PHR project final report 1995-2001

Associates, Inc, on the Partnerships for Health Reform (PHR) project (9/95-3/01), designed to support health sector reform and problem-solving worldwide. The report focuses on key project results in terms of strategic frameworks both of the project itself (health policy and management, health care financing, and health service improvement) and of the Global Bureau"s Population, Health and Nutrition (G/PHN) Center (maternal/child health and nutrition, HIV/AIDS, infectious diseases). A final section provides a synthetic look at significant results in key countries and technical areas. PHR worked in more than 40 countries and tested several innovative approaches to long-standing reform issues. Egypt represents a country where PHR"s efforts stretched over many different components of reform (financing, quality, information systems, and service delivery), offering the opportunity to develop and pilot a comprehensive package of reforms. In addition, PHR"s efforts come at the end of a long run of projects and studies in the health sector, such that the Ministry of Health and Population (MOHP) was prepared to make the decisions and embark on implementation. Senegal, a country where PHR started with only a few small-scale activities, developed into an opportunity to assist the Government of Senegal and MOH come to grips with the results of two uncoordinated, ill-prepared national reform agenda and their consequences for health. Rwanda, emerging from a devastating civil war, was looking for ways to increase the utilization of health care services by its poor, rural populations. In Morocco, a country transitioning to USAID "graduate" status, PHR used a variety of policy activities to facilitate the government"s efforts to reduce dependency on donor funding. PHR"s contribution to the Latin America and Caribbean (LAC) Health Sector Reform (HSR) Initiative significantly expanded information and tools to LAC policymakers. Key technical areas to which the project contributed include national health accounts (NHA); community-based health insurance schemes (also called mutual health organizations); and cutting edge applied research on the policy process in health financing reform (especially the financing of national immunization programs) and on emerging issues such as NGO contracting, participation in policy, and health worker motivation. PHR successfully leveraged USAID funds to obtain additional funding for key activities such as NHA; USAID funds would not have been sufficient to achieve the number of countries now being touched by NHA. PHR also prepared various summaries that highlighted the significance and results of PHR projects in Africa, Asia, Latin America and the Caribbean (LAC), and the Middle East and developed a user-friendly 275-page website that logged 1.5 million "hits" and recorded more than 20,000 document "downloads" by visitors from 134 countries. In concert with counterparts and partner organizations, PHR developed a wide range of innovative approaches to training, including on-the-job training; structured workshops and study tours; sensitization and consensus-based learning fora; and the use of electronic media (PHR-supported listservs and websites) to reinforce new knowledge, skills, and learning applications.