The symposium proved a pivotal moment in advocating for community health workers who should be trained effectively, paid as professionals, adequately supplied, and supportively supervised to advance critical public health goals. With over 700 participants gathered in Monrovia, the symposium included government representation from 46 countries, CHWs from around the world who participated in every session, and high-level representation from Liberia, participating countries, and development partners.

R4D’s Health Systems Strengthening Accelerator team was honored to support the development and delivery of the 2023 CHW Symposium. We facilitated a full-day pre-symposium workshop among 39 country delegations focused on advancing community health roadmaps and improving measurement of progress; and led development of four out of nine of the main symposium’s themed tracks dedicated to institutionalizing financing, professionalizing the community-led workforce, improving the use of data in CHW programs, and gender dimensions in community health programming.

We thank Liberia’s Ministry of Health, USAID, UNICEF, the Global Fund, Last Mile Health, the Community Health Impact Coalition, and all organizing partners for the great team effort that created such a successful global gathering.

R4D strongly supports the symposium’s culminating Monrovia Call to Action, an evidence-based mutual commitment to fund, scale and strengthen community health programs as an integral part of primary health care for the realization of universal health coverage. We commit to support the advancement of CHWs and their integration into strong primary health care systems as we work with governments, civil society, researchers, and other change agents to create self-sustaining systems that support healthy, educated people. 

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About Results for Development
Results for Development (R4D) is a leading non-profit global development partner. We collaborate with change agents — government officials, civil society leaders and social innovators — supporting them as they navigate complex change processes to achieve large-scale, equitable outcomes in health, education and nutrition. We work with country leaders to diagnose challenges, co-create, innovate and implement solutions built on evidence and diverse stakeholder input, and engage in learning to adapt, iterate and improve. We also strengthen global, regional and country ecosystems to support country leaders with expertise, evidence, and innovations. R4D helps country leaders solve their immediate challenges today, while also strengthening systems and institutions to address tomorrow’s challenges. And we share what we learn so others around the world can achieve results for development too. www.R4D.org

Photo © Patrick Adams, RTI International

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R4D experts who are involved with USAID’s Health Systems Strengthening Accelerator are participating closely in the symposium. Their participation includes leading the 2nd day of the pre-conference and contributing to several of the symposium’s technical tracks:

• Track 1: Institutionalizing and financing at-scale, sustainable community health worker programs for PHC2.
• Track 2: Professionalizing, compensating, and protecting CHWs and other community-based and community-led workforce
• Track 7: Digital health solutions to enhance CHW and other community-based and -led workforce programs
• Track 8: Gender dimensions in community health and CHW programming

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At Results for Development (R4D), Ms. Gates is a program associate on the Strategic Purchasing Africa Resource Center (SPARC) and Cross-Programmatic Efficiency Analysis (CPEA) teams. In this role, she assists in program management, country engagement and the facilitation of collaborative learning. She also works with R4D’s coaching team on management of the Experts Database.

Prior to joining R4D full-time, Ms. Gates interned with the R4D-led Health Systems Strengthening Accelerator (Accelerator), the Primary Health Care Performance Initiative (PHCPI) and R4D’s Frontier Health Market (FHM) Engage team to provide support in program management and day-to-day responsibilities.

Ms. Gates holds a BS in public health with an emphasis in environmental/occupational health and a minor in international development from Brigham Young University.

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As countries undertake health financing reforms to advance toward universal health coverage (UHC), the desired outcome or objectives of the reform, are often conflated with the instruments for achieving them. This has led to a proliferation of UHC pilots and schemes, as well as initiatives focused on specific interventions or diseases, that may be misaligned, or even work against, the objectives the reforms seek to achieve.

Over the course of four sessions high-level experts from national governments, academic institutions, NGOs and multilateral organizations discussed what it means to design “ends-driven” health financing reforms, and shared specific examples of challenges and progress.

Joe Kutzin, former coordinator for health financing at the World Health Organization, kicked off the series with the following questions: “How do we get the question right? If the question is: How do I subsidize the poor and get everyone else to contribute? Then I pretty much only have one policy option. But if it’s instead how to improve effective service use and with financial protection for people outside of the formal sector, then there are many policy options. So, it’s really about getting that question right, and also taking the entire system and population as the unit of analysis.”

