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End-of-Project Innovation Exchange

Info Circuits
Roundtable discussions on a range of health policy topics

Icons for Health Systems, Evidence, Localization, Equity, and Financing

Click the the theme to view the list of presentation topics and the related publications you can download from our site.

+ Health Systems

1) Beyond Training: A Portfolio of Capacity Development Approaches that Promote Tailored Transformation that Sticks

Hosted by: Ann Hendrix-Jenkins & Nancy Yinger
Developing capacity while simultaneously trying to reach technical objectives is a common challenge. Most people are not technical specialists and experts in learning theory, facilitation, organizational development, and change management. Lucky for you, we capacity development nerds have created easy-to-use mechanisms that can be built into project design and implementation. These enable capacity to improve, freeing you to focus most of your energy on other project roles and responsibilities. At this info circuit session, we will demonstrate a card-sorting exercise and engage everyone in a dialogue based on this classic participatory sorting methodology.

2) Policy and Governance through a Local Ownership Lens: A Focus on Capacity Development Outcomes with Women Leaders in Africa and Citizen Networks in Guatemala

Hosted by: Anne Jorgensen & Herminia Reyes
Meaningful engagement of diverse civil society groups in crafting local solutions to public health issues are key to inclusive country ownership—or local ownership—of sustainable development. In this session, HPP will share outcomes and insights from two capacity development activities to strengthen civil society's role in policy and governance: (1) empowering 70 African women leaders in family planning and reproductive health policy advocacy; and (2) strengthening three types of citizen networks at the national and local levels in Guatemala (nearly 800 members) to advocate and hold local governments accountable for the governance of health, nutrition, and education services. Roundtable participants will share key lessons learned from their related field experiences to create a collective list of tested practices to foster sustained civil society engagement in local systems for policy and governance. We will discuss recommendations for future program designs, including consideration of the principles for engaging local systems in USAID's Local Systems Framework (April 2014) and agency recommendations (draft, January 2015) for organizational capacity development measurement within local systems.

3) Positioning Respectful Care at the Forefront of the Maternal Healthcare Agenda

Hosted by: Mande Limbu & Mary Beth Hastings
While many interventions have aimed to improve the availability of skilled birth care, less consistent attention has been focused on the quality of such care, specifically to address the widespread occurrences of disrespect and abuse many women encounter in facility-based maternity care. Providing access to high-quality maternal healthcare—especially around the time of birth—is a critical, lifesaving issue for women and their newborns and a challenge for healthcare systems and providers. Since 2010, WRA and global and host-country partners have galvanized action among key stakeholders to promote the provision of respectful maternity care (RMC) and build the capacity of individuals and institutions to successful address disrespect and abuse in facility-based childbirth. Participants at this session will be introduced to global and national-level initiatives that have helped bring RMC to the forefront of the maternal healthcare agenda and have the opportunity to explore evidence-based approaches to advance RMC.

4) Reaching the Poor: A Policy Approach to Health Equity

Hosted by: Nicole Judice & Monica Wanjiru
Developing policies to target needed health services to reach to the poor is an essential element to progress toward universal health coverage. In the last two decades, evidence on the improvement of inequalities in use of key health services has been mixed across countries, where the effort to develop pro-poor policies is one of the determinants. This session will explore the trend in inequalities of health services at the global level and then use a case study from Kenya to illustrate how HPP generated evidence for advocating with the Ministry of Health to change its policies, such as the abolishment of user fees at public facilities to improve health services delivery for the poor. Participants will learn about the role of health policy in addressing health inequalities and the process that HPP used to inform the development of a pro-poor policy in Kenya.

