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From July 12-15, ThinkWell will virtually join health economists and health system leaders at the 2021 International Health Economics Association (iHEA) Congress to discuss bold, creative, and practical solutions that actually work.

In twelve organized sessions and four poster sessions, we will showcase transformative work from the Strategic Purchasing for Primary Health Care (SP4PHC), USAID Health Financing Activity, and Immunization Costing Action Network (ICAN) programs. 

Be sure to take a look at the full program. You can register here until July 5. We hope to see you there to untangle challenges and seek innovative solutions in health financing! 

ThinkWell’s sessions and posters that will be featured at iHEA are briefly summarized below. The titles link to iHEA’s more detailed session descriptions.

SESSIONS 

Institutional Arrangements for Increasing Facility Autonomy and Their Effect on Performance: Insights from Kenya  

Tuesday, July 13, 2021 

6:45 AM – 7:45 AM GMT 

Ensuring that facilities have funds that they can use flexibly and account for them is critical for improving service delivery in the public sector in Kenya. When Kenya transitioned to a devolved system of government in 2013, newly formed county governments required all public hospitals, which generate considerable own-source revenue from user fees and insurance reimbursements, to remit the funds to the county treasury. In contrast, some counties transferred funds they received from the national government through earmarked conditional grants to primary health care centers. In more recent years, counties have embarked on reforms to grant greater financial autonomy to public facilities. Against this backdrop, we undertook a study to explore the effect of facility autonomy on performance by comparing three counties: one with no facility autonomy, one with modest facility autonomy, and one with extensive facility autonomy. This session will discuss the study’s findings. 

Health Financing in Devolved Contexts and Its Implications for Progress Towards Universal Health Coverage 

Tuesday, July 13, 2021 

7:45 AM – 8:45 AM GMT 

This session focuses on health financing in devolved settings and explores how a devolved setting affects the health financing functions of revenue raising, pooling, and purchasing, and what this implies for progress towards universal health coverage (UHC) objectives. This draws on a multi-country study undertaken by the World Health Organization (WHO) and ThinkWell in Kenya, Uganda, Burkina Faso, Mozambique, Nigeria, the Philippines, and Indonesia, following an analytical framework developed for that purpose. The session will include a “real life” perspective from two sub-national government health officials from Kenya and the Philippines, who will respond to the country case studies and offer reflections from a local perspective. 

How Devolution Has Shaped Health Financing Arrangements: A Case Study of the Philippines 

Tuesday, July 13, 2021 

7:45 AM – 8:45 AM GMT 

The Local Government Code of 1991 reshaped the centralized health system of the Philippines into a highly decentralized system. Several major policy reforms have since been enacted to better facilitate the flow of money for health across the different levels of governance. Even with these changes, financing of health services continues to face considerable challenges brought about by the devolved structure. This session will explore how devolution has affected overall spending on health, equitable resource distribution and redistributive capacity, as well as strategic purchasing in the country as part of a World Health Organization (WHO) and ThinkWell multi-country study.    

How Does Devolution Affect Health Financing? A Synthesis of Findings from Seven Country Case Studies 

Tuesday, July 13, 2021 

7:45 AM – 8:45 AM 

Over the past decades, countries around the world have devolved decision-making authority to sub-national government units in various sectors including health. In parallel, countries have also initiated health financing reforms for achieving the goal of universal health coverage. While national governments exercise a high degree of control over the design of health financing reforms, their implementation is heavily influenced by the devolved institutional setup. Against this backdrop, the World Health Organization (WHO) and ThinkWell launched a multi-country study to explore how devolution has affected overall spending on health, equitable resource distribution and redistributive capacity, as well as local purchasers’ ability to make purchasing more strategic. This session will explore the countries’ findings.  

Challenges and Opportunities for Health Financing Reforms in the Age of Devolution: A Perspective from Kenya 

Tuesday, July 13, 2021 

7:45 AM – 8:45 AM GMT 

Kenya’s transition to a devolved system of government in 2013 fundamentally transformed the organization of health financing functions. While the national government continues to mobilize the bulk of public funds for health, over half of the funds are pooled at the county-level. Moreover, counties are the main purchasers of primary and secondary care services in the country. This session will discuss acase study that provides a detailed analysis of how devolution has impacted the three functions of health financing: revenue raising, pooling and purchasing. The session will also explore implications for the country’s strategy for achieving universal health coverage (UHC). 

A Rapid Situational Assessment of the Impacts of the COVID-19 Pandemic on the Provision and Utilization of Essential Health Services in Bangladesh 

You can view the presentation deck here

Tuesday, July 13, 2021 

12:15 PM – 1:15 PM GMT 

Despite early anecdotal evidence of significant reductions in health service utilization related to the COVID-19 outbreak in Bangladesh, the scale, incidence, and drivers of health service impacts were poorly understood. The Government of Bangladesh (GOB) has committed to maintain the provision of essential health services as a component of the National COVID-19 Preparedness and Response Plan. However, a lack of evidence on the scale of service impacts, as well as the drivers and root causes of these impacts, meant that the GOB lacked an evidence-base for important decisions on health service strategy, planning, and resource allocation. This session will share the results of a rapid situational assessment that revealed several important drivers of COVID-mediated health service and health financing disruptions with the potential to inform better strategy and planning in Bangladesh. 

