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National responses to global health targets: exploring policy transfer in the context of the UNAIDS '90-90-90' treatment targets in Ghana and Uganda.
Health Policy and Planning. 2018 Jan 1; 33(1):17-33.Global health organizations frequently set disease-specific targets with the goal of eliciting adoption at the national-level; consideration of the influence of target setting on national policies, program and health budgets is of benefit to those setting targets and those intended to respond. In 2014, the Joint United Nations Program on HIV/AIDS set ‘ambitious’ treatment targets for country adoption: 90% of HIV-positive persons should know their status; 90% of those on treatment; 90% of those achieving viral suppression. Using case studies from Ghana and Uganda, we explore how the target and its associated policy content have been adopted at the national level. That is whether adoption is in rhetoric only or supported by program, policy or budgetary changes. We review 23 (14 from Ghana, 9 from Uganda) national policy, operational and strategic documents for the HIV response and assess commitments to ‘90-90-90’. In-person semi-structured interviews were conducted with purposively sampled key informants (17 in Ghana, 20 in Uganda) involved in program-planning and resource allocation within HIV to gain insight into factors facilitating adoption of 90-90-90. Interviews were transcribed and analyzed thematically, inductively and deductively, guided by pre-existing policy theories, including Dolowitz and Marsh’s policy transfer framework to describe features of the transfer and the Global Health Advocacy and Policy Project framework to explain observations. Regardless of notable resource constraints, transfer of the 90-90-90 targets was evident beyond rhetoric with substantial shifts in policy and programme activities. In both countries, there was evidence of attempts to minimize resource constraints by seeking programme efficiencies, prioritization of program activities and devising domestic financing mechanisms; however, significant resource gaps persist. An effective health network, comprised of global and local actors, mediated the adoption and adaptation, facilitating a shift in the HIV program from ‘business as usual’ to approaches targeting geographies and populations.
American Mock World Health Organization: An Innovative Model for Student Engagement in Global Health Policy.
Global Health: Science and Practice. 2017 Mar 24; 5(1):164-174.The American Mock World Health Organization (AMWHO) is a model for experiential-based learning and student engagement in global health diplomacy. AMWHO was established in 2014 at the University of North Carolina at Chapel Hill with a mission to engage students in health policy by providing a simulation of the World Health Assembly (WHA), the policy-forming body of the World Health Organization that sets norms and transforms the global health agenda. AMWHO conferences are designed to allow students to take their knowledge of global health beyond the classroom and practice their skills in diplomacy by assuming the role of WHA delegates throughout a 3-day weekend. Through the process of developing resolutions like those formed in the WHA, students have the unique opportunity to understand the complexities behind the conflict and compromise that ensues through the lens of a stakeholder. This article describes the structure of the first 2 AMWHO international conferences, analyzes survey results from attendees, and discusses the expansion of the organization into a multi-campus national network. The AMWHO 2014 and 2015 post-conference survey results found that 98% and 90% of participants considered the conference "good" or "better," respectively, and survey responses showed that participants considered the conference "influential" in their careers and indicated that it "allowed a paradigm shift not possible in class."
New York, New York, UNICEF, 2017 Mar. 80 p.Climate change is one of many forces contributing to an unfolding water crisis. In the coming years, the demand for water will increase as food production grows, populations grow and move, industries develop and consumption increases. This can lead to water stress, as increasing demand and use of water strain available supplies. One of the most effective ways to protect children in the face of climate change is to safeguard their access to safe water and sanitation. This report shares a series of solutions, policy responses and case studies from UNICEF’s work around the world.
New York, New York, UNICEF, 2017 Sep. 92 p.This report presents data and outlines best practices and policies that can put governments on the path to providing every child with the best start in life. It outlines the neuroscience of early childhood development (ECD), including the importance of nutrition, protection and stimulation in the early years. And it makes the case for scaling up investment, evaluation and monitoring in ECD programmes. The report concludes with a six-point call to action for governments and their partners to help maximize the potential of the children who will build the future – by making the most of the unparalleled opportunities offered by the early moments in life.
The evaluation of comprehensive sexuality education programmes: a focus on the gender and empowerment outcomes.