5) You're Not the Boss of Me! Improving Quality in the Private Sector through Public-Private Engagement and Effective Government Stewardship in Afghanistan

Hosted by: Mohammad Yousuf Jabarkhil & Lauren Archer
Ensuring the quality of health services in the private sector is a challenge for many countries and requires effective government oversight and public-private engagement. Afghanistan has long lacked a systematic approach to objectively assessing health services and effectiveness in the private health sector. HPP supported the Ministry of Public Health (MoPH) to develop and implement policies and regulatory systems to better engage and oversee the rapidly growing private health sector and to develop Minimum Required Standards (MRS) to address safety and quality at private facilities. Private facilities, through the Afghanistan Private Hospitals Association, are using the MRS tool to self-regulate and improve quality; while the public sector, through the MoPH Monitoring and Evaluation Unit, is using the tool for the joint inspection of facilities. Use of the tool has increased transparency and improved cross-sectoral collaboration and is raising standards at private facilities. This info circuit session will provide a brief overview of the activities undertaken in Afghanistan to build MoPH capacity to regulate the private sector and improve health services, including the MRS tool and its implementation. Participants will then have the opportunity to explore how this approach could be applied in other settings and debate the role of the government and the extent to which it should regulate the private health sector.

+ Evidence

6) Getting It Right: Lessons Learned from Costed Implementation Plans for Family Planning

Hosted by: Modibo Maïga & Nichole Zlatunich
Through FP2020 and the Ouagadougou Partnership, many countries have made financial, policy, and program commitments to increase FP access and choice for women and girls. To achieve these commitments, a number of countries have developed costed implementation plans (CIPs) for family planning. Each new CIP provides an opportunity to tailor technical assistance and tools to help countries achieve their goals; presenting opportunities for lessons to be learned to further strengthen CIPs and their impact. A truly consultative process can capitalize on the synergies among stakeholders and effectively build and maintain a sense of ownership and commitment to fully execute and fund the plan. Setting goals that are ambitious (but realistic to the country's context), developing local capacity, putting systems in place, and fostering a culture that understands that the CIP is a living document that requires updating and adjusting to execute properly—including regular gap analyses to identify resource gaps and make actionable plans to fill them—supports FP goal achievement in countries. Participants at this session will discuss ways to improve the process for developing and implementing the next generation of CIPs, as well as contribute early thought-leadership on how to improve the current processes, models, and tools used to support countries in developing health strategies more broadly.

7) "Governor, if you invest in contraception ...": Using New Evidence to Motivate Action on Family Planning

Hosted by: Sada Danmusa & Kaja Jurczynska
With just five years left to implement programs and achieve FP2020 goals, advocates are seeking new tools/models to drive action on FP policies, programs, and funding at national and subnational levels now. In response to these and other needs, Futures Group developed a new model, ImpactNow, which quantifies the near-term health and economic benefits of family planning. To date, the model has been applied in more than seven low-income countries at both national and subnational levels. ImpactNow applications have been holistic and collaborative in nature, covering topics from model mechanics to the development of key messages for policymakers, advocacy simulations, and more. Armed with compelling evidence on the benefits of FP—including maternal and child deaths averted, savings to the health sector, and dollars saved per those spent on contraception—FP champions are successfully advocating to their governments to increase funding for contraceptive commodities, supplies, services, and information. This info circuit session will therefore discuss HPP's ImpactNow model application process and successes and discuss other new tools and approaches for motivating action.

8) How to Effectively Communicate Model Results: Field Experience with the DemDiv Model

Hosted by: Elizabeth Leahy Madsen & Senait Tibebu
The potential benefits of a demographic dividend have captured the attention of leaders in many countries, creating an opening for targeted policy strategies to realize a dividend while also improving individual health, education, and well-being. Yet, the dividend is a complex concept that poses challenges for policy communication and advocacy. In 2014, HPP developed DemDiv, a new resource to project the potential demographic dividend in any country. This customizable model is designed to increase decisionmakers' support for investments in the multisectoral policies required to achieve a dividend, integrating family planning and education with economic competitiveness and governance. DemDiv has been applied in Ethiopia, CÔte d'Ivoire, Kenya, Nepal, and Uganda. In this session, participants will learn how the DemDiv results were disseminated to policymakers in several of these countries. As a group, participants will strategize tactics and messages to effectively communicate and build support for these complex concepts among high-level decisionmakers.

