Private Healthcare Delivery MOMENTUM Private Healthcare Delivery (MPHD) Y1 Semi-Annual Report Submitted May 14, 2021 Resubmitted July 18, 2021 MOMENTUM: PRIVATE HEALTHCARE DELIVERY Year 1 Semi-Annual Report June 22, 2020 (project inception) – March 31, 2021 Submitted by: Population Services International (PSI); on behalf of the MOMENTUM Private Healthcare Delivery (MPHD) consortium Submitted to: United States Agency for International Development under Cooperative Agreement #7200AA20CA00007
Submitted May 14, 2021
Resubmitted July 18, 2021
MOMENTUM: PRIVATE HEALTHCARE DELIVERY
Submitted by:
Population Services International (PSI); on behalf of the MOMENTUM
Private Healthcare Delivery (MPHD) consortium
Submitted to:
2
Executive Summary
....................................................................................................................................
5
Core Workplan: Progress and Achievements
...............................................................................................
7
Result Area 1: Access to and use of evidence-based, quality
MNCH/FP/RH information, services, and interventions scaled-up and
sustained
...............................................................................................................
7
Result Area 2: Capacity of Host-Country institutions, local
Organizations, and Providers to Deliver evidence- Based, quality
MNCH/FP/RH services improved, institutionalized, measured,
documented, and responsive to population Needs
.........................................................................................................................................15
Result Area 3: Adaptive Learning and use of evidence in MNCH/FP/RH
programming Through sustained host Country Technical leadership
increased.
..........................................................................................................18
Result Area 4: Cross-sectoral collaboration and innovative
partnerships between MNCH/FP/RH and non- MNCH/FP/RH organizations
increased.
............................................................................................................24
New Partnerships Initiative (NPI)
..............................................................................................................
27
Benin NPI
..........................................................................................................................................................27
Uganda NPI
.......................................................................................................................................................27
Mozambique NPI
..............................................................................................................................................27
Ghana NPI
.........................................................................................................................................................28
Burundi
.............................................................................................................................................................29
Mali
...................................................................................................................................................................30
Indonesia
..........................................................................................................................................................31
Collaboration with other MOMENTUM Awards
.........................................................................................
35
MPHD-MKA Collaboration
................................................................................................................................36
Momentum-wide Collaboration
.......................................................................................................................37
Compliance with Family Planning and Abortion Statutory and Policy
Requirements ......................................40
Planned Activities and Events for next Six months
.....................................................................................
41
Annex 2– Indicator Table
..........................................................................................................................
42
Annex 3 - List of Key Reports produced/disseminated and academic
Manuscripts developed, accepted and under review and published; and
all conference abstracts submitted and accepted
................................... 47
3
ABBREVIATIONS ABMS Association Beninois pour le Marketing Social
AHB Africa Health Business AMELP Activity Monitoring, Evaluation,
and Learning Plan ANFS National Association for Social Franchise
ANC Ante Natal Care AOR Agreement Officer Representative BMGF Bill
& Melinda Gates Foundation CEI Client Exit Interview COVID-19
Coronavirus Disease 2019 CoP Community of Practice DHS Demographic
Health Survey DISC Delivering Innovation in Self-Care DMPA
Depot-medroxyprogesterone acetate EMMP Environmental Mitigation and
Monitoring Plan EQuiPP Enhancing Quality iCCM through Proprietary
and Patent Medical Vendors FHI 360 Family Health International 360
FP Family Planning GBV Gender Based Violence GCLA Global
Collaborative for Learning and Action GE General Electric Company
HIP High Impact Practice HMIS Health Management Information Systems
ICCM Integrated Community Case Management ICFP International
Conference on Family Planning IMNCI Integrated Management of
Newborn and Childhood Illness IWMP Integrated Waste Management Plan
KCCA Kampala Capital City Authority KEMSA Kenya Medical Supplies
Authority LARC Long-Acting Reversible Contraception LoC Letter of
Collaboration MaNE Kampala Slum Maternal and Newborn Health MCGL
MOMENTUM Country and Global Leadership MCH Maternal and Child
Health MCSP Maternal and Child Survival Program MEL Monitoring,
evaluation, and learning MIHR MOMENTUM Integrated Health Resilience
MKA MOMENTUM Knowledge Accelerator MNCH Maternal Newborn Child
Health MOH Ministry of Health MPHD MOMENTUM Private Healthcare
Delivery M-RITE MOMENTUM Routine Immunization Transformation and
Equity NPI New Partnerships Initiative PNC Post Natal Care
4
PPFP Postpartum Family Planning PPH Postpartum Hemorrhage PRH
Population and Reproductive Health PSE Private Sector Engagement
PSI Population Services International PWI Project-wide indicators
QA Quality Assurance QI Quality Improvement QoC Quality of Care
RCBIF Network of Religious Denominations for the Promotion of
Health and the Integral Well-
being of the Family RH Reproductive Health RMNCH Reproductive,
maternal, newborn and child health SCEG Self-Care Expert Group
SHOPS Plus Sustaining Health Outcomes through the Private Sector
Plus SIFPO2 Support for International Family Planning and Health
Organizations – 2 SPA Service Provision Assessment TAG Technical
Advisory Group TFHO Total Family Health Organization TMA Total
Market Approach ToR Terms of Reference UPMA Uganda Private Midwives
Association USAID United States Agency for International
Development WG Working Group WHO World Health Organization
5
EXECUTIVE SUMMARY MOMENTUM Private Healthcare Delivery (MPHD)
harnesses the potential of the private sector to expand access to
and use of high-quality, evidence-based maternal, newborn, and
child health services, voluntary family planning, and reproductive
health care. In addition to activity-level progress and
accomplishments highlighted herein, this first MPHD semi-annual
report covers three high-level themes: project start up; honing
MPHD’s technical focus; and building foundational elements to
deliver on MOMENTUM’s four Result Areas.
PROJECT START UP MPHD was awarded by USAID to the PSI-led
consortium, including Jhpiego, FHI 360, Avenir Health, and
ThinkWell, in June 2020. This reporting period, from project
inception through March 31, 2021, brought a busy and exciting
start-up phase, launch of innovative Year 1 core activities,
engagement with USAID Missions to co-create field buy-ins, and
development of workplans with deep focus on local capacity building
through the New Partnerships Initiative (NPI). In the early months
of MPHD, project leadership focused on key start-up deliverables,
including recruiting and onboarding a robust project team and
liaising with USAID stakeholders and other MOMENTUM suite awards to
engender collaborative and effective approaches to accelerating
reductions in maternal, newborn, and child morbidity and mortality,
and increasing access to and quality of voluntary family planning
and reproductive health care. Like others, MPHD faced an unusual
start-up phase in the face of the global COVID-19 pandemic.
Challenges and uncertainties were mitigated through adaptive
management, employed across aspects of the project.
TECHNICAL FOCUS Within its remit of private sector delivery of
MNCH/FP/RH care, MPHD puts private sector engagement (PSE) front
and center of its technical approach. This is applied through a
total market approach (TMA) lens, in support of private sector’s
constructive participation in effective mixed health systems. PSE
and TMA featured strongly as workplan development began in earnest
across multiple countries. For example, in Mali the project
inception phase included a participatory co-design process with
private providers, civil society, and government stakeholders to
design MPHD interventions that would respond to TMA opportunities.
This technical focus maximizes the private sector’s contribution to
Result Area 1: access to and use of evidence-based, quality
MNCH/FP/RH information, services, and interventions scaled-up and
sustained.
MPHD maintains a ubiquitous emphasis on client centered care across
its service delivery and enabling environment activities. In the
first half of Year 1, this took the form of refining definitions –
in collaboration with USAID and the MOMENTUM Knowledge Accelerator
(MKA) – and defining the scope for building tools for provider
training, support, and monitoring. This work will also include
building awareness and agency among clients to support their
understanding and expectations of high-quality care. Over the
reporting period, the project launched core activity 1.3 to build
out its client centered care approach, with the
6
requisite tools and resources for implementation. This core
activity will support better and more sustainable quality outcomes
across Result 1 service delivery activities.
MPHD’s fourth key technical focus, localization and capacity
building, is present across numerous core, NPI, and field
support-funded activities. In the first half of Year 1, MPHD worked
closely with country teams to identify high-performing and/or
high-potential local organizations for implementation partnership
and capacity building support. From core funds in Philippines and
Ghana, NPI funds in Benin and Uganda and field support funds in
Burundi and Mali, local organization partnerships are featuring
strongly in the developing MPHD workplans. This will necessitate
new ways of doing business for the MPHD consortium. During the
reporting period, MPHD’s project team developed a comprehensive
subaward package for USAID review; these resources will help set
local organizations up for success, even as some take on
institutional funding for the first time. This focus will continue
in subsequent reporting periods in support of Result Area 2:
capacity of host-country institutions, local organizations, and
providers to deliver evidence-based, quality MNCH/FP/RH services
improved, institutionalized, measured, documented, and responsive
to population needs.
BUILDING FOUNDATIONAL ELEMENTS Underpinning programmatic
accomplishments, which MPHD is excited to see unfold over the
coming years, are systems and processes to support high quality
implementation, measurement, and learning. This reporting period
saw substantial progress in building the project’s foundational
elements to enable this. MPHD’s Activity Monitoring, Evaluation,
and Learning Plan (AMELP) was written and approved by USAID, and
country teams worked closely with MPHD’s project team to configure
their data collection systems accordingly and sensitize their
program staff to the MPHD learning agenda. This sets the stage for
successfully delivering on Result 3: adaptive learning and use of
evidence in MNCH/FP/RH programming through sustained USAID and host
country technical leadership increased.