New York, New York, UNFPA, 2015. 64 p.Repeated evaluations have demonstrated that comprehensive sexuality education does not foster earlier sexual debut or unsafe sexual activity. By contrast, programmes that teach only abstinence have not proved to be effective. Additionally, recent research demonstrates that gender norms are a “gateway factor” for a range of adolescent health outcomes. Comprehensive sexuality education curricula that emphasize critical thinking about gender and power – the empowerment approach – are far more effective than conventional “gender-blind” programmes at reducing rates of sexually transmitted infections (STIs) and unintended early pregnancy. These studies also indicate that young people who adopt more egalitarian attitudes about gender roles, compared to their peers, are more likely to delay sexual debut, use condoms and practise contraception. They are also less likely to be in relationships characterized by violence. This report, The Evaluation of Comprehensive Sexuality Education Programmes: A Focus on the Gender and Empowerment Outcomes, represents an important milestone in our understanding of advances in the field of comprehensive sexuality education evaluation. It offers an extensive review and analysis of a wide range of evaluation studies of different comprehensive sexuality education programmes, at different stages of development and from different contexts and setting across the globe. It enriches our knowledge of new methodologies, available questionnaires and instruments that can be applied in future assessments and evaluations, most particularly to measure the gender empowerment outcome of comprehensive sexuality education programmes. It addresses the adaptation of the methodology to various contexts and age-specific groups of young people and children. This report is co-sponsored by UNFPA, the United Nations Educational, Scientific and Cultural Organization, the World Health Organization and the International Planned Parenthood Federation.
New York, New York, UNFPA, 2015. 56 p.This report, the first such published by the United Nations Population Fund (UNFPA), looks at FGM through the lens of population dynamics and the demographic dividend, based on current evidence and data. It offers quantitative information that both supports evidence-based programming, and frames financial implications for Member States and international donors. Evidence to define the size of the target population and orient actions around areas of greatest impact is of high value in developing interventions and formulating policies. UNFPA remains strongly committed to engaging with Member States, civil society, UN agencies and all other stakeholders to accelerate the elimination of FGM worldwide. Protecting girls upholds their sexual and reproductive health and rights, and enables them to realize their full potential.
Paris, France, UNESCO, 2015. 47 p.Comprehensive sexuality education (CSE) has attracted growing interest and attention over recent years. This is demonstrated and reinforced by increased political commitment globally and the development of expert guidance, standards, curricula and other tools to strengthen the implementation of CSE in practice. Across the world, there are a wide range of different approaches to delivering sexuality education; at this stage in the evolution of the field, it is timely to take stock of the evidence, practice and lessons learned to date. This report provides an overview of the status of CSE implementation and coverage on a global level, drawing on specific information about the status of CSE in 48 countries, generated through analysis of existing resources and studies. Best practice in terms of providing CSE continues to develop. The current report examines the evidence base for CSE and, through a series of case studies from every region, explores initiatives that are setting the standard and pioneering new practices in the delivery of CSE. It represents the first in a series of periodic reports that aims to monitor the global implementation of CSE. Comprehensive life skills-based sexuality education helps young people to gain the knowledge and skills to make conscious, healthy and respectful choices about relationships and sexuality.
Bonn, Germany, GTZ, 2016 Apr. 7 p.This factsheet summarises the results of the past collaboration between BACKUP and the International Planned Parenthood Federation (IPPF) on the ‘Shadows and Light’ project. BACKUP Health and the International Planned Parenthood Fed-eration (IPPF) have collaborated over many years to foster greater and more rapid action on SRH and HIV linkages within the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund). Recent collaborative work has highlighted gaps in addressing the specific needs of key populations within Global Fund pro-grammes. ‘Shadows and Light’, a three-year project funded by BACKUP Health, aims to address the linked SRH and HIV needs of key populations within four IPPF member associations. The project involved the Family Planning Association of India and transgender people, Reproductive Health Uganda and sex work-ers, Family Health Options Kenya and people who inject drugs, and the Cameroon National Association for Family Welfare and MSM. The project recognised that a comprehensive response to HIV must include initiatives that meet the needs of those who are marginalised, vulnerable, socially excluded and under-served. Based on these linkages, addressing SRH within HIV programmes and services funded by the Global Fund is a key opportunity to ensure sustainability in service provision to key populations.
London, United Kingdom, IPPF, 2015 Feb. 48 p.This report examines the links between sexual and reproductive health and rights and gender equality. It explores the different pathways of empowerment that girls and women experience, and analyzes how these pathways are affected by sexual and reproductive health and rights. Policy focus and attention given to gender equality and women’s empowerment has been growing over the last decade, and there are some areas where links are established more conclusively. Although there is strong documentation on the health benefits of investment in sexual and reproductive health, until recently the non medical benefits, such as higher levels of social and political participation, have been largely ignored, partly because they are difficult to measure. While the social and economic implications of sexual and reproductive health and rights are often overlooked, they are no less real. More attention is needed to explore the links between sexual and reproductive health and rights and other critical areas relating to gender equality, such as the representation of women in political and public life.
