Abstract: Rehabilitative care is often overlooked and underfunded despite being a key component of universal health coverage, and now faces further neglect due to indirect impacts of the coronavirus disease 2019 pandemic. Policy-makers can leverage strategic purchasing approaches to make the most of available funds and maximize health gains. To implement more strategic purchasing of rehabilitation, health planners must: (i) develop and prioritize evidence-based rehabilitation service packages; (ii) use fit-for-purpose contracting and provider payment mechanisms to incentivize quality and efficient service delivery; and (iii) strengthen stewardship. This paper examines these three policy priorities by analysing their associated processes, actors and resources based on country experiences. Policy-makers will likely face several obstacles in operationalizing these policy priorities, including: inadequate accountability and coordination among sectors; limited data and research; undefined and non-standardized rehabilitation services, costs and outcomes; and inadequate availability of rehabilitative care. To overcome challenges and institute optimal strategic purchasing practices for rehabilitation, we recommend that policy-makers strengthen health sector stewardship and establish a framework for multisectoral collaboration, invest in data and research and make use of available experience from high-income settings, while creating a body of evidence from low- and middle-income settings.

To read the full article, click here.

Photo © Alex Kamweru/USAID

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Linked will bring together immunization practitioners, policymakers and partners from middle-income countries (MICs) who are facing common immunization program challenges. Through highly participatory, and action-oriented collaborative learning approaches, Linked will support member countries to identify practical solutions and best practices to mitigate and prevent backsliding in vaccine coverage, drive the sustainable introduction of key missing vaccines, and promote increased immunization equity and sustainability.

“R4D is delighted to be facilitating Gavi’s Linked Immunisation Action Network with Curatio International Foundation and the Institute for Health Policy,” said Annette Ozaltin, a program director at R4D. “Collaborative learning and knowledge sharing has proved to be a valuable innovation, supporting countries to collectively solve problems and share lessons learned. These innovative learning approaches are ideal for bringing together countries that face similar challenges as they continue to strengthen and ensure the sustainability of their immunization programs, while improving vaccine coverage and equity and introducing new vaccines.”

Building upon the success of LNCT, the reoriented network is expanding to include all countries that have transitioned from Gavi support as well as select countries that have never received Gavi support. In line with the objectives of Gavi’s MICs Approach, the Linked Immunization Action Network will support these countries to identify practical solutions and best practices to mitigate and prevent decreases in immunization coverage and drive sustainable introduction of key missing vaccines.

The network will continue to be facilitated by R4D, CIF and IHP. We look forward to continuing this journey with you as we work to support countries to strengthen immunization programs and improve sustainability and equity, and we invite you to share questions, requests and suggestions for the reoriented network by email.

Linked will engage country partners to: 

• Understand top immunization program challenges, including barriers and threats to maintaining high and equitable immunization coverage and sustainably introducing new vaccines.
• Facilitate peer-to-peer knowledge sharing to elevate tested solutions and best practices for strengthening immunization programming.
• Support the implementation of solutions and best practices — working with and through country partners — to address immunization program challenges.
• Strengthen skills and capacities within immunization programs.
• Capture and disseminate implementation experiences to ensure learning is shared globally and not lost. 

 These approaches will include in-person and virtual learning exchanges, learning circles, in-person and virtual study tours, country institutional twinning, direct country-to-country linkages, and collaborative problem-solving sessions.

This network will be made up of — and driven by — a group of in-country stakeholders, including decision-makers and technical staff from ministries of health, ministries of finance and other relevant government ministries and departments, immunization technical advisory groups, as well as country partners providing support to national immunization programs.

Linked is an evolution of the Learning Network for Countries in Transition (LNCT), a learning network operating from 2017-2021, for which R4D served as the network coordinator. LNCT  supported over 20 countries transitioning from Gavi support to full domestic financing of their national immunization programs. Learn more about LNCT’s impact here.

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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    

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• Provision of immunization services in the private sector
• Engagement of CSOs to support advocacy and demand generation
• Partnership with commercial sector company to improve cold chain maintenance

Speakers:

• Abdulkadir Aladie Bello, Logistics and Health Commodities Department, NPHCDA
• Chizoba Wonodi, Epidemiologist, Johns Hopkins Bloomberg School of Public Health and Founder, Women Advocates for Vaccine Access (WAVA)
• Uchenna Igbokwe, Principal, Solina Health

The post Webinar: Engaging the Private Sector to Support Immunization Delivery – Lessons from Nigeria appeared first on Results for Development.

The universal health coverage movement has strengthened advocacy for integration in service delivery and its enabling systems and inputs, particularly following the 2018 Global Conference on Primary Health Care, which marked the 40th anniversary of the Alma Ata Declaration. Many see integration as a way to ensure equitable financing for and access to a range of services, not just those offered by a handful of privileged programs. Countries are also increasingly cognizant of resource constraints and are eager to increase health system efficiency, including through integration.

“Integrating Vertical Programs into Primary Health Care: A Decision-Making Approach for Policymakers” offers practical guidance for policymakers who need to make decisions about whether and how to more fully integrate specific vertical programs into their country’s broader health system, with a focus on PHC. It discusses what the evidence shows about the successes and failures of such efforts, considerations for policymakers when making decisions about integration, and ways to balance potential gains and losses. It also proposes use of a tool called the PHC Conceptual Framework for characterizing the relationship between a vertical program and the broader system and exploring the potential opportunities and constraints that come with integration. The Annex includes brief case studies from South Africa and Ethiopia illustrating how the framework can help to understand integration efforts.