Finally, MPHD’s first reporting period included foundational work
to build relationships, partnership opportunities, and overall
awareness of project remit, technical approaches, and anticipated
results. This included engagement with USAID PRH and MCHN offices
and with other MOMENTUM awards, including signing a Letter of
Collaboration with MKA to formalize coordination and collaboration.
Outputs like the MPHD factsheet and copy for the MOMENTUM external
website helped introduce MPHD to a wide variety of audiences and
stakeholders. These efforts will support the development of
innovative partnerships both within and outside the global health
sector, as encapsulated in Result 4: cross-sectoral collaboration
and innovative partnerships between MNCH/FP/RH and non-MNCH/FP/RH
organizations increased.
In summary, MPHD’s first reporting period has yielded an effective
start-up period, strong progress in key technical areas, and a
robust foundation from which to build project implementation over
the coming years. MPHD thanks USAID for their close collaboration
and continued support during this time.
7
CORE WORKPLAN: PROGRESS AND ACHIEVEMENTS
RESULT AREA 1: ACCESS TO AND USE OF EVIDENCE-BASED, QUALITY
MNCH/FP/RH INFORMATION, SERVICES, AND INTERVENTIONS SCALED-UP AND
SUSTAINED
ACTIVITY 1.1: BUILD UPON PROMISING PRACTICES FOR STRENGTHENING
QUALITY OF CARE AMONG PHARMACY AND DRUG SHOP PROVIDERS, AND TEST
VIABILITY OF LEVERAGING DIGITAL SOLUTIONS FOR COST-EFFECTIVE SCALE
UP (FP, RH, NH, CH, YOUTH) Background: Pharmacies and drug shops
are often the first place that women, men, and young people in
lower- and middle-income countries seek health care, including a
range of MNCH/FP/RH products and services, yet these providers are
often excluded from many critical components of formal health
system structures or not routinely supported or monitored for
quality of care. Under this activity, MPHD consortium members PSI,
FHI360, and Jhpiego are collaborating to build upon and scale up
effective approaches for training and support to pharmacy and drug
shop operations for high-quality MNCH/FP/RH care.
Expected Y1 Outputs and/or Deliverables:
• Rapid assessment of existing training curricula and support
models for MNCH/FP/RH care among pharmacy and drug shop
providers
• Consultation with USAID on opportunities to build upon the EQuiPP
approach and draw in other promising approaches
• Country selected, Mission concurrence obtained, and local
organization identified for implementation research
• Approach for digital delivery and hybrid delivery designed and
developed.
Progress and achievements during the reporting period: Having held
a series of foundational discussions among consortium members, MPHD
began activity 1.1 in November 2020 with a consultative meeting
with USAID’s PRH and MCH technical teams. This meeting helped
define the vision for the activity and set a direction for the
initial deliverable, a rapid review of programs in which
pharmacists or drug shop operators had been successfully trained to
improve the MNCH/FP/RH care they delivered to clients/ consumers.
The MPHD and USAID group also discussed several countries that
could be suitable for eventual implementation of a tailored
training and support approach for pharmacy and drug shop
providers.
During the reporting period, MPHD reviewed several key source
documents, including the EQuiPP approach implemented in Nigeria
under USAID’s Maternal and Child Survival Program (MCSP), as well
as a SHOPS Plus review of the case management model for childhood
illnesses. These documents were the starting point for the
landscaping deliverable. Since no central repository of training
curricula exists for this cadre, MPHD reached out to projects and
organizational networks, including the Child Health Advisor of the
SHOPS Plus project, to obtain the actual curricula used in these
programs. In this process, MPHD learned of
8
other programs of interest, adding these to the list of projects
scoped for training curricula.
Of the materials identified and obtained, the MPHD team selected
six child health curricula and four FP- focused curricula to
include in the landscaping assessment. These met essential elements
of the pre- defined criteria for high-quality training curricula:
essential technical content, clear information transfer, and
skill-building practice. MPHD then developed a set of criteria for
use in evaluating six child health and four FP curricula for final
landscaping deliverable. These criteria cover attributes, content,
structure, and suitability of each curriculum in transferring the
knowledge, skills, and abilities required to implement the approach
being developed. Completion of the landscaping will take place in
the second half of Y1 and will provide vetted high-quality content
for delivery of the country(ies) implementation stage of the
activity. During the reporting period, MPHD also held meetings with
PSI’s Digital Health and Monitoring team to determine the steps
involved in transferring the identified high quality curriculum
content into a digital format for hybrid digital/in-person training
of providers.
In March 2021, MPHD held a second consultative meeting with USAID’s
PRH and MCH technical teams. MPHD partner FHI 360 shared progress
on the child health curricula landscaping and PSI did the same for
the FP curricula portion. The group discussed finalization of the
landscaping review and next steps for country implementation. Based
on this conversation, MPHD has added a more substantial newborn
health technical component, with planned inputs from Jhpiego.
Country selection will be finalized in the second half of Y1.
ACTIVITY 1.2: FACILITATE HARMONIZATION OF QUALITY ACCREDITATION
APPROACHES FOR PRIVATE SECTOR PROVIDERS OF MNCH/FP/RH SERVICES
PARTICIPATING IN PUBLIC PURCHASING PROGRAMS (FP, RH) Background:
Governments and social or commercial health insurance schemes
purchasing MNCH/FP/RH services from private providers on behalf of
eligible clients need to ensure the services meet quality
standards. However, the ‘market’ for quality accreditation
approaches is fragmented and inefficient, with many third-party
purchasers setting up their own parallel systems rather than
joining existing ones. In response, ThinkWell is leading MPHD in
development of a framework to provide purchasers with a broad
understanding of their options to incorporate quality indicators
into their purchasing schemes. This work leverages a mapping
exercise of existing quality accreditation approaches supported by
the Bill & Melinda Gates Foundation (BMGF).
Expected Y1 Outputs and/or Deliverables:
• ‘Road test’ the framework and tool through a process of expert
review, which will include consortium members Jhpiego and PSI and
may be extended to include others.
• Share framework and tool – which will be an open-source global
good – through at least one dissemination channel, e.g. TMA Working
Group (WG), FP Financing Reference WG, IBP hosted webinar, MKA
hosted webinar, journal commentary, etc.
• Identify at least one PRH priority country in which to implement
the framework/tool in Y2, funding permitting.
9
Progress and achievements during the reporting period: During the
reporting period, ThinkWell initiated the BMGF-funded mapping
exercise of existing tools used by purchasing agencies to measure
service quality. The exercise identifies opportunities to link
service quality to purchasing decisions for MNCH/FP/RH services in
Burkina Faso, Kenya, and the Philippines. This work included a
literature review, the results of which will offer purchasers a
broad understanding of their options for using service quality
indicators in purchasing schemes from private providers.
Under MPHD, ThinkWell is ‘road testing’ the recommendations
stemming from the mapping and literature review. ThinkWell
developed a questionnaire and framework that identifies key sources
of data on quality in a country’s health system and ways in which a
purchaser can incorporate this data into purchasing decisions.
During the reporting period, ThinkWell began soliciting expert
feedback on the questionnaire and framework, starting with the
World Health Organization (WHO) and the Institute for Healthcare
Improvement (IHI). Feedback from these institutions was very
helpful. For example, WHO colleagues provided detailed feedback
aimed at better linking the framing document and the questionnaire
tool, and IHI suggested situating discussions of quality in the
context of the management literature on quality improvement. Making
explicit reference to the Deming Cycle helped frame and emphasize
the importance of measurement – or ‘Study’ – within the
‘Plan-Do-Study-Act’ cycle.
Following revisions, in the next reporting period, ThinkWell will
develop an addendum to the tool to show how it would be used in a
health area-specific manner, using voluntary family planning
services as the example. Following this, ThinkWell will share the
framework and tool with MPHD partners and USAID for further
feedback and refining. In the second half of Y1, ThinkWell will
lead MPHD in disseminating the tool to the global community of
practice through relevant working groups, conferences, and
platforms, and ThinkWell will identify a country where the approach
can be implemented in Y2.
ACTIVITY 1.3: ENHANCE TRAINING AND SUPPORT TO NETWORKED PROVIDERS
BY A) INTEGRATING MNCH SERVICES INTO EXISTING FP/RH-FOCUSED SUPPORT
PROGRAMS AND B) ADVANCING GLOBAL KNOWLEDGE AND COUNTRY PRACTICES
FOR CLIENT-CENTERED CARE IN THE PRIVATE SECTOR (FP, RH, MH, NH, CH,
GENDER) Background: Private clinics offer a substantial portion of
MNCH/FP/RH services in many PRH and MCH priority countries;
however, private providers often operate in isolation of many
valuable MOH regulatory and oversight mechanisms to support and
ensure quality. Further, as the global health community coalesces
around the importance of client centered care as a component of
clinical quality, too few pathways exist for private providers to
gain the awareness and tools to operationalize these approaches.
Through this activity, MPHD is strengthening and expanding the
package of support to networked private providers (initially) to
include MNCH services to its existing platform of FP/RH focused
support, with all areas enhanced by focus on client centered
care.