Are Public Facilities Set up to Respond to Strategic Purchasing Signals: Insights from East Africa

Tuesday, July 13, 2021 

1:45 PM – 2:45 PM GMT 

In this session, we will explore approaches for enhancing facility autonomy and whether they increase the marginal productivity of public facilities, drawing on evidence and insights from Kenya, Tanzania, and Uganda. Panelists from these three neighboring countries in East Africa will share information on ongoing public financial management reforms to enhance facility autonomy, such as initiating direct transfers of earmarked allocations to facilities, the inclusion of public facilities in the chart of accounts, and legal amendments to allow facilities to collect appropriations in aid. They will then share findings on the effect of these reforms, reflecting on the mechanisms through which facility autonomy boosts facility performance as well as the enabling factors that are necessary for improved facility autonomy.

Flow of Funds to the Frontlines: Insights from Uganda 

Tuesday, July 13, 2021 

1:45 PM – 2:45 PM GMT 

Decentralization in Uganda has taken a dynamic path since 1997, when the Local Government Act was passed to devolve decision-making powers and service delivery responsibilities to districts. Progressive reforms followed to channel more funds to the districts and strengthen subnational governance structures. The national government also introduced primary health care grants that flow directly to health facilities, including public health centers and hospitals under the jurisdiction of local governments. In recent years, donors have funded results-based financing programs where the national government channels additional payments to government-owned facilities based on outputs. Against this complex landscape, we undertook a study to map the flow of funds to the frontlines and explore the decision-making dynamics between local governments and health facilities to inform ongoing policy discussions around health financing reforms for making progress towards universal health coverage. The session will cover our findings. 

Econometrics of Acute Cardiovascular Services: Analyzing Pre- and Hospital Delays Among Acute Coronary Syndrome Patients in Jakarta, Indonesia 

Wednesday, July 14, 2021 

5:30 AM – 6:30 AM GMT 

Delay of treatments for patients with acute coronary syndrome (ACS) should be kept as short as possible to reduce complications and mortality. This session will discuss a study that investigated drivers of prehospital and hospital delays amongst ACS patients in Indonesia by determining the symptom-to-door times (prehospital) and hospital delays of ACS patients admitted at health facilities in Jakarta, Indonesia. The study also analyzed variables associated with such delays by looking at patients’ socio-demographical data, risk factors and comorbidities, and symptom characteristics. It’s critical to identify these factors for raising awareness as well as designing innovative policies. 

Sustainable Health Financing: Lessons from the USAID Health Financing Activity in Indonesia 

Wednesday, July 14, 2021 

8:30 AM – 9:30 AM GMT 

To ensure a long-term sustainable health financing USAID Indonesia, in collaboration with the Ministry of Health’s Center for Health Financing, implements a five-year project call Health Financing Activity. The program aims to ensure sustainable health financing and strategic purchasing. This organized session will provide lessons learned from the HFA USAID Project in Indonesia.  

The Cost of COVID-19 Management in Secondary and Tertiary Settings in Indonesia 

Wednesday, July 14, 2021 

4:00 AM – 5:00 AM GMT 

As of mid-December 2020, Indonesia had 598,933 cases of COVID-19, posing a burden on hospitals to care for COVID-19 patients in addition to other cases. Government of Indonesia (GoI) regulation requires COVID-related costs to be covered by the MOH because it is a pandemic. Once declared endemic, treatment will be covered by the National Health Insurance. The MOH quickly established an innovative system to pay hospitals for COVID-19 treatment. The hospital is paid fee-for-service for per-diem and other costs. However, there are concerns about the cost of this payment system and its effect on the national health budget. Since COVID-19 is new, there is limited understanding of which factors drive treatment costs and no cost standards. This session will review evidence of actual costs to develop a standard cost for a COVID-19 treatment package. 

The Cost of Integrated Immunization Campaigns: Findings from Sierra Leone and Nigeria 

You can view the presentation deck here

Wednesday, July 14, 2021 

4:00 PM – 5:00 PM GMT 

The COVID-19 pandemic has increased the need for integrated delivery of essential health services, including immunization, to ensure effective and efficient service delivery. Many countries have suffered from disruptions in immunization services, reductions in coverage, and have had to delay or cancel immunization campaigns, rendering populations vulnerable to outbreaks of vaccine preventable diseases. As part of catch-up vaccination strategies and while resources are particularly constrained, countries have been encouraged to explore the option of conducting multi-antigen campaigns or integrating immunization campaigns with other health services. Despite this recommendation, there is little evidence on the cost and efficiency gains of co-delivery during immunization campaigns. This session will discuss results of a study that will help global and country level decision makers in planning and budgeting for multi-antigen and co-delivery campaigns. 