9) Modeling Cost, Modeling Impact: A Runway to Smart Investment Cases for HIV

Hosted by: Alexander Paxton & Juan Dent
How can we link scale-up targets for HIV and AIDS strategies to potential impact? Can more be done with constrained resources at the strategic level? How can we show the impact of prioritizing only the "right places" and with the "right things"? Participants at this info circuit session will be exposed to different investment case modeling methods that allow stakeholders to apply evidence when preparing national HIV and AIDS targets, prioritizing interventions, and advocating for related resources. The use of mathematical models that combine cost and impact modeling allows stakeholders to incorporate impact indicators, such as the numbers of lives saved or infections averted, when prioritizing within constrained budgets. We will introduce participants to HPP's HIV investment cases in Ghana, Ukraine, and Mozambique (at the national and subnational levels) and discuss how the Spectrum Goals Model and the new Local Epidemic Assessment for Prevention (LEAP) model can support them. These discussions will help participants develop a greater appreciation for how investment cases and modeling studies can guide HIV strategic planning and geographic and intervention-based prioritization and learn how both PEPFAR and high-burden-country governments can expand the use of such methods.

10) When Cerebral Minutiae Meet Personal Passion: The Quantitative Side of Policy Analysis and Advocacy

Hosted by: Sandra Duvall & Ronald MacInnis
HPP Decision Models identify global standards for policies affecting access to HIV, STI, and addiction services for men who have sex with men, sex workers, transgender people, and individuals who use drugs. These models support an inventory and analysis of policy language to identify specific laws, regulations, policies, or procedures that need to be added, changed, or removed. Success in implementing these models includes identifying laws and other policies that fall outside of international norms and identifying language in foundational documents that support broader advocacy agendas. Challenges with implementing the model fall primarily into the realm of developing local understanding of the importance of and skills in this level of analysis. Participants at this session will be introduced to the general topic areas included in the analysis and broad findings from the implementation, as well as have the opportunity to explore the pros and cons of this approach and any potential broader application.

+ Localization

11) Building Political Will to Strengthen Social Protection Networks

Hosted by: Annie Chen-Carrington & Alyson Lipsky
Haiti, like many countries, has a large number of organizations providing child protection services and services for survivors of sexual and gender-based violence (SGBV) that often work in isolation. As a result, the country is facing critical challenges, such as low referral rates, poor data collection, and limited understanding of the service provision landscape. HPP developed and implemented an approach focused on strengthening multisectoral protection service networks by building political will, establishing referral networks, supporting linkages between state and service providers, and developing stakeholder capacity to use maps. Participants in this session will be introduced to HPP's multisectoral approach to strengthening networks and broad findings from implementation, as well as have the opportunity to explore the pros and cons of this approach and potential opportunities for broader application.

12) Facing the Devil in the Details: Health System Reform in Kenya

Hosted by: Taylor Williamson & Elkana Ong'uti
Decentralization is increasingly being implemented as a way to bring government to the people, providing opportunities for improved accountability, oversight, and management. Yet, the devil is in the details as local governments struggle with integrating staff from multiple agencies and levels, clarifying new roles, managing internal power dynamics, and building accountability relationships. This info circuit session will use HPP's work in two Kenyan counties to discuss some of these common challenges to meaningful decentralization of the health system, as well as innovative approaches to addressing them. We will also discuss preliminary results, including improved political will, accountability, and clear operational plans. Participants will provide thoughts on how decentralization affects health systems and potential local government responses to decentralization.

13) Supporting Strategic Planning and Sustainable Investments in GeoHealth Mapping for HIV

Hosted by: Anita Datar, Nate Heard & Isabel Brodsky
Geographic targeting is now a critical component of HIV epidemic response and control efforts. Using mapping and spatial analysis, countries can achieve a better understanding of variations in HIV prevalence at subnational levels; and more effectively link epidemiological trends with other available data, including health service facilities, transport routes (e.g., roadways, waterways), availability of social services, and funding. As countries pursue more routine use of mapping and spatial analysis for HIV, they must invest in long-term goal and priority setting, strategic planning, and continuous monitoring and evaluation. To support strategic planning of GIS as part of a national health data infrastructure, HPP developed a framework or roadmap to guide routine in-country discussions. This info circuit session will present HPP's draft roadmap and crowdsource refinements from three rounds of participants, with each group building on the feedback from preceding rounds. By the final round, HPP will have a vetted and refined framework, with a clear understanding of how this roadmap can be used in countries by multiple stakeholders to assess progress toward sustainable investments for GIS.