Expected Y1 Outcomes and/or Deliverables:
• Convene MPHD technical experts to review tools and approaches to
strengthen QoC for FH/RH-focused support to networked private
providers through social franchising programs. Identify
opportunities for inclusion of MNCH services, using appropriate
resources/ guidelines, into packages of training and supportive
supervision. Adapt existing tools to include an integrated package
of MNCH/FP/RH care and select at least one PRH/ MCH priority
country for implementation
• Contribute to a MOMENTUM-wide consultation and input process into
redesign of the Service Provision Assessments (SPA) surveys, one
goal of which is to move quality measurement from current approach
using the WHO’s definition of service readiness to more holistic
set of quality of care metrics
• Develop and disseminate guidance for MPHD field support buy ins
(and other country-level activities) to add client centered care
approaches to private healthcare delivery programming, including
integrating client centered care metrics into field support
monitoring, evaluation, and learning (MEL) plans/ indicators.
Progress and achievements during the reporting period: Activity 1.3
has enabled a strong MPHD focus on quality of care (QoC) activities
at both the global and field levels over the first months of the
project. Per the expected deliverables, this has included
participating in the review and revision of the SPA, engaging MPHD
partners to initiate design of an integrated FP/MNCH Client
Centered Care toolkit, and supporting field buy- ins to incorporate
quality of care focused activities into their workplans.
From November 2020 through January 2021, alongside other MOMENTUM
partners, MPHD participated in a series of SPA1 consultations with
the objective to review and revise the FP/RH SPA, placing emphasis
on modifying the Client Exit Interview (CEI) tool. The workstream
included reviewing the existing CEI questionnaire against other
validated tools and indicators used to measure client experience.
In January 2021, the workstream members returned their
recommendations to the DHS Program, noting which and how specific
indicators should be updated and improved to better measure client
centeredness and client
1 The Service Provision Assessment (SPA) survey is a health
facility assessment that provides a comprehensive overview of a
country’s health service delivery. The SPA survey is an initiative
of the DHS program.
Technical spotlight: Gender competency framework
During the reporting period, MPHD quality of care experts reviewed
the recently updated HR2030 Gender Competency Framework for FP
Service Providers and assessed how it aligns with PSI's Quality of
Care Framework for FP Service Provision and Self-Care, resources
used by MPHD programs. For comparison, each gender competency
domain was matched to one of the five PSI quality of care domains.
Aspects of each gender competency domain and how a provider can
achieve ‘gender competency’ are outlined within each quality of
care domain. This process illustrated how MPHD service delivery
programs can adapt the Gender Competency Framework to their quality
of care systems through the lens of provider competency
evaluations. PSI-supported service delivery networks are already
designed to support the development and monitoring of FP provider
competency using various tools. The gender competency framework's
domains naturally fit within each PSI QoC Framework domain,
allowing MPHD programs to extend their QoC trainings, supportive
supervision, and evaluations to include gender competency
considerations.
experience. Along with other workstream partners, MPHD awaits
feedback from the DHS program and will continue its involvement as
further SPA consultations take place in May 2021.
In February 2021, PSI’s and Jhpiego’s quality of care teams began
meeting regularly to generate ideas and plan a way forward for
creating a well-packaged suite of integrated client centered care
tools. Through this collaborative process, MPHD landed on the
development of one integrated, easy-to-implement client centered
care in FP/MNCH service delivery toolkit. This toolkit will pull
from existing but disparate FP and MNCH tools (training materials,
skills checklists, coaching and supervision plans, etc.) and will
update them to align with global best practice, including applying
a client centered care lens to all tools. The toolkit aims to
strengthen providers’ clinical competence and ability to deliver
high quality care with a client centered lens. With the
conceptualization phase of this activity nearly complete, MPHD will
engage a consultant to conduct a desk review of existing tools and
toolkits, propose a toolkit format that will work for in-person and
at-distance use, work across MPHD partners and stakeholders to
gather review of and gain buy-in for the toolkit, and identify a
list of possible countries in which to pilot the completed
toolkit.
A heavy focus this reporting period was on integrating best
practices in quality of care and client centered care into MPHD
field support workplan development. MPHD QoC staff collaborated
with country-level staff to design activities that will enable them
to build robust QoC systems for MPHD supported activities.
Workplans for Burundi, Indonesia, Mali, Nepal, and Niger received
dedicated technical support to weave quality care and client
centered care across FP and MCH service delivery. Burundi, as the
first buy-in to initiate service delivery activities, has also been
supported to develop tools that may be replicated or reused across
other countries, for example: selection criteria checklists for
partner health facilities and mixed face-to-face and remote
training models to comply with COVID-19 prevention
recommendations.
ACTIVITY 1.4 ADVANCE AN INTEGRATED APPROACH TO QUALITY OF CARE FOR
SELF CARE (FP, RH) Background: Self-care is an important avenue for
quality, integrated healthcare at scale, particularly in
MNCH/FP/RH. Private providers are very often the source of products
that facilitate self-care; therefore, the private sector is an
important partner in developing a wider ‘health systems approach’
to quality of care for self-care. Through activity 1.4, MPHD will
utilize and promote the Quality of Care Framework for Self-Care, a
tool developed with USAID SIFPO2 in at least one PRH priority
country.
Expected Y1 Outputs and/or Deliverables:
• Design and launch initiative. This will include engagement of
professional associations and government agencies with a stated
interest in advancing self-care
• Produce a report on advancing and integrated approach to quality
of care in self-care
• Produce and disseminate a guidance document on conducting a
similar activity in other countries
Progress and achievements during the reporting period: Since the
2019 launch of the WHO Consolidated Guidelines on Self-care
Interventions for Health: Sexual and Reproductive Health and
Rights, many countries have expressed interest in adapting the
high-level guidelines for operationalization in their country
context. Once such country is Uganda, where the emergence of
the
COVID-19 pandemic spurred government recognition of the urgency of
developing such adaptations. Under the leadership of the MOH,
Uganda established a multi-stakeholder self-care technical working
group called the Self-Care Expert Group (SCEG), which required
commitment across multiple MOH departments overseeing different
self-care interventions, as well as implementors and
researchers.
With non-MPHD funding, the SCEG worked collaboratively to define a
package of self-care interventions in consultation with the WHO
and, with the support of a national consultant seconded to the MOH,
oversaw the development of the Uganda self-care guidelines. By the
end of 2020, the MOH had produced the first draft of new national
self-care guidelines which are now undergoing review and
finalization. USAID/Uganda provided feedback on the guidelines, and
more routinely engaged in SCEG meetings and discussions in early
2021.
Based on consultations between PSI Uganda and the SCEG, MPHD will
support the SCEG in a pilot implementation phase, through which the
draft guidelines will be tested against the realities of the health
system. Experiences from this pilot will inform the final version
of the guidelines. Given the continuing momentum of the self-care
agenda in Uganda, MPHD and PSI Uganda agreed to pursue Mission
concurrence to implement this activity, which will be sought during
the next reporting period. In the meantime, PSI Uganda continues
discussions with the SCEG on the range and mode of operational
and/or technical support that can be provided by MPHD to forward
this important development in self- care approaches in
Uganda.
ACTIVITY 1.5: LEVERAGE THE FOOTPRINT AND CAPACITIES OF PRIVATE
SECTOR PROVIDERS TO EXPAND IMMUNIZATION COVERAGE IN LOW-RESOURCE
SETTINGS (IMM, CH, FP) Background: Traditionally, within health
systems, the public sector has led the way in immunization
delivery. However, given its size and scale, the private sector
could substantially contribute to wider immunization coverage if
private providers were systematically integrated into vaccine
programs. To improve immunization outcomes - especially in the
context of global COVID-19 vaccine needs – models for engagement of
the private sector are needed. Through activity 1.5, Jhpiego is
leading MPHD to strengthen application of a total market approach
to immunization programs through meaningful engagement of private
sector vaccinators.
Expected Y1 Outputs and/or Deliverables:
• Establish a technical exchange for understanding and implementing
best practices for private sector immunization programming,
starting with establishing connections to existing Communities of
Practice (such as the Child Health Task Force) with private sector
interest groups relevant to MOMENTUM.
• Produce a robust TMA-informed situational analysis capturing
common typologies of public-private sector mix of immunization
coverage. This would include private sector engagement in
‘upstream’ aspects, e.g. vaccine supply chain.
• Identity at least two MCH priority countries to tailor 2017 WHO
guidance and implement service delivery improvements in private
sector’s role in immunization coverage.
13
Progress and achievements during the reporting period: Year 1 work
began with a series of stakeholder consultations within the
immunization space. This included MPHD engagement with two WHO
teams – Immunizations, Vaccines, and Biologicals (IVB) and
Universal Health Coverage (UHC) teams – and with the M-RITE award.
Per the expected deliverables, the first steps of establishing a
stakeholder group for regular technical exchange have been
undertaken. This stakeholder group, convened with M-RITE, will
include invitations for the WHO, USAID, and UNICEF among
others.
As expected, during the reporting period, the immunization
community of practice was, and continues to be, coalescing around
the tremendous task of rolling out COVID-19 vaccines in lower- and
middle-income countries. MPHD produced the first draft of a
technical brief on private sector engagement for immunization
programs and PSE’s relevance for COVID-19 vaccine roll out.
