals for
LARC&PM services
Young married couples are often excluded from family planning (FP) due to their shyness and/
or inexperience in using services. Addressing the unmet need of young couples will improve
coverage and therefore accelerate progress towards UHC. Focus areas include: reaching men
(and women) for counseling sessions; targeting couples who are usually excluded (e.g., minority,
disabled, or ethnic groups, bedes, and hard-to-reach communities); increasing access to confidential
services closer to where people live; increasing service quality (both actual and perceived) through
appropriately trained service providers; providing effective counseling about side-effects or
discontinuation processes; and reducing financial risk by increasing accessibility and providing free
supplies where possible.
Effective implementation of
post-partum FP action plan
Ensure availability of
post-partum FP services,
particularly post-partum
bilateral tubal ligation, post-
partum intra-uterine device
services, and post-partum
implant services, as well as
post Menstrual Regulation/
Menstrual Regulation with
Medication (MRM)/Post
Abortion Care (PAC) FP
services in DGHS hospitals,
DGFP facilities, private
hospitals, and NGO facilities.
The post-partum period is a critical opportunity for FP method acceptance. Engagement by all
facilities where deliveries take place (including those belonging to DGHS or DGFP, as well as
private or NGO facilities), can improve coverage and therefore contribute towards UHC. In
most circumstances, services are provided by qualified staff, thus ensuring quality, and FP services
are free with some compensation (e.g., stipend or transport) provided, thus reducing financial
risk. However counseling services may be sub-optimal, which limits quality and may lead to
discontinuation. Effective counseling is therefore needed for all post-partum FP clients.
Strengthening LARC&PM
services in hard-to-reach,
low performing,and urban
areas
Register all slum and non-
slum couples in urban areas
through government-NGO
collaboration with the
assistance of volunteers
In order to achieve UHC, all eligible couples from both slum and non-slum areas should be
registered for services. With the assistance of volunteers, coverage of eligible populations can be
increased by identifying and registering excluded couples, especially those in slum areas or living on
the streets. Once eligible populations are registered, appropriate and quality FP services should be
provided closer to where they live (reducing financial risk). Proper counseling is also important to
avoid discontinuation due to discomfort or other side-effects.
6. 6 BANGLADESH UHC SESSIONS WITH OPERATIONAL PLANS
Community Based Health Care OP
OP Components
and Activities
OP Implementation and UHC Considerations
Proper staffing of CC
Undertake initiatives to
improve staffing of CCs to
deliver ESP services
All the services mentioned in the ESP for the CC level could be delivered if appropriate staffing
were in place, and staff capacity built. This would increase access to quality services closer to
where people live for free, thus satisfying all UHC elements.
Community engagement
Prepare a community
engagement manual detailing
roles of different stakeholders
(e.g., CC staff and their
supervisors, community group
and community support group
members, Union Parisad,
and other local institutions
such as NGOs, schools, and
religious institutions) to create
community momentum for
improved health outcomes.
Currently each CC has one community group and three community support groups, but their
engagement varies. Some limitations need to be addressed:
yy Committee formation should be representative, with inclusion of females;
yy Committees should meet frequently with an adequate quorum, active participation by all,
decision-making, minutes, and follow-up of decisions; and
yy Broad community engagement is needed for improved health outcomes.
Community groups and support groups need to be revitalized through orientation on their roles
and responsibilities, not only for proper functioning of the CC, but also to create community
momentum for a health movement. This can be achieved through inclusive engagement of other
institutions, such as Union Parisad, NGOs, schools, and religious institutions to promote healthy
lifestyles, ensure a conducive environment for health, and ensure utilization of all required
services from CCs and higher-level facilities.
Referral system
Orient CC staff on the
referral system, including
their respective roles and
responsibilities.
CCs are required to send their patients to higher-level facilities where necessary through
appropriate referral and adequate follow-up. Initially CCs may refer patients to the Upazilla
Health Complex, and where union facilities have been strengthened, to union facilities. CC staff
orientation on quality referrals, including where patients can access appropriate, quality services
through referral, is an important dimension of UHC.
Urban health
Address barriers to urban
dwellers, particularly the poor,
preventing access to and use of
available health services
Municipality/city corporation authorities are responsible for delivering health services to their
respective dwellers. Overcoming barriers to and utilization of health services, especially by the
poor, requires working with these authorities to improve access without financial risk.