14) The Buck Starts Here: Budget Advocacy for RMNCH

Hosted by: Olive Mtema & Erin McGinn
Increasingly, governments have comprehensive national strategies to address RMNCH issues; yet, many countries are dependent on donor resources to implement these strategies. Through HPP, advocates in several African countries have engaged in health budget advocacy to hold governments accountable for allocating domestic resources for RMNCH. This info circuit session will start with sharing HPP Malawi's successful experience partnering with various Members of Parliament, including from the Parliamentary Health Committee and Women's Caucus, to strengthen their capacity to conduct advocacy during the budget formulation process, as well as follow up on disbursement and hold government accountable for expenditures. We will provide a quick overview of the activities, partners, and challenges involved in establishing an FP budget line item and three years of increasing allocations. We will then invite participants to explore what advocacy goals and strategies have been successful in other contexts to achieve improved health budget allocations.

15) Through the Looking Glass: Data Transparency in Guatemala's Social Sector

Hosted by: Lorena Moreina & Bobby Jefferson
Everyone needs information: policymakers and government leaders to better design interventions; civil society organizations to advocate and demand accountability from authorities; and beneficiaries of social interventions to better demand their right to access high-quality services. Often, uncertainty from no information is the only thing they find. Everyone is also keen on complete transparency and accountability when it comes to government actions. Yet, few countries can claim that they have created an environment where transparency is a given. In Guatemala, HPP helped the government develop the National Social Information System as a means to achieve complete democratization of information. This info circuit session will review the challenges that come after making information available: how to build trust in the data; how to make it understandable for all audiences so they can make it part of their everyday work; and how to change a culture focused on seeking information to a culture of using information. Discussion on these issues will provide insight for the definition of strategies that allow broad dissemination and use of information that can be added to the methodology for developing an integrated information system based on HPP's roadmap developed for this purpose.

+ Equity

16) Gender-based Violence Prevention and Response: Policy, Finance, and Community-based Programs

Hosted by: Rachel Kiesel & Elisabeth Rottach
USAID and PEPFAR are investing in the development, implementation, evaluation, and scale-up of a wide range of gender-based violence prevention and response interventions. HPP supported these efforts by developing innovative tools and approaches for policymakers, advocates, and civil society organizations. During this info circuit session, participants will learn about three of HPP's GBV tools/approaches and select one to discuss more in-depth: (1) the GBV Program Cost Calculator—a tool used to estimate the costs of GBV programs and services; (2) Policy Prevents Violence—an interactive, web-based toolkit that enables users to learn about policy approaches to preventing violence against women and to undertake a guided situation analysis of their own country context; or (3) Community-based Prevention—a strategy for preventing violence in low resource settings.

17) Advocacy to Action: Creating an Enabling Environment in Jamaica, Burkina Faso, and Togo

Hosted by: Sandra McLeish & Marguerite Thiam Niangoin
The participation of PLHIV and key populations is critical in the development of an effective HIV response. The Jamaican Network of PLHIV, Ministry of Health, and HPP engaged PLHIV leaders in developing a Jamaica-specific Positive Health Dignity and Prevention (PHDP) curriculum to strengthen PLHIV capacities for reducing S&D. Topics included gender, sexuality, diversity, disclosure, advocacy, and treatment literacy. Similarly, in West African countries (Burkina Faso and Togo), there was capacity building of key populations in advocacy, which was supported by a mapping of needs assessment with the African Sex Worker Alliance. Trained PLHIV leaders were deployed to reinforce workplace policy development in ministries of health. Representatives from the cohorts have moved on to occupy national leadership positions, SWs and MSM have been involved in Country Coordinating Mechanisms countries where they participated in the development of the Global Fund conceptual note, minimum package of HIV services, strategic plan 2015–2020, as well as stopping a law criminalizing homosexuality; a significant paradigm shift for the country. Through culturally specific, meaningful engagement, PLHIV and key population communities can witness a more effective response to their national HIV programs. After presenting some key results, participants will give their opinions about how advocacy can strengthen the leadership of PLHIV and key populations in national responses.