Specifically, the technical brief includes a comparison of
WHO-produced COVID-19 planning tools – the Vaccine Introduction
Readiness Assessment Tool (VIRAT) and the National Deployment and
Vaccination Plan (NDVP) – against the 2017 WHO Immunization
Guidance on PSE in order to identify recommended approaches for
including the private sector in national plans for COVID-19 vaccine
roll out. A case study on the role of the private sector in
COVID-19 vaccine roll out in India is included as well. The
technical brief will be finalized and disseminated in the second
half of Y1.
During the reporting period, MPHD had the opportunity to share its
immunization and PSE technical perspectives through several
external channels. These included:
• MPHD presented at the January 2021 Teach for Reach conference, a
BMGF-funded initiative hosted by Global Council of Learning Leaders
for Immunization under the auspices of the Geneva Learning
Foundation. The conference was well attended and featured five
immunization experts from four MOMENTUM awards (MCGL, MIHR, MPHD,
and M-RITE) who presented a joint session titled, “Innovations for
capacity-building to address COVID-19: strategies from the MOMENTUM
projects.”
• An MCGL-hosted technical forum in March 2021 attended by the
MOMENTUM suite awards, USAID technical advisors, and Johns Hopkins
University colleagues. The forum was organized to facilitate
knowledge exchange and provide an update on deployment of COVID-19
vaccines. MPHD presented on its planned work under this
activity.
• During the reporting period, MPHD coordinated with MKA on
strategic communications content for World Immunization Week 2021
(April 24-30). Blog posts and social media excerpts will be shared
in the next report.
The next reporting period will also see MPHD plan for country-level
implementation of ‘test and adapt’ pilots operationalizing the WHO
2017 guidance in support of COVID-19 vaccine coverage, which will
start with a TMA analysis of opportunities for an effective mixed
health system response to expanded immunization coverage. At the
close of this reporting period, MPHD is establishing criteria for
pilot country selection.
14
ACTIVITY 1.6: DEVELOP A PROJECT WIDE GENDER STRATEGY THAT WILL
EMBED PROGRAMMING ADDRESSING GENDER BARRIERS TO ACCES TO AND UPTAKE
OF HIGH-QUALITY MNCH/FP/RH CARE (FP, RH, MN, NH, CH, IMM, YOUTH,
GENDER) Background: Realizing sustainable improvements in
MNCH/FP/RH outcomes requires attention to gender- related barriers,
including those introduced by gender inequality, gender-based
violence (GBV), lack of supportive male engagement, and limited
awareness of and shifts in gender norms, including among young
people. MPHD strives to embed an understanding of, and an
appropriate response to, these barriers across core and field
support activities. As part of operationalizing this commitment,
activity 1.6 focuses on developing, finalizing, and rolling out a
gender strategy for the MPHD consortium to create a strong
foundation for gender integration across MPHD activities.
Expected Y1 Outputs and/or Deliverables:
• MPHD gender strategy produced and shared with project
stakeholders
Progress and achievements during the reporting period: During the
reporting period, MPHD undertook development of a project-wide
gender strategy. MPHD reviewed existing resources on gender and
MNCH/FP/RH, with a specific focus on identifying resources that
documented and analyzed gender-related factors in private sector
service delivery. These included gender analyses and gender
programming best practices and guidance. Very little was found in
the gender literature as relates to the private sector
specifically; and consultation with the SHOPS Plus project
confirmed this gap (although SHOPS Plus itself had undertaken
several pieces of relevant work that were incorporated in MPHD’s
review). MPHD reviewed the gender resources compiled by MKA for the
benefit of the MOMENTUM suite, all of which were very useful for
the strategy development process.
In early 2021, MPHD revised its gender strategy in response to
USAID feedback, with a final version planned for completion early
in the next reporting period. At the close of the reporting period,
MPHD is in the process of recruiting a gender technical specialist
to support integration of gender transformative and gender aware
programming in core and field support activities alike. This will
include supporting countries in implementing tools for gender
analyses and baseline data collection. MPHD continues to be an
active participant in cross-MOMENTUM gender technical meetings,
including participating in the Gender CAs meeting hosted by
USAID/PRH in March 2021 and quarterly MOMENTUM suite gender
meetings organized by Sr Gender Advisors from USAID’s MCH and PRH
offices. Further, MPHD participates in the MOMENTUM Hub Gender
Technical Group, where resources and experiences can be quickly
disseminated among MOMENTUM suite projects.
15
RESULT AREA 2: CAPACITY OF HOST-COUNTRY INSTITUTIONS, LOCAL
ORGANIZATIONS, AND PROVIDERS TO DELIVER EVIDENCE-BASED, QUALITY
MNCH/FP/RH SERVICES IMPROVED, INSTITUTIONALIZED, MEASURED,
DOCUMENTED, AND RESPONSIVE TO POPULATION NEEDS
ACTIVITY 2.1: BUILD THE CAPACITY OF PRIVATE SECTOR PROVIDERS TO
PARTICIPATE IN PUBLIC PURCHASING PROGRAMS, IN COLLABORATION WITH AT
LEAST ONE LOCAL ORGANIZATION THAT WILL DELIVER CASCADE TRAININGS
AND SUPPORT (FP, RH) Background: Public purchasing of privately
provided MNCH/FP/RH services allows private providers to
participate in publicly funded programs, such as national and
sub-national health insurance schemes, which can potentially
provide a reliable revenue stream for them and increases their
ability to serve clients for whom cost of services might be a
barrier. Many LMICs aspire to well-functioning programs of public
purchasing of private sector services, but among countries
currently operating such programs, many face challenges in the
practicalities of implementation. Led by ThinkWell, MPHD will
identify and address common barriers to successful engagement
between public purchasers and private providers of MNCH/FP/RH care
in at least one PRH priority country.
Expected Y1 Outputs and/or Deliverables:
• Rapid landscape of ‘what’s on the table?’ with regard to public
purchasing of MNCH/FP/RH in priority PRH and MCH countries. This
landscape will draw on existing mapping done by projects such as
SHOPS Plus and Health Policy Plus and will fill in gaps in
available information.
• Barriers identified that inhibit successful contracting
relationships; this will build on the literature, ongoing ThinkWell
work, and may include qualitative work in one or more countries or
remote engagement through interviews with country stakeholders.
This will frame potential in-depth work in specific countries
• Training and support plan for providers (likely structured as a
ToT training) developed and one or more professional association
partner(s) identified for delivery and sustained support to private
providers.
Progress and achievements during the reporting period: The first
half of Y1 saw ThinkWell gather information to inform
identification of common barriers to well-functioning purchasing
arrangements. Drawing on mapping exercises completed by other
USAID-funded projects (i.e., SHOPS Plus and Health Policy+),
ThinkWell established an internal resource repository and has
initiated a rapid landscape review of potential barriers for
contracting private providers in public purchasing schemes in
priority PRH and MCH countries, where evidence is available.
ThinkWell is compiling results of the landscape exercise into an
accompanying resource tool that can assist public purchasers and
the broader global community with identifying mechanisms to enable
private providers to participate in publicly funded networks. Based
on this early analysis, MPHD selected the Philippines to serve as a
case country to develop a training and support plan for private
providers under this activity. In the Philippines, MPHD will
identify private sector partners to deliver
16
additional voluntary FP and RH services through participation in a
local government-supported health care provider network (HCPN) in
Antique and Guimaras provinces. MPHD will obtain concurrence for
this activity from USAID/Philippines in April 2021.
ACTIVITY 2.2: PILOT AND SCALE DIGITAL SOLUTIONS TO IMPROVE
COMMUNICATIONS AND COLLABORATION BETWEEN PUBLIC SECTOR AND PRIVATE
PROVIDERS OF MNCH/FP/RH (FP, RH) Background: In PRH priority
countries, the private sector is often large and diverse, which
presents challenges for government visibility, stewardship, and
support, a situation which, in turn, poses risks for high quality
FP service delivery in the private sector. For example, private
providers may be excluded from access to MOH-donated commodities or
receive insufficient training and support to roll out new
technologies and service protocols, e.g. training on the new
Implanon NXT. Activity 2.2 helps address this vast challenge
through a digital stewardship approach, linking MOH with private
providers.
Expected Y1 Outputs and/or Deliverables:
• Undertake a review of current digital interventions to connect
public health system stewards with private providers. Emphasis will
be placed on identifying and highlighting interventions that have
demonstrated (or show promise of) scale and sustainability
• Identify priority countries and engage with relevant MOH
officials to gauge interest and commitment. Select one country and
obtain Mission concurrence
• Design and launch pilot. Launch will include engagement of
professional associations and quasi- government agencies whose
contacts will be leveraged to reach private providers at scale
(Q3-Q4)
• Assessment of successes and challenges conducted at end of Y1 to
determine viability for Y2
Progress and achievements during the reporting period: During the
reporting period, MPHD developed a scope of work for the first
deliverable, a rapid review of currently implemented digital
interventions. In January 2021, MPHD, led by PSI’s Nairobi office,
held an open tender for consulting firm to carry out the “Rapid
Ecosystem Assessment,” to scope and analyze current digital
solutions connecting public health system stewards with private
sector providers in Kenya, Uganda, Ghana, and Nigeria. Africa
Health Business (AHB), based in Nairobi, Kenya, was selected to
undertake the assessment, in partnership with MPHD.