7. 7 BANGLADESH UHC SESSIONS WITH OPERATIONAL PLANS
National Nutrition Services OP
OP Components
and Activities
OP Implementation and UHC Considerations
Nutrition-specific activities
Promote, protect, and support
Infant and Young Child Feeding
(IYCF) Practices
According to BDHS 2014, 23 percent of children aged 6-23 months are fed according to
recommended IYCF practices. Feeding practices have changed very little (2 percentage point
increase between 2011 and 2014 BDHS), and this is far below the target of 45 percent by 2022.
Appropriate feeding is especially low during the period 6-8 months (7 percent), increasing to
34 percent among 18-23 month-old children. Boys are as likely as girls to be fed according to
recommendations. Adherence to IYCF practices is better in urban areas than in rural areas (29
compared with 21 percent). The recommended IYCF practices are lowest in Sylhet (17 percent)
and highest in Khulna (31 percent). Overall IYCF practices are low among all subgroups, but
IYCF practices improve with the mother’s education level and wealth score. Even among the
highest wealth quintile, only 3 out of 10 children receive appropriate feeding. This suggests a
lack of knowledge about appropriate feeding practices. Creation of more rigorous awareness is
required to achieve UHC for IYCF, particularly targeting the low uptake period (6-8 months),
rural areas, and Sylhet division, as well as sub-populations with low literacy levels or in the
poorest economic groups.
Control of micronutrient
deficiencies
Implement bi-annual Vitamin A
supplementation program for
children aged 6-59 months
Sixty-two percent of children aged 6-59 months received vitamin A supplementation (BDHS
2014) – this has only increased by two percentage points since 2011 (BDHS). Among children
aged 6-23 months, 67 percent consumed foods rich in vitamin A (BDHS 2014). Sub-clinical
vitamin A deficiency is 20 percent in pre-school aged children (Programme Implementation
Plan [PIP] of 4th
HPNSP). Achieving UHC for Vitamin A supplementation requires significant
interventions.
Promotion of adolescent
nutrition
Raise awareness and promote
adolescent nutrition
Around 10 percent of adolescent girls (aged 10-18 years) are undernourished (National Food
Security Nutritional Surveillance Project 2014). Prevalence of iron deficiency is 10 percent in
school aged children (12-14 years), increasing to 40 percent among older school aged children
(PIP of HPNSP). Achieving UHC for adolescent nutrition requires multiple efforts in both macro
and micronutrients.
Promotion of maternal
nutrition
Counsel pregnant and lactating
women during ANC and post-
natal care services, as well as
during domiciliary visits by
health and FP workers.
As mentioned earlier, ANC from a medically trained provider is 64 percent, while this is 36
percent for post-natal care (BDHS 2014). Eleven percent of currently-married women said they
were visited by a government FP fieldworker, four percent by a government health worker, and
five percent by an NGO fieldworker. In order to promote maternal nutrition, domiciliary visits
by health and FP workers need to improve substantially.
8. 8 BANGLADESH UHC SESSIONS WITH OPERATIONAL PLANS
Lifestyle and Health Education and Promotion OP
OP Components and Activities OP Implementation and UHC Considerations
Comprehensive social and behavior
change communication strategy
Facilitate district level workshop
on promotion of a healthy diet, the
effects of dietary salt intake, hazards of
excessive sugar and oil intake, and the
need for high fruit and vegetable intake;
implement activities to stop tobacco
consumption and substance abuse; and
conduct public education campaigns
about the benefits of exercise.
By cascading district level workshops, anti-tobacco initiatives, and public education
campaigns involving all segments of society and using correct information and messages,
will accelerate progress towards UHC. This approach ensures every individual is aware
of and practicing promotive health, and provides financial protection through disease
prevention.
Inter-sectoral collaboration on lifestyle,
including private sector engagement
Promote safe and healthy environments
within facilities, the household,
workplaces, and schools, including
increasing cleanliness, ordinary and
medical waste management, and
sanitation facilities.
Inter-sectoral collaboration, including with the private sector, can result in an
improved environment in terms of increased cleanliness, sanitary facilities, and waste
management. This will be a step forward in promotive and preventive health from
which the whole population can benefit (through households, workplaces, and schools/
academic institutions) without financial risk.
Communication campaign through
different media for behavior change
Use different communication methods
to change individual and community
behavior and social norms.
Changing individual and community behaviors and social norms around healthy lifestyles,
early treatment seeking, and compliance with health provider advice, contributes
significantly to UHC. Healthier lifestyles prevent or control disease, and early treatment
seeking and compliance contributes to early detection and/or improved recovery, which
reduces financial risk.