18) Recent Studies on Stigma and Discrimination Specific to Sex Workers and Adolescents Reveal Need for Action in Healthcare Settings

Hosted by: Laura Nyblade &Melissa Stockton
Grounded by the harsh reality of several key findings from two recently completed HPP studies on stigma—with male and female sex workers in Kenya and with adolescents in Tanzania—participants will discuss existing approaches and tools to move stigma reduction from being the exception to a routine and fundamental part of how we deliver health services. This info circuit session will provide highlights of hot-off-the-press data from two studies: (1) a quantitative study on stigma and utilization of health service among male and female sex workers in four sites in Kenya and (2) a qualitative study on stigma and adolescent access to family planning and reproductive health information and services in two sites in Tanzania. We will then segue into a participant discussion on ways to creatively respond to stigma in health facilities, taking into consideration existing structures, programs, and constraints and the importance of a total facility approach—since stigma often begins at the gate or door of health facilities.

19) The Tyranny of Boxes or How to Acknowledge Diversity in Gender and Sexuality

Hosted by: Diego Solares & Ryan Ubuntu Olson
Gender has become shorthand for "women and girls" in the field of global health. This long-held association discourages men and boys and anyone other than women and girls from examining their own gender and considering its health impacts. The Gender & Sexual Diversity Training instead emphasizes a broad view of gender and sexuality and encourages training participants to acknowledge the importance of gender in their own lives, no matter who they are or how they might identify. This info circuit session will introduce participants to the four gender and sexuality continuums used in the training and will then facilitate a discussion aimed at exploring opportunities for integrating this framework in varied public health programs.

20) Toward Gender-responsive Health Policy and Governance: Translating Good Intentions into Practice

Hosted by: Jennifer Pendleton, Madison Mellish, & Henry Sapuwa
While a number of countries have recognized the importance of gender equality in principle—through high-level policy commitments and the establishment of national gender ministries and health sector gender units—those commitments do not always translate into gender-sensitive health programs and services. HPP's work in Malawi to strengthen the Ministry of Gender, Children, Disability and Social Welfare will serve as an entry point for discussion about why and how we should include and support national gender machineries as a part of health policy, advocacy, and governance. With a focus on Malawi, and an opportunity to compare experiences and findings from other countries, this info circuit session will offer a framework for policymakers, donors, and development practitioners to examine country-specific efforts to strengthen national and subnational policy, stewardship, and multisectoral coordination for gender integration and equality in the health sector.

+ Financing

21) Cutting Where it Counts: Strategic Focus for VMMC Programs

Hosted by: Katharine Kripke & Melissa Schnure
The Global AIDS Coordinator has asked PEPFAR programs to pay greater attention to strategic prioritization—by geography, program performance, and other parameters—to focus resources where they will have the greatest impact. Modeling analyses have suggested that voluntary medical male circumcision (VMMC) should be a pillar of the sustainable response to the HIV pandemic in countries where male circumcision prevalence is low and HIV prevalence is high. The Decision-Makers' Program Planning Tool (DMPPT) 2.0 was developed in 2013 to disaggregate HIV impact and the cost-effectiveness of the VMMC program by geography and client age group. Participants will be introduced to the analytical framework and country applications of the model and then be asked to discuss how they would use the model results to inform a country strategy.