In February and March 2021, AHB carried out a desk review of
existing digital solutions used by stewards of voluntary FP/RH and
MNCH care services alongside key informant interviews with key
healthcare stakeholders in Kenya, Uganda, Ghana, and Nigeria. The
desk review highlighted the limited availability of information on
existing digital interventions connecting public health stewards
with private sector providers in the focus countries. Some
stewardship solutions exist, but they are primarily focused on
public sector stewardship, i.e. few involve interaction between the
public sector and private sector. Further, no digital stewardship
solution could be found that focuses on public sector connection
with private providers in the area of MNCH/FP/RH, revealing a
potential gap in existing solutions to improved MNCH/FP/RH outcomes
in the private sector.
In addition to the desk review, AHB conducted 20 key informant
interviews with strategically identified stakeholders from the four
countries representing Ministries of Health, regulatory bodies, and
specific
ACTIVITY 2.3: BUILD CAPACITY, CREATE OPPORTUNITIES, AND REDUCE
BARRIERS TO INCLUSIVE AND EQUITABLE TECHNICAL AND MANAGERIAL
LEADERSHIP IN MNCH/FP/RH GLOBAL HEALTH (FP, RH, GENDER) Background:
As USAID and implementing partners prioritize country ownership and
sustainability across interventions, efforts are needed to reduce
barriers and proactively support inclusive and equitable technical
and managerial leadership for national staff, including those from
groups traditionally underrepresented in senior decision-making
roles, e.g. women, young people. Through this activity, MPHD will
identify and address barriers and create opportunities for project
representation and decision making to become more representative of
the demographics and views of its most critical stakeholders –
providers and their clients in PRH and MCH priority
countries.
Expected Y1 Outputs and/or Deliverables:
• A MPHD gender strategy that recognizes and responds to the
intersection of gender and race/ethnicity, including a section on
intercultural views on gender equality
• At least two high performing/high potential host country national
staff working for or with MPHD identified for training
opportunities and mentoring in Y1
• At least 50% of MPHD publications include at least one country
national co-author
Progress and achievements during the reporting period: As the
reporting period coincided with project set-up and start-up, MPHD’s
commitment – articulated through activity 2.3 – to building a
diverse and inclusive team and network of collaborators served as a
foundational principle of the project. Per the expected
deliverables, MPHD developed a project-wide gender strategy (see
activity 1.6) that recognized the intersectionality of gender with
race/ethnicity and socio-economic status and the need to
contextualize and adapt gender-related interventions to the
specific needs of countries, regions, and communities. Further,
MPHD is working closely with PSI’s Human Resources (HR) department
to broaden PSI-specific leadership training for national staff
working in MPHD country programs. In the first half of Y1, MPHD and
PSI’s HR identified a training program to utilize, and MPHD
developing a transparent set of criteria for candidate selection
for participation. The second half of Y1 will see a first cohort of
country staff join the program. Finally, while the reporting period
did not see many publications, due to the start-up phase of
activities, MPHD strategic communications efforts included a
balanced contribution from Washington- based and from country-based
staff.
RESULT AREA 3: ADAPTIVE LEARNING AND USE OF EVIDENCE IN MNCH/FP/RH
PROGRAMMING THROUGH SUSTAINED HOST COUNTRY TECHNICAL LEADERSHIP
INCREASED.
ACTIVITY 3.1: PILOT A COUNTRY-LEVEL METHODOLOGY TO MAP PRIVATE
SECTOR FAMILY PLANNING RESOURCE FLOWS FOR BETTER VISIBILITY BY
GOVERNMENTS AND DONORS INTO HEALTH FINANCING TRENDS AFFECTING FP
ACCESS AND UPTAKE (FP, RH) Background: Financing is a key component
of improved access to and uptake of voluntary FP. While the
majority of work mapping FP financing has focused on global level
dynamics, a detailed picture of country- level FP expenditures
would illuminate the contributions and complexities of the private
sector’s role in FP service delivery, thereby helping inform
healthcare planning discussions for future resource flows. Led by
Avenir Health with contributions from ThinkWell, MPHD is piloting a
methodology to map country level financing flows for FP, with
attention to resource flows to the private sector.
Expected Y1 Outputs and/or Deliverables:
• Report produced entitled, “Pilot Mapping of Private Sector FP
Resource Flows in two LMIC countries”
• Guidance document on conducting a similar mapping activity in
other countries produced and disseminated.
Progress and achievements during the reporting period: For this
activity –led by Avenir Health with inputs from ThinkWell – a
mapping exercise conducted by ThinkWell (using separate funding
from BMGF) served to inform work on the first MPHD deliverable,
i.e. development of a methodology to track FP resource flows at
country level. During the reporting period, Avenir Health conducted
initial scoping of potential data sources and countries for pilot
implementation of the methodology. Per the initial activity plan,
Avenir approached IQVIA as a potential data partner, as ideally
this activity would build upon an IQVIA analysis from Kenya
conducted under the USAID Global Health Supply Chain
Program-Procurement and Supply Management project. (IQVIA had
presented this analysis at the September 2020 Total Market Approach
(TMA) working group meeting). However, the available data obtained
from Kenya Medical Supplies Authority (KEMSA) proved insufficient
for the purposes of this activity, since IQVIA’s analysis included
distribution data at the national warehouse level, but not to
service delivery outlet level. Avenir also explored with IQVIA
using their data from Benin and Togo, but like the Kenya data, it
was insufficient for the purposes of the activity. Therefore, this
partnership will not serve the activity’s needs and will not be
pursued further.
MPHD will still pursue Kenya as an initial country for this
activity, as the IQVIA analysis showed that most private sector
providers are receiving free commodities from KEMSA; therefore, the
distinction of where a person obtains their voluntary FP service is
not closely correlated with the financing of the commodities
received or bought. As such, MPHD expects that carrying out this
activity in Kenya will provide more visibility for donors and
policymakers into what voluntary FP services and commodities at
private service points are generally provided through free
commodities, and which are financed through other means. For
19
the activity, MPHD is tentatively proposing to focus on three
illustrative Kenyan counties: Kilifi (a ThinkWell focus county),
and Kisumu and Nakuru (as both have active private FP sectors and
presence of social marketing and social franchising). The activity
would also leverage work done previously by Track20 for an FP
Spending Assessment in Kenya, which focused primarily on public
sector and infrastructure costs.
At the end of the reporting period, efforts were underway to submit
a concurrence request for this activity to USAID/Kenya. The
methodology will be finalized, and a second country will be
identified in the next reporting period, likely leveraging data
from PSI’s FP Watch BMGF-funded databases (available for Ethiopia,
DRC, India, Myanmar, and Nigeria).
ACTIVITY 3.2: EXPLORE VARIATIONS IN COST STRUCTURES AND COST
DRIVERS OF PUBLICLY PROVIDED AND PRIVATELY PROVIDED MNCH/FP/RH
SERVICES, TO IMPROVE ALLOCATION OF RESOURCES AND ADVOCATE FOR
GREATER INTEGRATION OF PRIVATE PROVIDERS INTO THE WIDER HEALTH
SYSTEM. (FP, RH) Background: Under this Avenir Health-led activity,
MPHD is investigating the variations in public and private provider
cost structures and cost drivers for key MNCH/FP/RH services in
three countries. To maximize cost efficiencies, the activity uses a
normative costing approach, soliciting inputs from stakeholders to
inform key model inputs, as opposed to a detailed facility-based
study. MPHD intends that this study will inform decision makers
about the costs and cost drivers incurred by the public and the
private sectors for the delivery of MNCH, FP and RH services, so
that they can make informed, efficient choices regarding the
allocation of resources. Using the approach and experiences from
this activity, MPHD intends that global guidance will be developed
to allow application to other country settings.
Expected Y1 Outputs and/or Deliverables:
• Adapt the OneHealth costing model to include a private provider
perspective. Apply in three PRH priority countries. (Countries are
to be determined, but choosing Tanzania, Guatemala, Ethiopia or
Bangladesh, would allow Avenir Health to leverage data that has
already been collected).
• Develop a report and deliver a webinar on costing results from
three countries; the approach used; recommendations for country
level decision-makers to use findings; and opportunities and gaps
for further action.
Progress and achievements during the reporting period: During the
reporting period, MPHD selected three preliminary countries to
explore for this activity: Tanzania, Bangladesh, and the DRC. The
countries were chosen based on a mix of contextual factors: diverse
social and cultural contexts, substantial private health sectors
with varied types of providers, local consultant pools with strong
research skills, and ease of conducting research within MPHD’s
required timelines. The MPHD team developed a draft protocol, which
outlines how data will be collected at nine sites (three public,
three private for-profit and three NGO facilities) in each
respective country. PSI research advisors initially reviewed the
draft protocol and interview guides and advised that the research
would likely be determined as “exempted” from a local IRB
submission for Human Subjects Research by PSI’s internal Research
Ethics Board. Based on this information, MPHD and USAID/Washington
worked together to sensitize the activity with the respective
20
Missions and to submit draft concurrence requests for all three
countries to USAID/Washington by the end of the reporting
period.
In the next reporting period, MPHD expects to finalize the protocol
for the required reviews, onboard local data collection
consultants, and complete data collection and analysis. Just after
the close of this reporting period, concurrence was received from
Missions in DRC and Tanzania. However, conversations with USAID/
Bangladesh have led to this activity not being pursued in
Bangladesh. An alternative third country will be identified in the
next reporting period. Avenir Health will also apply the OneHealth
tool to this activity in the next reporting period. The OneHealth
tool is a globally recognized multi-year strategic planning and
budgeting tool for the health sector, developed by the United
Nations Inter-Agency Working Group on Costing. The tool has been
used to cost strategic plans in over 25 low- and middle-income
countries.