Under-served and over-looked: prioritizing contraceptive equity for the poorest and most marginalized women and girls.
London, United Kingdom, IPPF, 2017 Jul. 40 p.This report is a synthesis of evidence revealed from a literature review, including 68 reports from 34 countries. The results are dire: the poorest women and girls, in the poorest communities of the poorest countries are still not benefitting from the global investment in family planning and the joined up actions of the global family planning movement. Women in the poorest countries who want to avoid pregnancy are one-third as likely to be using a modern method as those living in higher-income developing countries.
Washington, D.C., Center for Global Development, 2015. 68 p.Founded in 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) is one of the world’s largest multilateral health funders, disbursing $3-$4 billion a year across 100-plus countries. Many of these countries rely on Global Fund monies to finance their respective disease responses -- and for their citizens, the efficient and effective use of Global Fund monies can be the difference between life and death. Many researchers and policymakers have hypothesized that models tying grant payments to achieved and verified results -- referred to in this report as next generation financing models -- offer an opportunity for the Global Fund to push forward its strategic interests and accelerate the impact of its investments. Free from year-to-year disbursement pressure (like government agencies) and rigid allocation policies (like the World Bank’s International Development Association), the Global Fund is also uniquely equipped to push forward innovative financing models. But despite interest, the how of new grant designs remains a challenge. Realizing their potential requires technical know-how and careful, strategic decisionmaking that responds to specific country and epidemiological contexts -- all with little evidence or experience to guide the way. This report thus addresses the how of next generation financing models -- that is, the concrete steps needed to change the basis of payment from expenses to something else: outputs, outcomes, or impact. (Excerpts)
Who pays for cooperation in global health? A comparative analysis of WHO, the World Bank, the Global Fund to Fight HIV / AIDS, Tuberculosis and Malaria, and Gavi, the Vaccine Alliance.
Lancet. 2017; 390:324-332.In this report we assess who pays for cooperation in global health through an analysis of the financial flows of WHO, the World Bank, the Global Fund to Fight HIV / AIDS, TB and Malaria, and Gavi, the Vaccine Alliance. The past few decades have seen the consolidation of influence in the disproportionate roles the USA, UK, and the Bill & Melinda Gates Foundation have had in financing three of these four institutions. Current financing flows in all four case study institutions allow donors to finance and deliver assistance in ways that they can more closely control and monitor at every stage. We highlight three major trends in global health governance more broadly that relate to this development: towards more discretionary funding and away from core or longer-term funding; towards defined multi-stakeholder governance and away from traditional government-centred representation and decision-making; and towards narrower mandates or problem-focused vertical initiatives and away from broader systemic goals.
Maternal and Child Nutrition. 2017 Apr; 13(2):1-16.Poor linear growth in children <5 years old, or stunting, is a serious public health problem particularly in Sub-Saharan Africa. In 2013, the World Health Organization (WHO) released a conceptual framework on the Context, Causes and Consequences of Childhood Stunting (the ‘WHO framework’) that identifies specific and general factors associated with stunting. The framework is based upon a global review of data, and we have applied it to a country-level analysis where health and nutrition policies are made and public health and nutrition data are collected. We reviewed the literature related to sub-optimal linear growth, stunting and birth outcomes in Ethiopia as a case study. We found consistent associations between poor linear growth and indicators of birth size, recent illness (e.g. diarrhea and fever), maternal height and education. Other factors listed as causes in the framework such as inflammation, exposure to mycotoxins and inadequate feeding during and after illness have not been examined in Ethiopia, and the existing literature suggests that these are clear data gaps. Some factors associated with poor linear growth in Ethiopia are missing in the framework, such as household characteristics (e.g. exposure to indoor smoke). Examination of the factors included in the WHO framework in a country setting helps identifying data gaps helping to target further data collection and research efforts.
New York, Evaluation Office, United Nations Population Fund [UNFPA], 2016. 24 p.This evaluation focuses on how UNFPA performed in the area of family planning during the period covered by the UNFPA Strategic Plan 2008-2013. It provides valuable insights and learning which can be used to inform the current UNFPA family planning strategy as well as other relevant programmes, including UNFPA Supplies (2013-2020). All the countries where UNFPA works in family planning were included, but the evaluation focuses on the 69 priority countries identified in the 2012 London Summit on Family Planning as having low rates of contraceptive use and high unmet needs. The evaluation took place in 2014-2016 and was conducted by Euro Health Group in collaboration with the Royal Tropical Institute Netherlands. It involved a multidisciplinary team of senior evaluators and family planning and sexual and reproductive health and rights specialists, which was supervised and guided by the Evaluation Office in consultation with the Evaluation Reference Group. The outputs include a thematic evaluation report, an evaluation brief and country case study notes for Bolivia, Burkina Faso, Cambodia, Ethiopia and Zimbabwe.