22) Generating Cost and Impact Data to Guide the Next Generation of RMNCH Plans during the SDG Era

Hosted by: Elise Lang & Tewodros Bekele
n line with a new global focus by countries and partners to end preventable deaths, there is a crucial need to provide analytic evidence and help countries re-focus their investment priorities on cost-effective interventions that can ensure equity and universal access to maternal, neonatal, and child health services. Governments need costing and impact data to guide prioritization and set national targets as countries prepare their post-2015 strategic plans to align with the SDGs. To support this need, HPP implemented the OneHealth Tool and LiST model, which serve as a costing and impact analysis platform for the entire health sector, helping to inform health system investments, MNCH program needs, and resource mobilization for the scale-up of maternal and child health interventions. This info circuit session will present HPP's results and lessons learned from implementing costing and impact analyses and prioritization exercises in seven countries in Africa and will discuss next steps on how evidence can best inform national health strategic plans and advocate the prioritization of RMNCH.

23) Getting to 90-90-90 and Beyond: The Math and the Dollars behind the HIV Treatment Challenge of Our Time

Hosted by: Arin Dutta & John Stover
Countries with significant HIV epidemics are moving toward the adoption of increasingly ambitious targets for antiretroviral treatment—largely in response to the UNAIDS call for a 90-90-90 global target for 2020 of 90 percent of people living with HIV diagnosed, 90 percent of them on treatment, and 90 percent of those on treatment virally suppressed. These targets represent a possible reduction in AIDS-related deaths and new HIV infections, but come with significantly higher resource needs. The World Health Organization may soon recommend a "test and offer" approach that will vastly simplify the guidelines for initiating persons living with HIV on treatment. This info circuit session will present methodologies used to estimate the need for ART and to project the costs of related services. We will review key assumptions and data sources and identify the areas where our collective knowledge still has gaps. We will build on successive rounds of info circuit participants to explore the methods of estimation and the implications of rising ART costs. How can our underlying methods to estimate ART needs and costs improve? What can countries do to increase efficiency at the site level? Participants will gain an understanding of the key challenges in estimating needs and the implications of rising costs, in order to motivate the call for sustainable financing of HIV treatment.

24) Connecting the Dots—Using Data to Link Program Outcomes with Health System Realities: A Primer on the OneHealth Tool

Hosted by: Veena Menon, Ricardo dos Santos e Silva, Catherine Cantelmo, & Wame Mosime
Many ministries of health have been implementing health programs without knowing what resources are available to support programming, staff, and infrastructure—let alone what is needed to achieve their health strategic objectives. Estimating resource needs has been challenging because collecting the cost information is difficult. Many ministries have not had one place to store and analyze this data. And specific health program objectives are not always aligned with health system capabilities. For example, a goal to increase coverage rates for voluntary counseling and testing might be set without accounting fully for staff, infrastructure, and logistics requirements to meet that goal. Better integration of data and understanding what costs are needed can avoid the pitfalls of wasted resources and unmet goals. Info circuit participants will learn about the OneHealth tool (OHT), a costing model designed to estimate overall resource needs for a health program—intervention by intervention—and discuss how it can be used to best effect, including data requirements. In this info circuit session, participants will learn about how OHT has been used in several countries and offer ideas based on their experience with strategic planning on health budgets.

25) Using Evidence to Squeeze More Dollars for Health Amid Competing Needs

Hosted by: Stephen Muchiri, Rosemary Silla, & Mariam Ally
As low- and middle-income countries adopt ambitious new goals for HIV and AIDS treatment, as well as for scale-up in the use of modern contraceptive methods for family planning, they face a plateau in traditional sources of external financing such as the U.S. Government or the Global Fund. This comes even as countries are looking to finance a broad scale-up in services, including for non-communicable disease programs and the achievement of the SDGs. In this info circuit session, we explore real policy cases from Kenya and Tanzania, two countries with real movement in domestic resource mobilization (DRM). Participants will learn about the experiences of our presenters, who actively provide technical support on DRM to the government, civil society, and development partners. Participants will then explore how DRM mechanisms—such as AIDS Trust Funds, set-asides from government budgets for antiretroviral drugs, and other sustainable financing ideas—are being implemented. Participants can also explore broader questions: Is there further potential for growth in tax-funded public provision of services? How should ministries of health interact with ministries of finance to secure the resources needed? What is the role of civil society in ensuring that governments fulfill their funding commitments? What technical analyses are needed to facilitate progress toward greater DRM?

Icons for Health Systems, Evidence, Localization, Equity, and Financing