ACTIVITY 3.3: ESTABLISH AND HOST A GLOBAL COLLABORATIVE FOR
LEARNING AND ACTION (GCLA) FOR PRIVATE HEALTHCARE TO ADVANCE THE
QUALITY OF CARE AGENDA AND ACCELERATE ADOPTION OF EVIDENCE-BASED
BEST PRACTICES FOR HIGH QUALITY MNCH/FP/RH SERVICES IN THE PRIVATE
SECTOR (FP, RH, MH, CH, IMM, NH) Background: Unlike the public
sector where the MNCH/FP/RH quality of care agenda is supported by
numerous global and local initiatives, the private sector is often
under-prioritized in donor and national efforts. In response, MPHD
will bring together private sector stakeholders to advance
strengthening of quality of care in the private sector by
contributing the private sector voice, needs, and experiences in
established global and national platforms focused on MNCH/FP/RH
care.
Expected Y1 Outputs and/or Deliverables:
• Rapid Assessment: Conduct a rapid landscape of existing QoC
platforms and networks, including assessing the extent to which
they are addressing private sector service delivery.
• Determine priority themes: Agree with USAID and other
stakeholders on priority themes to be emphasized in the first year
of the collaborative.
• Co-design and establish the Global Collaborative for Learning and
Action with an initial group of countries.
Progress and achievements during the reporting period: Led by
Jhpiego, MPHD initiated activity 3.3 with a preliminary landscaping
of existing platforms and networks. This assessment included review
of 20 networks and platforms and 10 examples of private sector
initiatives for improving quality of care. In total, 23 key
informant interviews were conducted with 26 subject matter experts
and/or representatives of initiatives or platforms. Additionally,
three focus groups were conducted comprised of
Technical spotlight: Small & sick newborn care During the
reporting period, MPHD’s Sr Technical Advisor for MNCH was invited
to co-lead the ‘leadership and governance building block’ for the
UNICEF, WHO, LSHTM and NEST-360 led process to develop the Global
Small and Sick Newborn Care Implementation Toolkit.
This MPHD collaboration will provide the opportunity to ensure the
needs and capabilities of private sector providers are included in
this important forthcoming global resource.
21
private provider stakeholders in Pakistan, Ghana, and Indonesia,
respectively. At regular interval points throughout the preliminary
assessment, MPHD consortium members Jhpiego and PSI met and
discussed early findings and any needed pivots in the plan to a
wide array of relevant platforms and initiatives in MNCH/FP/RH.
Early assessment findings pointed to an emerging consensus that,
rather than establishing a new platform via the GCLA, efforts were
much needed to complement existing initiatives with a value add in
offering the private sector voice to global and country-level
policy and practice discussions. MPHD will present the findings of
the landscaping to USAID’s PRH and MCH teams in the second half of
Y1; these discussions will inform development of the ToR for the
GCLA, strategy and roadmap, that will inform approaches for Y2. At
the time of writing, MPHD anticipates that, through the Y2 core
workplan, activity 3.3 will serve to:
• Increase private sector participation and representation in
existing RMNCH platforms and networks (QED Network, Child Health
Task Force, Align MNH, ICFP, FP2030) by establishing strategic
partnerships with existing networks and platforms. MPHD will also
foster dialogue with global, regional, and country professional
associations to articulate the voice of the private sector in these
discussions.
• Increase access to priority content and products for private
sector: This will include co-creating learning opportunities in
partnership with the aforementioned networks and platforms and
increasing access to relevant content for the private sector.
Through country level implementation mechanisms, MPHD will engage
private sector representatives on platforms and networks and curate
tailored private sector events, e.g. webinars, to private sector
stakeholders at country level.
• Support country implementation and best practices in PSE to
ensure quality RMNCH service delivery is documented and
disseminated. MPHD will co-create opportunities for shared learning
across countries on mutual priorities including virtual exchanges,
facilitated discussions and sharing of relevant materials., MPHD
will also promote sharing and comparative analysis of examples of
qualify of care efforts in private sector facilities.
ACTIVITY 3.4: CONDUCT SECONDARY ANALYSIS OF EXISTING COUNTRY SURVEY
DATA TO ASSESS QUALITY OF CARE OF MNCH/FP/RH SERVICES IN THE
PRIVATE SECTOR (FP, RH) Background: Understanding the quality of
FP/RH care provided in the private sector is a crucial step in
identifying areas for improvement and advocating for private
providers who deliver high quality care. Utilizing Service
Provision Assessment (SPA) surveys, under activity 3.4, Avenir
Health is conducting a comprehensive analysis looking at the
variation in quality of care among public, private for profit, and
private non-profit facilities.
Expected Y1 Outputs and/or Deliverables:
• Analysis conducted
• A report on findings, disseminated through the Global Learning
Collaborative and other MKA- supported channels.
Progress and achievements during the reporting period: During the
reporting period, seven country SPAs were identified for inclusion
in the analysis. This includes all countries with a SPA conducted
since
22
2010, with the exception of Afghanistan (2018-19) which is not
nationally representative and includes relatively few private
facilities. The SPAs under review include: Bangladesh (2017); DRC
(2017/18); Haiti (2017/18); Malawi (2013/14); Nepal (2015); Senegal
(2017); Tanzania (2014/15).
Using data from the SPAs, the analysis is quantifying differences
in quality between the public, community, private for profit, and
private nonprofit sectors in the two dimensions of the SPA:
• Quality of services (Availability of methods, FP
integration/constellation of services, Management, Facility
infrastructure); and
• FP infrastructure (Access, equipment, guidelines, staffing) A
statistical analysis was conducted to look at quality of family
planning services by managing authority (public, not-for-profit,
private), controlling for urban vs. rural residence and facility
type. This preliminary analysis revealed that, for structure
quality aspects of quality, in most countries there is no
statistically significant difference in quality between public and
private facilities. In the next reporting period, the analysis will
be expanded to include client experience aspects of quality. These
analyses will be combined and analyzed, and a final reporting will
be produced in the next reporting period.
ACTIVITY 3.5: AMPLIFY AND DISSEMINATE TECHINCAL LEARNINGS FROM MPHD
TO COUNTRY- LEVEL, REGIONAL AND GLOBAL AUDIENCES IN COLLABORATION
WITH MKA (FP, RH, MH, NH, CH, GENDER) Background: Under activity
3.5, MPHD actively participates in global and country communities
of practice related to improving MNCH/FP/RH service delivery,
especially in the private sector. Participation in technical
working groups and other fora enables MPHD to share project
learnings and learn from others’ efforts, incorporating an adaptive
management approach to programming. In addition, MPHD works closely
with MKA to ensure the private sector’s ‘voice’ is clearly
represented in the MOMENTUM-wide narrative and learnings are widely
shared.
Expected Y1 Outputs and/or Deliverables:
• Present MPHD technical outputs at least once in each technical
forum of participation. Deliver other contributions as agreed with
working group and MPHD AOR team.
• Liaise on an ongoing basis with MKA to tell the MOMENTUM-wide
story, with emphasis on elevating country technical
leadership
• Represent MPHD at the International Conference on Family Planning
(ICFP) 2021
Progress and achievements during the reporting period: During the
reporting period, MPHD participated in a number of technical
working groups and technically oriented meetings focused on key
FP/RH and MNCH topics. These included:
• Method Choice Community of Practice (CoP): MPHD and MGCL assumed
joint leadership of the Method Choice CoP from the E2A project on
March 31, 2021. Prior to this handover, MPHD and MCGL held several
meetings with E2A on matters related to the administration and
management of the CoP; for example, MPHD and MCGL assumed
responsibility for operationalizing the CoP
23
terms of references (ToR) and managing the CoP listserv. MPHD
participated in the final technical advisory group (TAG) meeting
under E2A leadership in order to formalize the handover, and MPHD’s
deputy director facilitated a participatory session on
brainstorming high priority topics for the planned technical
consultations and/or webinars in 2021. High priority technical
areas identified by the TAG included: male engagement (such as male
youth, couples counseling, toxic masculinity); long-acting
reversible contraceptive (LARC) removal; digital platforms related
to method use (such as fertility awareness platforms); and/or new
products and methods in development. At the close of the reporting
period, MPHD and MCGL remain in discussions with USAID PRH team on
strategy and priorities for the next phase of the CoP.
• TMA Working Group (WG): During the February 2021 meeting, MPHD
presented on PSI’s approach to client insight gathering. MPHD is
also serving on the TMA WG sub-group, the FP Research Priorities
workstream, which is a smaller group of TMA WG members analyzing
possible evidence gaps in private sector FP research;
• Drug Shops and Pharmacies WG: At the March 2021 meeting, MPHD
presented on PSI’s work in self-injection of DMPA-SC at the drug
shops level in Uganda and Nigeria. Although funded by a non- USAID
donor, learnings from this work will be incorporated into MPHD’s
approach under core activity 1.1.
• Child Health Task Force (CHTF): MPHD participated in the March
2021 meeting of the child CHTF’s private sector subgroup. During
this meeting, MPHD participated in assessment of tools for
maternal, newborn, and pediatric quality of care standards. Also in
this reporting period, MPHD senior technical staff from Jhpiego and
FHI 360 provided input into the CHTF’s review of the WHO Nurturing
Care Handbook.
• FP Financing Reference Group: MPHD participated in the March 2021
meeting of the FP Financing Reference Group.