Recordings of the sessions can be found below.

• Session 1: What is ends-driven reform? Practical examples from the field

In session one, experts shared concepts and country experience from Argentina, Ghana, Malaysia, Mexico, and Uganda that illustrated the practical importance of separating ends (the objectives a reform seeks to achieve) and means (the instruments for achieving health systems reforms).

• Session 2: Building universality into fragmented health financing systems

In session two, experts shared experiences from Burkina Faso, India and Tanzania targeting public spending on those most in need while strengthening foundations for universality in fragmented health financing systems.

• Session 3: Using systems-level approaches to sustainably address specific objectives

In session three, experts focused on the theme of integration — how to achieve greater efficiency through cross-program integration, including across donor programs, how to achieve greater integration across sectors and how to achieve greater integration across different levels of government.  Country examples included Rwanda and Kenya.

• Session 4: How to produce ends-driven research at a system level

In session 4, experts from Benin, Burkina Faso, India and Mexico discussed how to pursue ends-driven research at the systems level. The session discussed the challenges and opportunities for ends-driven research and proposed research questions to be taken forward.

The sessions were organized by Results for Development, the WHO, ThinkWell, Wellcome Trust and the Strategic Purchasing Africa Resource Center. They featured 18 speakers from Argentina, Benin, Burkina Faso, Ghana, India, Kenya, Malaysia, Mexico, Rwanda, Switzerland, Tanzania, Uganda and the United States.

Speakers included: Susan Sparkes, WHO; Joe Kutzin, WHO; Nirmala Ravishankar, Thinkwell; Octavio Gómez-Dantés (National Institute of Public Health, Mexico); Martin Sabignoso (Independent consultant, Argentina); Michael Reich (Harvard T.H. Chan School of Public Health); Joel Arthur Kiendrébéogo (RESADE, Burkina Faso), Kéfilath Bello, (CERRHUD, Benin); Wangari Ng’ang’a (Senior Program Officer, Bill & Melinda Gates Foundation; Board Member, R4D); Gemini Mtei (Abt Associates, Tanzania); S Pierre Yameogo (MOH, Burkina Faso); Parfait Uwaliraye (MOH, Rwanda); Aliyi Walimbwa (MOH, Uganda); Grace Achungura (WHO, India); Praneetha Vissapragada (University of Michigan); Scott Greer (University of Michigan); Nat Otoo (R4D); Rozita Halina Hussein  (Ministry of Health, Malaysia); Hélène Barroy (WHO, Switzerland); Agnes Munyua, (R4D/SPARC); Cheryl Cashin (R4D/SPARC); Edwine Barasa (KEMRI/Wellcome Trust).

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About Results for Development
Results for Development (R4D) is a leading non-profit global development partner. We collaborate with change agents — government officials, civil society leaders and social innovators — supporting them as they navigate complex change processes to achieve large-scale, equitable outcomes in health, education and nutrition. We work with country leaders to diagnose challenges, co-create, innovate and implement solutions built on evidence and diverse stakeholder input, and engage in learning to adapt, iterate and improve. We also strengthen global, regional and country ecosystems to support country leaders with expertise, evidence, and innovations. R4D helps country leaders solve their immediate challenges today, while also strengthening systems and institutions to address tomorrow’s challenges. And we share what we learn so others around the world can achieve results for development too. www.R4D.org

The post Recordings: How to achieve UHC goals with health financing reforms — top experts share insights appeared first on Results for Development.

At Results for Development (R4D), Ms. Handigol is a senior program associate on the evaluation & adaptive learning team. She executes project management and collaboration with the Tanzania Ministry of Health to test innovative solutions to improve health provider diagnosis and prescription for childhood pneumonia. She also conducts qualitative research and coordination for programs funded by USAID and the Bill & Melinda Gates Foundation focused on health systems strengthening, evidence uptake and resiliency-building in the face of civic space closures with partners across Sub-Saharan Africa, Latin America and the Caribbean, South Asia and Eastern Europe. 

