Review of the inclusion of SRHR interventions in essential packages of health services in low and lower-middle income countries.

HEARD, 2021.Sexual and reproductive health and rights (SRHR) and universal health coverage (UHC) are fundamental to health as a human right. One way that countries operationalise UHC is through the development of an essential package of health services (EPHS), which describes a list of clinical and public health services that a government aspires to provide for their population. This study reviews the contents of 46 countries’ EPHS against the standard of the Guttmacher-Lancet Report’s (GLR) nine essential SRHR interventions. The analysis is conducted in two steps; EPHS are first categorised according to the level of specificity of their contents using a case classification scheme, then the most detailed EPHS are mapped onto the GLR’s nine essential SRHR interventions. The results highlight the variations of EPHS and provide information on the inclusion of the GLR nine essential SRHR interventions in low- and lower-middle income countries’ EPHS. This study also proposes a case classification scheme as an analytical tool to conceptualise how EPHS fall along a spectrum of specificity and defines a set of keywords for evaluating the contents of policies against the standard of the GLR. These analytical tools and findings can be relevant for policymakers, researchers, and organisations involved in SRHR advocacy to better understand the variations in detail among countries’ EPHS and compare governments’ commitment to SRHR as a human right

The Paris Declaration in practice: challenges of health sector aid coordination at the district level in Zambia

<p>Abstract</p> <p>Background</p> <p>The increasing resources available for and number of partners providing health sector aid have stimulated innovations, notably, the Paris Declaration on Aid Effectiveness, which aim to improve aid coordination. In this, one of the first studies to analyse implementation of aid coordination below national level, the aim was to investigate the effect of the Paris Declaration on coordination of health sector aid at the district level in Zambia.</p> <p>Methods</p> <p>The study was carried out in three districts of Zambia. Data were collected via interviews with health centre staff, district managers and officials from the Ministry of Health, and from district action plans, financial reports and accounts, and health centre ledger cards. Four indicators of coordination related to external-partner activity, common arrangements used by external partners and predictability of funding were analysed and assessed in relation to the 2010 targets set by the Paris Declaration.</p> <p>Findings</p> <p>While the activity of external partners at the district level has increased, funding and activities provided by these partners are often not included in local plans. HIV/AIDS support show better integration in planning and implementation at the district level than other support. Regarding common arrangements used for fund disbursement, the share of resources provided as programme-based support is not increasing. The predictability of funds coming from outside the government financing mechanism is low.</p> <p>Conclusion</p> <p>Greater efforts to integrate partners in district level planning and implementation are needed. External partners must improve the predictability of their support and be more proactive in informing the districts about their intended contributions. With the deadline for achieving the targets set by the Paris Declaration fast approaching, it is time for the signatories to accelerate its implementation.</p

Theory and practice – a case study of coordination and ownership in the Bangladesh health SWAp

BACKGROUND: In the past decade the sector-wide approach (SWAp) model has been promoted by donors and adopted by governments in several countries. The purpose of this study is to look at how partners involved in the health SWAp in Bangladesh define ownership and coordination, in their daily work and to analyse the possible implications of these definitions. METHODOLOGY: The study object was a process of decision-making in the Government of Bangladesh in 2003. Information was collected through participant observations, interviews and document review. RESULTS: During the study period the Government of Bangladesh decided to reverse a decision to unify the two wings of the Ministry of Health and Family Welfare. The decision led to disagreements with development partners, which had serious implications for cooperation between key actors in the Bangladesh health sector leading to deteriorated relationships and suspension of donor funds. The donor community in itself was also in disagreement which led to inconsistencies in the dialogue between the development partners and the Government of Bangladesh. CONCLUSION: The case shows that main actors in the Bangladesh health SWAp interpret ownership and coordination, fundamental aspects of SWAp, differently. As long as work ran smoothly, the different definitions did not create any problems, but when disagreements arose they became an obstacle. It is concluded that partners in development should devote more effort to their working relationships and that responsibilities within a SWAp need to be more clearly delineated

Toward a Consensus on Guiding Principles for Health Systems Strengthening

Based upon a review of the literature, Robert Chad Swanson and colleagues present a set of guiding principles for health systems strengthening

Health sector aid coordination in Zambia : From global policy to local practice

The volume of foreign aid to the health sector in low- and middle-income countries and the number of donors involved have increased in recent years. During the last two decades, more attention has been directed towards better coordination of donor resources and activities, particularly in the health sector. Models and agreements for how to improve the coordination of aid, such as the sector-wide approach (SWAp) and the Paris Declaration, have been launched. Significant effort has been invested in designing models for coordination, but comparatively little time has been devoted to studying how these models are implemented or what effects they have had. This thesis explores and analyses how health-sector aid coordination is implemented, from its definition in global policies to its practical application at the local level in Zambia. Aid coordination is analysed from the perspective of policy implementation. All four studies described in this thesis were conducted in Zambia, a country with extensive experience of coordination of activities and resources in the health sector. A case-study design was applied, which combined qualitative and quantitative methods for data collection. Nonparticipant observations, semi-structured interviews, document review and data on financial and administrative accounts were used. In total, more than 100 interviews were conducted with key actors: donor representatives and government officials. Findings were compared with nationally and internationally agreed indicators for efficiency in resource allocation and aid effectiveness. Findings showed that coordination is translated as it is adopted, being adapted to suit the existing administrative structures in different contexts. Translations varied more between actors than between different institutions. In general, actors were content with how healthsector aid was coordinated, although stakeholders had different ideas about how such coordination should be implemented. In Zambia, coordination efforts that started in the early 1990s have so far contributed little to the efficient allocation and use of resources in the health sector. Indicators for aid effectiveness showed that the coordination of resources at the district level is still a challenge since the number of external partners is increasing and the predictability of resources is not improving. Coordination of health-sector aid has led to changes in the ways that development aid is organized. In practice, however, the effects of these changes are still limited. The lack of effects is explained partly by observed decoupling between policy and practice, as processes are adjusted to match the actors needs and fit into the local context. The actors different understandings of how coordination is implemented and the fact that many resources are still uncoordinated weaken government ownership and are contrary to the global agreement of the Paris Declaration

Sexual and Reproductive Health and Rights: : An Essential Element of Universal Health Coverage. Background document for the Nairobi Summit on ICPD25 - Accelerating the promise

The Nairobi Summit on ICPD25 provided an opportunity to complete the unfinished business of the International Conference on Population and Development Programme of Action and also a chance to commit to a forward-looking sexual and reproductive health and rights agenda to meet the Sustainable Development Goals and targets by 2030.This background document for the Nairobi Summit on ICPD25 was conceived from the international commitments of several governments and organizations and in the context of the adoption of the Political Declaration of the High-Level Meeting on universal health coverage (A/74/RES/2) in 2019. Its purpose is to define and describe the key components of a comprehensive life course approach to sexual and reproductive health and rights. Furthermore, the ambition is to describe how countries can move towards universal access to sexual and reproductive health and rights as an essential part of universal health coverage and to provide inspiring examples from countries that have moved in this direction