New York, Evaluation Office, United Nations Population Fund [UNFPA], 2016 Apr. 214 p.The purpose of the evaluation was to assess the performance of UNFPA in the field of family planning during the period covered by the Strategic Plan 2008-2013 and to provide learning to inform the implementation of the current UNFPA Family Planning Strategy Choices not chance (2012-2020). The evaluation provided an overall independent assessment of UNFPA interventions in the area of family planning and identified key lessons learned for the current and future strategies. The particular emphasis of this evaluation was on learning with a view to informing the implementation of the UNFPA family planning strategy Choices not chance 2012-2020, as well as other related interventions and programmes, such as the Global Programme to Enhance Reproductive Health Commodity Security (GPRHCS- 2013-2020). The evaluation constituted an important contribution to the mid-term review of UNFPA strategic plan 2014-2017. The evaluation features five country case study reports: Bolivia, Burkina Faso, Cambodia, Ethiopia, and Zimbabwe.
New York, Evaluation Office, United Nations Population Fund [UNFPA], 2016 Apr. 105 p.The purpose of the evaluation was to assess the performance of UNFPA in the field of family planning during the period covered by the Strategic Plan 2008-2013 and to provide learning to inform the implementation of the current UNFPA Family Planning Strategy Choices not chance (2012-2020). The evaluation provided an overall independent assessment of UNFPA interventions in the area of family planning and identified key lessons learned for the current and future strategies. The particular emphasis of this evaluation was on learning with a view to informing the implementation of the UNFPA family planning strategy Choices not chance 2012-2020, as well as other related interventions and programmes, such as the Global Programme to Enhance Reproductive Health Commodity Security (GPRHCS- 2013-2020). The evaluation constituted an important contribution to the mid-term review of UNFPA strategic plan 2014-2017. The evaluation features five country case study reports: Bolivia, Burkina Faso, Cambodia, Ethiopia, and Zimbabwe.
Marketing of breast-milk substitutes: National implementation of the international code. Status report 2016.
Geneva, Switzerland, WHO, 2016.  p.This report provides updated information on the status of implementing the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolutions (“the Code”) in and by countries. It presents the legal status of the Code, including -- where such information is available -- to what extent Code provisions have been incorporated in national legal measures. The report also provides information on the efforts made by countries to monitor and enforce the Code through the establishment of formal mechanisms. Its findings and subsequent recommendations aim to improve the understanding of how countries are implementing the Code, what challenges they face in doing so, and where the focus must be on further efforts to assist them in more effective Code implementation.
Washington, D.C., World Bank, 2015. 199 p.The sustained benefits of early childhood interventions are well established in developed countries. Early development plays a major role in subsequent school performance, health, socialization, and future earnings. For children born into poverty, the equity enhancing impact of early childhood interventions hold the promise of overcoming social disadvantages and breaking the intergenerational transmission of poverty. The World Bank’s support to early childhood development (ECD) is well aligned with the Bank’s twin goals of reducing extreme poverty and promoting shared prosperity. This evaluation by the Independent Evaluation Group examines the Bank’s design and implementation of projects across sectors supporting ECD interventions to inform future operations and provide inputs to the new Global Practices and Cross-Cutting Solutions Areas.
Geneva, Switzerland, WHO, 2015.  p.The World Health Organization (WHO) calls on enhanced global efforts to improve health in some of the world’s poorest and most vulnerable communities by tackling the root causes of disease and health inequalities. In order to address this and to spur up action, raise awareness and facilitate implementation of a Health in All Policies (HiAP) approach WHO launched this week a Health in All Policies training manual. This manual is a training resource to increase understanding of the importance of Health in All Policies among health and other professionals. The material will form the basis of 2- and 3-day workshops, which will: build capacity to promote, implement and evaluate HiAP; encourage engagement and collaboration across sectors; facilitate the exchange of experiences and lessons learned; promote regional and global collaboration on HiAP; and promote dissemination of skills to develop training courses for trainers.
Quality maternal and newborn care to ensure a healthy start for every newborn in the World Health Organization Western Pacific Region.