• SBC for Service Delivery WG: MPHD participated in the March 2021
meeting of the SBC for Service Delivery WG in which PSI presented
work on the SIFPO2-funded counseling for choice (C4C) approach to
provider counseling for a broad range of FP methods.
• Global Task Force on Implant Removals: MPHD participated in the
March 2021 Global Task Force on Implant Removals co-hosted by
JHPIEGO and the BMGF.
• Gender Collaborating Agencies (CAs) Meeting: MPHD participated in
the Gender CAs meeting hosted by USAID/PRH in March 2021. This
meeting offered a chance to better understand the PRH office’s
three key gender priorities, with a deep dive on GBV
programming.
• Youth PRH Implementing Partners (IPs) Meeting: MPHD participated
in the February Youth PRH IPs meeting, in which PSI presented on
youth FP programming under the SIFPO2 project.
• During the reporting period, MPHD participated in the monthly
working group meetings of MKA’s three main working groups (more
detail is provided in the section on MPHD-MKA collaboration later
in the report).
o MKA Monitoring & Evaluation/ Innovation & Learning
(ME/IL) WG
24
o MKA Knowledge Management (KM) WG o MKA Strategic Communications
(SC) WG
The activity 3.5 deliverable, represent MPHD at ICFP 2021, will be
delayed to a later project year in response to the conference’s
in-person rescheduled date on account of COVID-19 travel
restrictions.
RESULT AREA 4: CROSS-SECTORAL COLLABORATION AND INNOVATIVE
PARTNERSHIPS BETWEEN MNCH/FP/RH AND NON-MNCH/FP/RH ORGANIZATIONS
INCREASED.
ACTIVITY 4.1: FACILITATE DIALOGUE AND COLLABORATION WITH CORPORATE
AND PHILANTHROPIC PARTNERS FOR IMPROVED MNCH/FP/RH OUTCOMES (FP,
RH) Background: Strategic partnerships with corporate and
philanthropic organizations offer tremendous opportunities to
amplify USAID investments to increase MNCH/FP/RH coverage,
sustainably and cost- effectively, and to contribute to resilient
health markets. To increase and deepen collaboration with countries
toward sustainable improvements in MNCH/FP/RH outcomes, through
activity 4.1, MPHD works to build on the partnership history of
consortium member organizations to innovate market-based solutions
and unlock the private sector’s capacity to contribute to positive
health outcomes. Consistent with USAID’s private sector engagement
policy and operational principles, MPHD is engaging “early and
often” with these partners to share information, collaborate, and
formalize partnerships (where appropriate) in areas of shared
interest and value for MNCH/FP/RH care.
Expected Y1 Outputs and/or Deliverables:
• Map MPHD partners’ existing and potential partnerships at the
global and country levels with corporations, foundations, and
philanthropists
• Identify at least two priority opportunities for dialogue and
exploring collaboration with corporate and philanthropic partners
at the global or country level, with a view to implementing
innovative partnerships in Y2
• Engage with USAID on incorporating PSE metrics into programming
approaches and/or local healthcare business development
workstreams, e.g. Center for Innovation and Impact (CII) to share
learnings, experiences, and networks
Progress and achievements during the reporting period: During the
reporting period, MPHD conducted interviews with PSI’s corporate
partnerships team to understand the status of current and
developing partnerships with private companies in key programming
areas. In collaboration with PSI colleagues, MPHD undertook
(separate) partnership exploration discussions with General
Electric Company (GE) and ‘MSD for Mothers’ based on emerging areas
of mutual interest. While the discussions with GE did not yield
clear opportunity for FP/RH outcomes, and therefore will not
continue through MPHD, the discussions with MSD for Mothers
continue to be promising. Thus far, conversations have led to an
informal commitment to MSD for Mothers, PSI and MPHD partnering
together at a future point, with MSD for Mothers with both parties
being mentioned in a January 2021 Devex article
interview with USAID’s Assistant Administrator of the Bureau for
Global Health at USAID. The discussions at this stage are focused
on where the opportunities most align between MPHD field support
programs and priorities, and MSD for Mothers strategic and
geographic priorities.
ACTIVITY 4.2: PARTNER WITH LOCAL BUSINESSES TO ACCELERATE LOCAL,
MARKET BASED SOLUTIONS FOR EXPANDED ACCESS TO AND UPTAKE OF FP/RH
INFORMATION, PRODUCTS AND SERVICES (FP, RH, GENDER) Background:
Scaling up market-based solutions for expanded access to and use of
high quality MNCH/FP/RH care requires viable business models, sound
business operations that attract and retain high caliber management
talent and access to growth capital. Through this activity, MPHD is
partnering with local Ghanaian organization, Total Family Health
Organization (TFHO), to assess and plan a programming approach for
identifying and supporting local businesses that are well
positioned for growth in operations that would lead to measurable
impact on access to and uptake of MNCH/FP/RH services. This will
replicate the successful approach under the USAID SIFPO2 project
whereby TFHO identified and strengthened local businesses
positioned to scale up/ alter production in order to meet demand
for COVID-19 prevention products. Using a similar model, this
activity will enhance the ability of local businesses to meet FP/RH
product and service needs, especially in underserved regions of the
country.
Expected Y1 Outputs and/or Deliverables:
• Partnership identified, developed, and operationalized with a
local organization in one or more PRH priority country
markets
• Model for engagement developed, first cohort of businesses
identified (likely 1-3), plans for technical assistance developed,
and memorandums of understanding for collaboration agreed
• Stakeholders engaged to support alignment, where possible,
replication of successes, and avoid duplication of effort (e.g.
USAID Center for Innovation and Impact, USAID CATALYZE Project,
USAID INVEST Project, healthcare experts at U.S. International
Development Finance Corporation)
Progress and achievements during the reporting period: In the first
half of Y1, MPHD and TFHO met to discuss and further refine the
scope of the activity. It was decided to engage a consultant with
background in sourcing and due diligence on impact-oriented
investments in local companies to support TFHO’s roadmap for
expansion of this programming approach, beyond the initial foray
with COVID-19 supplemental funds (under SIFPO2). In February and
March 2021, MPHD conducted a procurement process for a consultant
or consulting firm to provide these support services. At the close
of the reporting period, Volta Capital Ltd had been selected to
collaborate with MPHD and TFHO on this initial ‘roadmap’ phase of
this activity. MPHD held conversations with USAID/Ghana to describe
plans for this work, which was received favorably. In the next
reporting period, Volta Capital will design a plan for TFHO to map,
identify, engage, and conduct due diligence with companies active
in the value chain of FP/RH product and service delivery.
26
Technical spotlight: Adaptive management in AMELP adoption by
country programs The Activity Monitoring, Evaluation, and Learning
Plan (AMELP) is the framework to guide the approaches and tools
MPHD uses for project monitoring, evaluation, and learning (MEL).
The AMELP sets out monitoring indicators used by MPHD across a
diverse array of activities, funded by core, NPI, and field
support, to measure the project’s progress and achievements. It
also articulates the project’s learning questions and reiterates
the commitment to adaptive management and research ethics.
The AMELP may be considered an ‘unsung hero’ on a global project
such as MPHD. It provides a unifying umbrella of success metrics,
while also offering enough flexibility to meet measurement needs of
emerging and innovative approaches. The MPHD AMELP is also
responsible for linking the award with the cross- MOMENTUM MEL
Framework – by utilizing cross-MOMENTUM indicators and learning
agenda questions – so that MPHD can contribute to the MOMENTUM-wide
results narrative, alongside the additional private sector-focused
indicators and learning questions needed to measure private sector
service improvements.
The MPHD AMELP includes project-wide indicators (PWIs) that all
core, NPI, and field support activities must report on. These PWIs
draw heavily on the contextual and global indicators from Result
Area 1 from the MKA-developed cross-MOMENTUM MEL Framework.
Included here are measures such as number of health facilities
receiving MPHD support (cross-MOMENTUM service delivery indicator
#6) and the number of MPHD-supported activities that integrate
gender (cross-MOMENTUM gender indicator #1). In addition to the
PWIs, the MPHD AMELP provides a menu of MOMENTUM service delivery
indicators covering MNCH, FP/RH, WASH, etc. that MPHD countries can
select to report on pursuant to their scopes of work.
Implementing the MPHD AMELP at country level provides an example of
adaptive management. As field support programs started up, it
became clear that some USAID Missions needed different indicators
collected to meet their consolidated reporting needs. The prospect
of collecting both MOMENTUM indicators and Mission-specific
indicators concerned country teams. In response, MPHD’s project
management team developed an indicator crosswalk tool to overlay
MOMENTUM indicators with Mission-specific indicators, thereby
highlighting overlaps where data collection could be consolidated
to meet the data collection needs of similar indicators.
MPHD conducted the crosswalk exercise with four field support
programs as their workplans developed – Burundi, Indonesia, Nepal,
and Mali – with positive feedback from country teams on how this
simplified the process while still meeting the needs of their
different key stakeholders. Although this process requires an extra
step, country teams report that integrating the MOMENTUM-wide
indicators helps them understand the broader MOMENTUM initiative
and how their country efforts and contributions fit into the ONE
MOMENTUM story.
27
NEW PARTNERSHIPS INITIATIVE (NPI) During the reporting period, MPHD
received two tranches of NPI funding through the USAID/PRH office.