Occupational and environmental health
Engage employers and supervisors,
concerned ministries, Bangladesh
Small and Cottage Industries
Corporation (BSCIC), trade/worker
unions, and interested organizations
to develop appropriate policies and
foster workplace norms, design
communication programs to reduce
health hazards, and raise awareness
about climate change, food safety,
injuries, and healthy aging.
More people are joining the workforce, but every occupation has inherent health and
safety hazards. Being aware of and taking appropriate measures to prevent accidents,
including using appropriate protective devices, can prevent mortalities and morbidities.
This requires engagement with stakeholders, including business owners, legislative
bodies, and worker organizations to use quality, consistent messages and practices to
promote health and prevent hazards. This will contribute towards UHC by reducing/
preventing morbidities and mortalities and contributing significantly towards financial
risk protection.
9. 9 BANGLADESH UHC SESSIONS WITH OPERATIONAL PLANS
Hospital Services Management OP
OP Components and Activities OP Implementation and UHC Considerations
Structured referral system
Prepare and implement referral
procedures and rules across health
service levels, and within and
between institutes.
Improved and structured referrals across different levels or tiers of health facilities will
results in better access to and utilization of quality health services by those in need, thus
addressing multiple UHC dimensions. In addition, referral services are often provided close
where people live, and are usually provided by government, thus reducing financial risk.
Support to secondary and tertiary
care hospitals
Provide support to District
Hospitals, Medical College
Hospitals, and Specialized Institutes
and Hospitals.
The current aim is to upgrade all existing District Hospitals to 250 beds, so that District
Hospitals are the referral facility for corresponding Upazila Health Complexes in each
district, and provide primary care and the ESP for their urban catchment population. The
capacity and efficiency of Medical College Hospitals will be enhanced. Old Medical College
Hospitals will be upgraded to 1,000 beds with all specialized services available. These will
be tertiary level referral hospitals providing all services. National Institutes will be truly
national centers of excellence, providing state-of-the-art specialized services, as well as
acting as a national resource center for technical support and guidance throughout the
country in their technical field. Together, secondary and tertiary facilities will therefore be a
critical component of progress towards UHC, ensuring access to quality services for all, and
providing services at an affordable cost.
Private healthcare facilities
Update the regulatory framework
to ensure close supervision
of private healthcare facilities.
Establish an autonomous National
Accreditation Body.
Through enforced regulation, private healthcare facilities may contribute towards improving
access to quality services at an affordable cost. An accreditation body will improve access to
and enable provision of quality services, while also regulating the cost of services and thus
contributing to financial protection.
10. 10 BANGLADESH UHC SESSIONS WITH OPERATIONAL PLANS
Health System Implications
Although the OPs were all related to service delivery, there were some discussions about health system implications for
OP implementation and thus UHC advancement. For example:
yy The availability of funds to pre-finance activity expenses is constrained by delays in budget disbursement and
permission (which may involve Ministry of Finance).
yy Imprest funds in non-DGFP facilities are not currently available to increase long-acting and permanent method
contraceptives.
yy Retention of staff, particularly in hard-to-reach areas, is challenging.
yy Continuity of OP personnel is problematic, with frequent changes of Line Director, Program Manager, and Deputy
Program Manager.
yy Coordination – within different components of each OP, and between different OPs, as well as between MOHFW
departments (e.g., DGHS, DGFP, Directorate General of Nursing and Midwifery, and National Institute
of Population Research and Training) and with other ministries (e.g., Ministry of Local Government, Rural
Development and Cooperatives, Ministry of Chittagong Hill Tracts Affairs, Ministry of Women and Children
Affairs, and Ministry of Social Welfare) is poor.
Non-Communicable Diseases Control OPs
OP Components and Activities OP Implementation and UHC Considerations
Screening
Use the primary health care system
(community, CCs, union health facilities,
and Upazila
Health Complexes) for prevention of non-
communicable diseases (NCDs) through
public awareness, screening, and early
detection, treatment, and referral.
Public awareness, screening, early detection, treatment, and referral by community
workers, CCs, UH&FWCs, and Upazila Health Complexes will accelerate progress
towards UHC. This approach will ensure every individual receives required quality
services close to where they live and through government facilities either for free or
at minimum cost and thus with no financial hardship.
Conventional NCDs (Cardiovascular
Diseases,Diabetes,Chronic Obstetric
Pulmonary Disease (COPD) Cancer)
Provide quality care for NCDs at: the
primary care level (CCs, UH&FWCs/
Union Sub Centers, and Upazila Health
Complexes); secondary level (District
Hospital); and tertiary level (Medical
College Hospital and Specialized Institutes).