BJOG: An International Journal of Obstetrics and Gynaecology. 2014 Sep; 121 Suppl 4:154-9.In the World Health Organization Western Pacific Region, the high rates of births attended by skilled health personnel (SHP) do not equal access to quality maternal or newborn care. 'A healthy start for every newborn' for 23 million annual births in the region means that SHP and newborn care providers give quality intrapartum, postpartum and newborn care. WHO and the UNICEF Regional Action Plan for Healthy Newborn Infants provide a platform for countries to scale-up Early Essential Newborn Care (EENC). The plan emphasises the creation of an enabling environment for the practice of EENC; thereby, preventing 50,000 newborn deaths annually. (c) 2014 Royal College of Obstetricians and Gynaecologists.
Global Public Health. 2014; 9(8):865-879.Lauded for getting specific health issues onto national and international agendas and for their potential to improve value for money and outcomes, public-private global health initiatives (GHIs) have come to dominate global health governance. Yet, they have also been criticised for their negative impact on country health systems. In response, disease-specific GHIs have, somewhat paradoxically, appropriated the aim of health system strengthening (HSS). This article critically analyses this development through an ethnographic case study of the GAVI Alliance, which funds vaccines in poor countries. Despite GAVI’s self-proclaimed ‘single-minded’ focus on vaccines, HSS support is fronted as a key principle of GAVI’s mission. Yet, its meaning remains unclear and contested understandings of the health systems agenda abound, reflecting competing public health ideologies and professional pressures within the global health field. Contrary to broader conceptualisations of HSS that emphasise social and political dimensions, GAVI’s HSS support has become emblematic of the so-called ‘Gates approach’ to global health, focused on targeted technical solutions with clear, measurable outcomes. In spite of adopting rhetoric supportive of ‘holistic’ health systems, GHIs like GAVI have come to capture the global debate about HSS in favour of their disease-specific approach and ethos.
Road-mapping a total market approach for family planning and reproductive health commodity security. Workshop materials.
Seattle, Washington, PATH, 2013.  p.To meet the challenge of sustaining reproductive health commodity security in Eastern Europe and Central Asia, the United Nations Population Fund and PATH developed workshops to increase awareness about total market approaches and develop an action plan for the region. These workshop materials are from two regional workshops that were held in April 2013.
Journal of Ethnic and Migration Studies. 2014 Jun; 40(6):924-941.This article investigates the complex relationship between the practices of the United Nations High Commissioner for Refugees (UNHCR) in the field of refugee protection and the more recent political rationality of 'migration management' by drawing from governmentality studies. It is argued that the dissemination of UNHCR's own refugee protection discourse creates certain 'figures of migration' allowing for justifying the build-up and perfection of border controls, which in turn enable any attempt to 'manage' migration in the first place. Conversely, the problematisation of population movements as 'mixed migration flows' allows UNHCR to enlarge its field of activitiy despite its narrow mandate by actively participating in the promotion, planning and implementation of migration management systems. Based on ethnographic research in Turkey and Morocco, this article demonstrates, furthermore, that UNHCR's refugee protection discourse and the emerging migration management paradigm are both based on a methodological nationalism, share an authoritarian potential and yield de-politicising effects. What UNHCR's recent embracing of the migration management paradigm together with its active involvement in respective practices then brings to the fore is that UNHCR is part of a global police of populations.
Zimbabwe: An AIDS strategy focused and aligned with our vision and the United Nations targets for 2015. Case study.
[Geneva, Switzerland], UNAIDS, 2013.  p. (Case Study)This case study looks at how Zimbabwe evolved its work with UNAIDS and the Global Fund for HIV, Tuberculosis and Malaria to fit the New Funding Model for the Global Fund, and received a US$311 million three-year grant --- equal to the combined total of HIV assistance the country received from the Global Fund in the past decade. This case study examines how a country whose AIDS response was effective, people-centred and prioritized, but heavily under-funded, seized the chance to take its response to a new level, and the part UNAIDS played.
Love, sexual rights and young people. Learning from our peer educators how to be a youth-centred organisation. Report of a participatory assessment of the IPPF Danida-funded A+ programme on adolescent sexual and reproductive health and rights.
[London, United Kingdom], IPPF, 2013 May.  p.The A+ program was implemented by IPPF’s Member Associations in 16 countries across sub-Saharan Africa, South Asia and Central America. The goal was to increase access to sexual and reproductive health services and comprehensive sexuality education for young people, and to promote their sexual and reproductive health and rights. This report, guided by the unique insights of young people themselves, will contribute to shared learning on how best to implement a youth-centered approach across IPPF and beyond. Integral to the program ethos were cross-cutting issues of youth participation, gender equity and partnerships, with a focus on reaching the most marginalized young people.