Prior to joining R4D, Ms. Handigol served as Princeton in Asia Public Health Fellow based in Hồ Chí Minh, Việt Nam where she worked on HPV and cervical cancer prevention, education and access to testing. As a Fellow, Apoorva also served as a Senior Analyst with Tractus Asia, supporting global businesses on their market entry and investment strategy in Asia, Latin America and the Caribbean. Previously, she conducted healthcare integration project management at El Camino Hospital, working on quality metric analysis to increase Medicare reimbursement for El Camino physicians. 

Ms. Handigol holds a BA in sociology & anthropology from Carleton College. She is a native English speaker and is conversational in French, Vietnamese, and Kannada. 

Additional Resources

• Translating Modeled Evidence for Decision Making – Webinar 

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Abstract: The overall goal of this study is to explore the rollout of the community health policy in Guinea in the context of decentralization, and the role of decision space (the decision authority, capacities, and accountability of local officials) in explaining gaps between the policy’s conceptualization and actual implementation. The implementation research study will employ a sequential explanatory mixed-methods design. The study will be conducted in 27 communes purposefully selected across the country and include communes where the national community health policy is fully, partially, and not yet being implemented. The quantitative component, based on a survey questionnaire and secondary data, will use ordinary least squares (OLS) multiple regression to compare maternal and child health (MCH) coverage indicators according to the level of policy implementation in the commune. An interrupted time series analysis will be conducted to assess changes in routine MCH service delivery indicators associated with implementation of the community health policy, comparing indicators from one year prior to implementation. OLS regression will be conducted to assess the association between decision space and MCH indicators; all analyses will be carried out in Stata. Findings from the quantitative study will be used to inform the key qualitative questions and areas to explore in greater depth, to develop the interview and focus group guides, and to generate an initial codebook. Qualitative data will be double coded in NVivo by two qualitative analysts, and results generated using thematic analysis. Findings from the quantitative and qualitative components will be integrated and triangulated for interpretation and reporting. Findings and recommendations of this study will inform revisions to the National Community Health Policy to improve its rollout and effectiveness.

To read the full article, click here.

Photo © Results for Development/Lane Goodman

The post PLOS ONE: Implementation research protocol on the national community health policy in Guinea appeared first on Results for Development.

Mr. Mayenga has successfully developed engagement and evaluation plans for subcontracts and budget monitoring tools for multiple international projects. He has also created financial reports including half-year and annual reports for donors. His experience has involved managing grants, implementing program activities based on grant agreements and donor compliance.

Before joining R4D, Mr. Mayenga was a senior project administrator, where he strengthened operations, reduced audit findings and contributed to the launch of business world as a super trainer. 

Mr. Mayenga holds a bachelor’s degree in business administration from Iringa University, formerly known as Tumaini University. He is a native speaker of Swahili and also speaks fluent English.  

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In June 2022, Results for Development (R4D) and the Strategic Purchasing Africa Resource Centre (SPARC) partnered with the WHO Health Financing Team and the WHO Regional Office for Africa, to host a three-day virtual workshop convening a diverse set of stakeholders, primarily from seven countries that conducted a CPEA assessment: Côte d’Ivoire, Comoros, Kenya, Ghana, United Republic of Tanzania, Nigeria and Uganda.

The workshop’s primary objective was to enable collaboration and learning across countries in the WHO African Region that have conducted a CPEA and to facilitate real and sustainable policy progress
to address and resolve inefficiencies.

This summary report synthesizes the findings and messages related to CPEA implementation, including both the cross-programmatic inefficiencies identified as well as mechanisms to address them. Key themes and learnings include:

• Undue fragmentation across health programs constrained each country’s progress towards Universal Health Coverage (UHC)
• CPEA can be institutionalized as a lever and integrated with other health system reforms to improve efficiency across health programs
• Both technical expertise and political commitment are required to address inefficiencies identified by CPEA
• Coordination, both vertically and horizontally, is critical and can have a multiplier effect throughout the system
• Having a single national plan that’s unified and well connected brings coherence and accountability across the system to address cross programmatic inefficiencies

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