Establish strong referrals with feedback
from the CC to the Upazila Health
Complexes, with further referral to the
District Hospital, and Maternal and Child
Health or other specialized institutes.
This activity will ensure provision of quality care for NCDs in health facilities at all
levels. If quality care for NCDs can be availed for free and close to where people
live, financial protection would also be addressed. Improving quality of care and
institutionalizing quality service delivery across the health system will not only
address the core UHC concept of quality, but also reduce the NCD burden. A
robust referral system with feedback mechanisms will improve care quality and
equity, as referrals ensure service access for everyone.
Specialized NCD program.
Target marginalized populations and
migrant workers.
Specialized NCD programs are needed for marginalized populations and migrant
workers. Marginalized populations, especially ethnic minorities (e.g., bede and horijon
communities), are often excluded from mainstream health programs due to their
limited access to services. Accessibility and financial risk protection can be addressed
if services are provided within communities. Migrant health workers often cannot
access services due to the high cost in migrating countries/cities. Identifying the
geographic location of migrant workers and providing services according to their
health needs would increase population coverage in line with UHC.
11. 11 BANGLADESH UHC SESSIONS WITH OPERATIONAL PLANS
OP and a Relevant
Component
Thematic Area for UHC
Coverage for All Service Coverage with Quality Financial Protection
MNCAH*
Integrated Management of
Childhood Illness (IMCI)
Community case management
training for all field level service
providers following the IMCI
protocol will cover all children for
IMCI
IMCI case management in the
community by trained field-level
service providers will ensure
quality service coverage for
IMCI
IMCI case management in the
community, close to where
people live, and by trained field
level service providers, will reduce
financial risk
Maternal, Child,
Reproductive and
Adolescent Health*
Reproductive Health Care
Services
Strengthening safe menstrual
regulation by skilled service
providers at facilities (UH&FWCs,
Upazila Health Complexes,
and Mother and Child Welfare
Centers (MCWCs) will be step
forward to cover all
Menstrual regulation by
skilled service providers at
UH&FWCs, Upazila Health
Complexes, and MCWCs will
improve coverage and ensure
quality service provision
Menstrual regulation services
provided at UH&FWCs, Upazila
Health Complexes, MCWCs will
help ensure financial protection as
services are provided for free and
close to residences
National Nutrition
Services*
Iron Folic Acid (IFA)
Supplementation
IFA supplementation for
pregnant or lactating women and
adolescent girls will help ensure
coverage for all suffering from
micronutrient deficiencies
Quality IFA supplementation
with appropriate dosage for
pregnant and lactating women
and adolescent girls will ensure
coverage of those who require
this service
Financial protection will be
ensured as IFA supplementation
will be free and availed during
other services
Communicable
Disease Control
Malaria Elimination
Program
Universal coverage of rapid
diagnosis and prompt treatment
(RDT) in the 13 appropriate
districts
RDT by trained workers
ensures availability of essential
and quality services in the
relevant 13 districts
RDT is provided free and close to
patient homes, ensuring financial
protection
Tuberculosis (TB),
Leprosy and AIDS/
Sexually Transmitted
Disease (STD)
Programme
Case detection of TB
Increase detection of TB cases
through strengthening and scaling
up laboratory diagnostic facilities
to cover all
Quality diagnostic facilities to
ensure case detection of all
who need services
Financial protection is ensured
through providing free
services. Other costs such as
transportation or wage loss may
be minimized through community
resource mobilization
NCD Control*
Health Promotion and Risk
Reduction
Massive and rapid public health
campaign to cover all for healthy
lifestyles and practices
Qualitative information of the
campaign to cover those who
need to adopt proper healthy
lifestyles and practices
Since prevention is much cheaper
than cure, financial protection
is ensured through adopting
appropriate lifestyles
National Eye Care
Service Delivery
Eye health care services at upazila
and district hospitals will improve
coverage for all
Quality eye care services at
upazila and district hospitals will
increase availability
Free services at upazila and
district hospitals will support
financial protection. Other costs
such as transportation and wage
loss may be covered through
community resource mobilization
CBHC*
Tribal Health
District-specific tribal health
strategies for each of three
districts in the Chattagram hill
tracts (CHT) will help ensure
coverage, especially where
populations are usually excluded
Quality services needed for
diverse populations may be
provided through proper
implementation of district-
specific tribal health strategies
in the CHT
By implementing district-specific
tribal health strategies, and
providing services close to where
people live and for free, financial
protection will be ensured
Table 3: OP Implementation Framework for Addressing UHC
Framework for Incorporating UHC Concepts in OP Implementation
Many of the participants stressed the need for a common framework to help implement OP activities addressing UHC
concepts. Based on the working session discussions and the three core UHC thematic areas (coverage for all, service
coverage and quality, and financial protection), illustrative examples were identified from each service delivery OP and
summarized as a framework.This framework (see Table 3) can be applied during implementation of any OP activity so that
UHC thematic areas are addressed.
