momentum: private healthcare delivery

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:
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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
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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
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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
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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
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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.
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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
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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).
• ‘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.
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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.
• 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.
• 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.
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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.
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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.
• 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.
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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.
• 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
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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.
• 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.
• 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.
• 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
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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.
• 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
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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.
• 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.
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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.
• 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
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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.
• 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
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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
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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.
• 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.
• 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.
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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.
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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
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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.
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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
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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,

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