What is PHRplus doing in Reproductive and Maternal Health?
Raising awareness about health systems strengthening and financing of reproductive and maternal health services
In many developing countries, health system strengthening activities have brought changes to the structure of the health sector and raised concerns that vertical programs, such as family planning (FP) and reproductive health (RH), may suffer as a consequence. Countries are increasingly implementing measures, or health reforms, designed to strengthen their health systems so that they can better achieve public health goals. To increase understanding among policymakers, PHRplus and the Population Reference Bureau (PRB) developed a policy brief on Health Sector Reform: How it Affects Reproductive Health.
The brief provides an overview of health sector reform, discussing its potential impact on reproductive health services and ways to incorporate reproductive health priorities into evolving health care systems. PHRplus highlighted the brief at a July 2003 forum, jointly conducted with CATALYST Consortium, on Financing Reproductive Health Services in the Context of Health Sector Reform.
In September 2003, PHRplus presented key findings from a policy brief, Improving Access to Maternal Health Care through Insurance, as part of the USAID Maternal Health seminar series. This policy brief draws together experience and lessons learned from insurance and prepayment mechanisms that cover maternal health care services in Bolivia and Rwanda. In addition to identifying critical issues for policymakers to consider, the paper offers guidance and tips for developing country health planners and policymakers implementing health insurance or alternative financing mechanisms targeted for maternal health services.
Increasing knowledge of the impact of emerging development assistance mechanisms on reproductive health and contraceptive security
PHRplus has contributed to the knowledge base in this area by investigating whether new trends in development assistance (Sector-Wide Approaches [SWAps] and Poverty Reduction Strategy Papers [PRSPs]) impact contraceptive security. PHRplus has conducted a thorough literature review and interviewed key informants in Bangladesh, Ghana, and Zambia on the affect of funding mechanisms like SWAps and PRSPs on contraceptive security. The purpose of the review was to make recommendations on strategies on how to include contraceptive security as a health sector priority in SWAps and PRSPs.
Major findings conclude that there is little to no involvement by RH/FP advocates in new funding arrangements and therefore RH/FP is often not given priority for funding. Preliminary results were presented at the APHA conference in San Francisco in November 2003 and in Ensuring Contraceptive Security within New Development Assistance Mechanisms.
Developing tools to increase low-resource country capacity to plan for and achieve contraceptive security
At the request of USAID, the project helped develop tools for the Strategic Pathway to Achieve Reproductive Health Commodity Security (SPARHCS) Initiative. Tools were developed in collaboration with DELIVER, POLICY, CMS, PATH, JHU/HCP, Population Reference Bureau, UNFPA, and other organizations working with USAID's Contraceptive Security and Logistics Division. Participation in SPARHCS has provided PHRplus the opportunity to contribute expertise in the areas of health financing and systems strengthening and underline their importance to RH/FP advocates and stakeholders.
In May 2003, project staff, in collaboration with POLICY, DELIVER, UNFPA, and local counterparts, conducted a reproductive health commodity security (RHCS) assessment in Madagascar using the SPARHCS diagnostic tool and framework. This led to the creation of a multi-sectoral committee to oversee the SPARHCS process - a multi-year strategic plan to improve RHCS in Madagascar.
Increasing information on public and private expenditures on reproductive health
Based on PHRplus experience with health reform in developing countries, national health decisionmakers and policymakers need to have the best available information to guide, design and implement policy options for providing reproductive health services and commodities. PHRplus is using the National Health Accounts (NHA) framework to conduct expenditure analyses for reproductive health services. NHA is an internationally accepted tool that provides a comprehensive estimate of national health expenditures. It captures and examines a nation's use of public, private (including households), and donor funds. NHA organizes and tracks the flow of funds from one health care dimension to another starting from the funding source to the end users. Currently, PHRplus is conducting RH NHA analysis in Jordan and Rwanda.
Identifying factors that affect Mutual Health Organization (MHO) decisions to include family planning services and commodities in their benefits
A growing body of evidence exists to show that community-based health financing schemes, such as Mutual Health Organizations (MHOs), contribute to greater utilization of priority services. Selection of services to be covered under the schemes is done by the communities involved. In some cases, MHO packages have included family planning services and commodities. For example, in Senegal, many MHOs that are developed by women's groups include the provision of family planning counseling and offer commodities to their members. PHRplus is examining what factors influence the decision to include family planning services and commodities in the benefits package.
This study aims to provide policymakers and communities in West and Central Africa with information that can assist in the development of strategies to strengthen the role of Mutuelle Health Organizations in their efforts to increase access to and utilization of family planning and other priority health services. The results will be useful to MHO administrators, institutions providing technical assistance to MHOs (e.g., International Labour Organization, Groupe de recherche sur l'apprentissage interactif multimédiatisé or GRAIM), donors, and Ministries of Health, Finance and Local Government.
Evaluating the impact of community financing and an IEC/BCC campaign on utilization of maternal health services
In Mali, the PHRplus project has been working with local communities in two pilot sites to develop and implement community financing mechanisms to increase utilization of health services. In the rural district of Bla, the project is working with local staff and counterparts to examine how financing alternatives through Mutual Health Organizations (MHOs) can contribute to increased rates of assisted deliveries and other maternal health service utilization, such as prenatal and postnatal consultations. In addition, PHRplus staff and community stakeholders will continue to carry out a directed Information, Education and Communication (IEC) campaign in discrete zones of Bla. In two MHO areas and two areas outside the MHO communities, the project will regularly carry out the IEC campaign components (consisting of radio messages, informational materials and targeted interactive educational sessions, such as storytelling), in order to measure the impact on maternal health service utilization where MHOs are present.
These analyses will hopefully include increased use of maternal health services in study sites and a better understanding about the role of financing and IEC in generating greater use of Skilled Birth Attendants, especially among the poor, and faster progress in reducing maternal mortality in Africa.
Other Reproductive and Maternal Health Related PHRplus Activities and Products