12. The Health Finance and Governance (HFG) project works with partner countries to increase their domestic resources for health,
manage those precious resources more effectively, and make wise purchasing decisions. Designed to fundamentally strengthen health
systems, the HFG project improves health outcomes in partner countries by expanding people’s access to health care, especially
to priority health services.The HFG project is a five-year (2012-2017), $209 million global project funded by the U.S.Agency for
International Development under Cooperative Agreement No:AID-OAA-A-12-00080.
The HFG project is led by Abt Associates in collaboration with Avenir Health, Broad Branch Associates, Development Alternatives Inc.,
Johns Hopkins Bloomberg School of Public Health, Results for Development Institute, RTI International,Training Resources Group, Inc.
For more information visit www.hfgproject.org/
Agreement Officer Representative Team: Scott Stewart (sstewart@usaid.gov) and Jodi Charles (jcharles@usaid.gov).
DISCLAIMER:The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for
International Development (USAID) or the United States Government.
Abt Associates
6130 Executive Boulevard
Rockville, MD 20852
abtassociates.com
12
Way Forward
Participants appreciated the sessions as they helped improve their understanding of UHC issues
and their ability to implement their respective OP activities. Some Line Directors committed to
keeping UHC as a standing agenda item in all their trainings, thus equipping more stakeholders to
take forward the UHC agenda.Through improved understanding of and commitment to UHC by a
wide range of stakeholders involved in service delivery, more people and communities in need will
be covered by quality services. In addition, with increased understanding of financial risk protection,
services are expected to be affordable.
* HFG conducted sessions with these eight OPs. In addition to these, the framework contains examples from six other service delivery OPs.
OP and a Relevant
Component
Thematic Area for UHC
Coverage for All Service Coverage with Quality Financial Protection
Hospital Services
Management*
afe Blood Transfusion
Universal access to safe blood for
the patient
Safe blood through proper
screening and cross-matching
will ensure provision of
essential, quality services
Financial protection may be
ensured through the provision
of safe blood close to the point
of requirement and at affordable
cost
Clinical Contraception
Services Delivery
Programme*
Strengthening LARC&PM
services in hard-to-reach,
low performing, and urban
areas
Coverage of LARC&PM will be
improved through the Regional
Service Package and by involving
the Roving Team, which is a step
towards universal coverage
Quality LARC&PM services
provided by the Roving Team
will ensure coverage for eligible
couples
LARC&PM services are provided
for free with compensation for
wage loss and transportation
costs. In addition, Roving Teams
provide services close to the place
of residency, which addresses
financial protection
FP Field Services
Delivery
Strengthening Field
Services Delivery
Strengthening domiciliary services
through FWAs will accelerate
universal coverage
Proper client selection using
the appropriate FP method will
ensure provision of quality FP
services
Financial protection is ensured as
services are provided at home and
for free
Lifestyle, and Health
Education and
Promotion*
Legislative Framework
Implementation of appropriate
legislation (e.g., banning smoking
in public places, or wearing a
helmet while driving motor
cycles) will contribute towards
universal coverage of health
promotion
Implementation of appropriate
legislation for proper
management of medical waste
will improve quality of care
at facilities and coverage of
medical waste management
services
Changes in lifestyles and health
promotion through legislation will
ensure prevention of diseases and
injuries, and thus improve financial
protection
Information, Education
and Communication
Community Mobilization,
Sensitization and Advocacy
Country-wide awareness
campaigns will strengthen
universal coverage of FP
Client awareness will also
increase demand for coverage
and quality of needed FP
services
Client awareness will lead to
uptake of FP services, which are
free and provided by the closest
outlet, thus protecting from
financial risk
Alternative Medical
Care (AMC)
Strengthening AMC
services
Availability of AMC services
in public facilities, such as the
Upazila Health Complex or
District Hospital, will contribute
to universal coverage
Qualified AMC providers
ensure the quality of required
services through public health
facilities
Free AMC services at Upazila
Health Complexes or District
Hospitals will contribute towards
ensuring financial protection
June 2018