The first tranche was incorporated into “regular” core activities
to support discrete opportunities for capacity building local
partners meeting the NPI criteria. The second tranche of NPI funds
is being programmed in support of the following countries through
stand-alone NPI-funded activities.
BENIN NPI Beginning in January 2021, MPHD undertook a co-creation
process with the Association Beninois pour le Marketing Social
(ABMS) to produce a 12-month workplan funded through the NPI.
Workplan activities fall under three overarching themes: 1) access
to and delivery of quality, client centered care, 2) engaging and
reaching youth, and 3) building capacity of local private sector
actors and local organizations. To make progress across those
themes, ABMS will work across static health care facilities,
through mobile outreach units, and by using digital, client-facing
interventions. Key deliverables in the recently approved workplan
include: partnering with and building capacity of three national
level organizations and 12 district level local organizations,
identifying and working with Youth Ambassadors who will collaborate
with ABMS on project activities, and conducting a landscaping
assessment of the GBV services gap for rural communities.
UGANDA NPI During the reporting period, MPHD and PSI Uganda
developed a draft 18-month workplan for NPI-funded activities.
After consultation with USAID/Uganda, this workplan incorporates
the Mission’s technical FP- related priorities and builds upon
USAID/Uganda’s innovative Kampala Slum Maternal and Newborn Health
(MaNe) project, implemented by the Kampala Capital City Authority
(KCCA) municipal entity and PSI Uganda. Through this NPI-funded
workplan, PSI Uganda will build the capacity of a local
organization, the Uganda Private Midwives Association (UPMA), to
deliver increased access to high quality voluntary postpartum
family planning (PPFP) services, including the High Impact Practice
(HIP) of access to immediate PPFP services as part of
facility-based childbirth care prior to discharge from the health
facility.
The workplan will build on and complement the pillars of Respectful
Maternity Care as promoted under the MaNe Project. PSI Uganda will
support UPMA to analyze the current status of PPFP services at 40
UPMA facilities in Kampala, Wakiso, and Mukono and then identify
bottlenecks that can be addressed through a co-design process with
key stakeholders. UPMA will then ensure training and support
received is diffused to all 536 UPMA member sites in its national
network. The workplan will also support facilities to integrate
voluntary PPFP into Expanded Program on Immunization (EPI) services
at UPMA facilities, and to leverage user-centered design principles
to generate demand for high quality services at supported sites.
MPHD anticipates that up to 20,000 women and couples may be reached
with high quality PPFP services under this activity. The workplan
was submitted in March 2021 to USAID/Uganda for a second review
before submission to USAID/Washington for review, feedback, and
anticipated approval for activities to start in May 2021.
MOZAMBIQUE NPI
28
Starting in early 2021, PSI Mozambique engaged USAID/Mozambique to
gauge its interest in providing technical concurrence for an
NPI-funded MPHD workplan in country. Under this workplan, PSI
Mozambique plans to scale a package of demand creation tools for
rural adolescents and young people in Mozambique by providing
training and capacity building to youth-focused organizations to
implement these tools in their own communities. The package of
tools includes a combination of videos, discussion guides, and
visual aids and were designed with funding from the UK's Foreign,
Commonwealth & Development Office (FCDO) using a human-centered
design process. Training will build skills among community
volunteers or activists to more effectively engage rural
adolescents and their influencers in conversations around voluntary
FP, sharing health information, and promoting informed
decision-making. This will include subawards to one or more
youth-focused local organizations in Mozambique.
The workplan will also build on the learnings from the private
sector landscape conducted by PSI under the USAID-funded SIFPO2
project. Under this component, PSI Mozambique plans to partner with
a local professional association to co-create private sector-based
FP solutions. PSI plans to work with this partner and a limited
number of private sector providers to pilot the solutions
identified and measure their impact on the delivery of FP services.
In doing so, PSI Mozambique will leverage its experience from Tem+,
a network of public facilities receiving tailored support to
deliver quality voluntary FP services. USAID/Mozambique is
supportive of these plans, and during the next reporting period,
PSI and the Mission will engage in a co-creation process to develop
a detailed workplan for an anticipated May 2021 submission to
USAID/Washington for approval.
GHANA NPI During the reporting period, MPHD engaged with local
Ghanaian organization and PSI network affiliate, Total Family
Health Organization (TFHO) and Jhpiego Ghana to explore
opportunities to expand access to a broad method mix of family
planning in the private sector and complement activities with
implementation research conducted by local researchers/ academics.
Initial plans for NPI-funded workplan were discussed with
USAID/Ghana, and pursuant to that, concurrence will be sought in
the next reporting period.
Proposed activities focus on filling the gap in private clinical
providers’ ability to offer voluntary LARC methods, as part of a
broad method mix. In Ghana, access to LARC is largely through
public sector health facilities with only a limited number of
private clinical providers providing these services. Private
clinical providers face barriers that limit the range of family
planning methods offered to their clients. MPHD will partner with
TFHO to expand training approaches currently utilized in the public
sector; this will focus on support to approximately 200 private
providers in Greater Accra, Ashanti, Western, Eastern, Northern,
North East and Savannah regions. Additional support will include
access to a supply of IUD and implant commodities, through donated
commodity sources, and routine follow-up and supportive supervision
to private providers conjunction with district Ghana Health
Services. An important component of this activity will be
implementation science research (both building TFHO's capacity to
carry it out and conducting the research itself). Discussion on the
research question(s) to be studied are underway at the close of the
reporting period.
29
FIELD SUPPORT: PROGRESS AND ACHIEVEMENTS
BURUNDI Following an iterative work plan and budget development
process (October 2020-January 2021), MPHD Burundi commenced Year 1
activities on February 1, 2021. To transition MPHD from the
workplan development phase to Year 1 startup, the project team
executed a series of kick-off events, both virtually and in person.
Notably, a virtual USAID-MPHD joint kickoff call was held on
January 27, 2021, and a virtual internal MPHD kickoff call was held
on February 18, 2021. These events brought together relevant
stakeholders to align on the project objectives, key technical
approaches, and anticipated outcomes of MPHD Burundi. Further, the
MPHD internal kickoff call covered key topics related to the
standards of the MPHD global cooperative agreement, including
adherence to compliance requirements across the programmatic,
financial, procurement, environmental, and family planning
components of the award, as well as reporting requirements. On
March 15 and 16, 2021, MPHD Burundi held an in-person inception
workshop for all project staff and potential local partners,
focusing on the project activities, intermediate results,
objectives, and indicators. The inception workshop also identified
key areas of alignment with the Embassy of the Kingdom of the
Netherlands-funded project “Expanding and Improving Family Planning
and ASRH through Private Health Care Delivery” (EKN) that will
provide cost share to the MPHD award.
STRATEGIC SELECTION AND VETTING OF LOCAL PARTNERS Key to the MPHD
Burundi workplan approach will be the leveraging and capacity
building of local organizations, with the aim of increasing the
remit for these partners year-on-year, supporting localization of
activities and local ownership of the project. To this end, MPHD
Burundi identified two local organizations, the National
Association for Social Franchise (ANFS) and the Network of
Religious Denominations for the Promotion of Health and the
Integral Well-being of the Family (RCBIF), as potential partners on
the award. These two local organizations bring experience engaging
with private and faith- based health facilities, and their existing
linkages with private providers are anticipated to enable swift
engagement and relationship building with the facilities that the
MPHD will support. During the reporting period, MPHD conducted
due-diligence procedures with the local organizations, developed
Year 1 subaward scopes of work and budgets, and compiled subaward
approval packages for submission to USAID.
SELECTION AND ASSESSMENT OF HEALTH FACILITIES In Year 1, MPHD
Burundi anticipates engaging with and supporting 125 private and
faith-based health facilities. In alignment with the approved
workplan, the project team developed (in collaboration with
consortium partner Jhpiego, and using insights gathered from ANFS
and RCBIF) a health facility selection and assessment tool, which
outlines key criteria for health facility inclusion in the project.
In addition to assessment criteria (such as registration with the
MOH, number of staff, available physical space at the facility,
availability of data, and current service offerings), the selection
tool includes questions that seek to understand provider motivation
and interest in engaging with MPHD, in alignment with USAID
principles for Private Sector Engagement. Following meetings with
NGOs Pathfinder and LifeNet, who are also active
30
in private sector support in Burundi, to avoid geographic overlap,
the selection of facilities is ongoing at the time of reporting.
The health facility selection and assessment tool was also piloted
at two private facilities in Bujumbura to ensure acceptability and
ease of use, before being rolled out across the anticipated project
districts at the end of March.
HIGHLIGHTS OF PLANS FOR NEXT SIX MONTHS Building on the initial
MPHD MEL plan included in the MPHD Burundi workplan, the project
will leverage the health facility assessments to finalize indicator
projections and build out the DHIS2 data reporting system that will
be used to report MPHD indicators into the global project and
onward to MKA. MPHD will also update monitoring tools and
supervision checklists in alignment with the indicators for the
supported health areas. In addition, the next six months will see
MPHD provider training in FP/RH and malaria and use of DHIS2 with
the supported health facilities. This will include updating
training materials in collaboration with consortium partner
Jhpiego, as well as the anticipated local organizations, following
USAID subaward approvals. MPHD Burundi will also assess the
feasibility of a hybrid in-person and remote training model, given
the recent increase of COVID-19 cases in the country.
MALI MPHD Mali commenced its startup phase on February 8, 2021.
Between February 14, 2021 and March 31, 2021,