Two other, more detailed case studies about ongoing integration efforts in Ghana and Malawi are also available. You can also read more about this work on the R4D blog.

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The Ministry of Finance is a crucial ally for Ministries of Health and country immunization programs aiming to successfully manage Gavi transition. Ministries of Health, Ministries of Finance, Ministries of Budget, and development partners often have separate planning processes, which can make it difficult to plan for the needs of changing immunization programs as they move toward self-sustainability. Four essential points for Ministry of Finance staff in Gavi transitioning countries are below.

1. Immunization is a critical driver of primary health care (PHC), Universal Health Care (UHC) and the health Sustainable Development Goal (SDG).

The immunization schedule requires numerous points of contact between the child, mother, and health system, particularly in the first year of life. To successfully prevent disease outbreaks, immunization coverage rates of around 80-95% of the population are needed in all districts. Immunization programs therefore strive for equity and often reach farther into hard-to-reach, mobile or otherwise marginalized populations than do other health services. These contacts can serve as an entry point for the child and mother into primary healthcare through referrals or, in some cases and with careful planning, through the integration of immunization service delivery with delivery of vitamin A, deworming, family planning, or other services. Investing in immunization program performance may also bolster health system performance as whole, including primary healthcare and surveillance capacity.

To read the full blog, click here.

Photo © Alex Robinson for CHMI/Kusuma Buana Foundation

The post LNCT: 4 Things Ministers of Finance Need to Know About Immunization in Gavi Transitioning Countries appeared first on Results for Development.

Please see below for related resources.

1. 2016 Women Deliver Conference Presentation: “Making Health Systems Work for Girls and Women”
   Drawing on Results for Development’s work with PSI under the SIFPO2 project, this presentation explores issues of financial sustainability facing social franchises, and the opportunities presented by recent universal health coverage commitments and sustainable development goals It discusses how linking social franchises with UHC efforts can result in better, fairer, and more sustainable and accessible care for women and girls.
2. 2016 Webinar to the Social Franchising Community of Practice under University of California San Francisco: “Enhancing the Financial Sustainability of Social Franchise Networks: An analytical and participatory approach” (Women Deliver Conference Presentation)
   This webinar presents an overview of Results for Development’s framework and approach for systematically identifying opportunities to link social franchises to third-party systems, and provides a deep dive into the application of this approach with PSI’s network member in Nigeria, Society for Family Health.
3. 2016 USAID Global Health Mini-University Presentation: “Saving Client Sara”
   This interactive workshop introduced university students and early health care professionals to an innovate framework that identifies strategies to improve financial sustainability of social franchise networks for family planning. The framework and case study were based on the work of Results for Development and PSI, under the USAID-supported SIFPO2 project.
4. 2017 International Health Economics Association Congress Presentation: “Building the Facilitation and Intermediation Functions”
   Governments in many low- and middle-income countries recognize the need to improve their stewardship of and strategic purchasing from private providers to create strong mixed health systems. But they tend to rely too heavily on (weakly enforced) regulation and lack knowledge of the importance and the “how-to” of private sector stewardship and strategic purchasing. In this presentation, Results for Development shares its cross-country experience in Nigeria, Uganda, and Tanzania under SIFPO2 in bridging this gap between purchasers and private providers.
5. 2017 USAID Global Health Mini-University Presentation: “Get that Contract Signed”
   To help attain universal health coverage (UHC), some governments are considering the option of working more closely with the private sector to help fill gaps and address system needs through public-private partnerships (PPPs). In this collaborative session, university participants learned about and designed/negotiated a PPP from the public and private sector perspectives; the process drew directly from recent work by R4D/PSI under the USAID-supported SIFPO2 project.
6. 2018 USAID Attaining Sustainable Financing for FP in Sub Saharan Africa Meeting
   At this USAID-funded meeting, FP stakeholders from national governments, civil society, the private sector, USAID, and other development partner organizations gathered at a week-long meeting in Accra, Ghana to share country experiences and explore innovative approaches and tools. Over the course of the five-day meeting, participants shared challenges, lessons learned, and best practices in FP financing. SIFPO2 organized and contributed to 5 of the 14 total sessions, including: Health Financing Basics, Planning for and Succeeding with FP Funding Transition, Purchasing FP, Improving Affordability & Quality of FP Services & Supplies in the Private Sector, and Improving the Allocation Process & Budget Execution.
   – Improving Allocative Efficiency and Budget Execution for Family Planning – Case of Malawi
   – From Donor to Domestic: Transitions for Family Planning|
   – Strategic Purchasing for Family Planning: The Basics
   – Improving Allocative Efficiency and Budget Execution for Family Planning
   – Public Financial Management in Tanzania and Links to Family Planning Service Delivery
   
7. Expanding Access to Voluntary Family Planning Services in Mixed Health Systems: Lessons from linking private health care networks to domestic financing
   Many low- and middle-income countries (LMICs) have committed to ambitious family planning (FP) goals, including expanding access to and choice of high-quality FP services and products. These initiatives are often underpinned by service delivery in both the public and private health care sectors. This report provides insights on engaging the private sector within national stewardship and financing systems for FP. These insights draw upon private sector engagement efforts under SIFPO2 and are of relevance to global and national funders, as well as stewards and managers of family planning programs.

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