POSTERS 

Patterns of Health Care Utilization and Referrals Amongst HIV Patients in Indonesia: Cross-Sectional Analysis of National Health Insurance Claims Data 

Tuesday, July 13, 2021 

6:00 AM – 7:15 AM GMT  

As of December 2019, approximately 640,443 people in Indonesia were living with HIV, but only 57% knew their status, only 127,613 (19%) were on treatment, and only 10,009 viral load tests were performed. Indonesia seeks to scale-up its HIV response and replace declining donor funding through better coverage of HIV/AIDS services by its National Health Insurance Scheme (JKN). This session will discuss a study that analyzed current patterns of service use, referral, and costs of HIV care under JKN to identify opportunities to improve coverage. 

Applied Stakeholder Analysis in Mapping Political Actors Involved in the Implementation of Universal Health Care in 25 Provinces in the Philippines   

Tuesday, July 13, 2021 

6:00 AM – 7:15 AM GMT 

Stakeholder perceptions on health policy reforms are key for evidence-based policy development and implementation. To this end, stakeholder analysis (SHA) is a useful tool for gathering insights on stakeholders’ interests in, positions on, and power to influence health policy issues that aim to achieve universal health coverage (UHC). There is little evidence on the use of SHA in health policy development and even less in informing the politics of implementing health system reforms towards UHC. This poster summarizes a study that demonstrates the utility of SHA as a tool for evidence-based policy development for UHC, drawn from the experience of doing SHA with political actors in 25 provinces involved in the pilot implementation of the recently enacted UHC Law in the Philippines. 

The Impact of Indonesia’s Social Health Insurance on Out-of-Pocket Health Expenditures: Financial Risk Protection, and Its Potential for Stimulating Macroeconomic Growth 

Tuesday, July 13, 2021 

6:00 AM – 7:15 AM 

Since the single payer national health insurance scheme in Indonesia (JKN) rolled out in 2014, the proportion of out-of-pocket (OOP) health expenditure in Indonesia has steadily decreased over time. The OOP health expenditure at the national level was 32% of Total Health Expenditure (THE) in 2018, a substantial decrease from 47% in 2013, prior to JKN. Public spending became the largest component of national health expenditure from 2018 onwards (54%). To better understand the root causes and characteristics of OOP at the household level, this poster summarizes a study that estimates the effect of JKN towards reducing OOP spending and how this effect changes by key sociodemographic (e.g., poverty level) and provider (e.g., type, service) characteristics. 

The Impact of Free Maternity Policies in Kenya: An Interrupted Time Series Analysis 

Tuesday, July 13, 2021 

6:00 AM – 7:15 AM GMT 

User fees have been reported to limit access to services and increase inequities. As a result, Kenya introduced a free maternity policy in all public facilities in 2013. Subsequently in 2017, the policy was revised to the Linda Mama program to expand access to private sector, expand the benefit package, and change its management. The free maternity policies show mixed effects in increasing access to maternal health services. Emphasis on other accessibility barriers and service delivery challenges alongside user fee removal policies should be addressed to realize maximum benefits in maternal health utilization. this poster summarizes an interrupted time series analysis on facility deliveries, antenatal care and postnatal care visits data between 2012-2019 to determine the effect of the two free maternity policies. 

Written by Matt Boxshall and Jennifer Santisi at ThinkWell, this blog summarizes expert discussions on family planning and national health insurance at the recent ThinkWell Counterpoint webinar, access the recording here.

“I’m passionate about family planning; empowering women to have children by choice, not by chance, can transform societies for the better,” said Matt Boxshall, Program Director at ThinkWell. “To achieve this, it’s clear that governments must invest in improving access to quality family planning (FP) services.  But it’s also clear that the way those investments are made – how that money is spent – is critical.  As more governments choose national health insurance (NHI) to support the drive to universal health coverage (UHC), we ask if NHI is the right tool to ensure that those most in need have access to quality FP services.”

Matt opened the first webinar, “Putting the ‘Universal’ into ‘UHC Schemes’ for Family Planning,” in ThinkWell’s Counterpoint series. Health professionals from around the world attended the webinar on June 3, 2021, to hear from leading experts in health financing and FP.

When deciding whether to finance FP through health insurance, first ask “Who will benefit?”

“UHC is a goal, not a scheme,” said Joe Kutzin, who leads the World Health Organization’s Health Financing Team in Geneva. He reiterated that every country can make progress towards the goals of UHC, reducing the gap between need and utilization, improving quality, and increasing financial protection. To do so, however, it is important to consider the performance of the health system as a whole, rather than focusing on a particular scheme in isolation.  With this framing, Joe described a cascade of decisions about whether to include a specific service (like FP) within a health insurance scheme. The first, and critical, decision is based on whether the entitlement to services under the insurance scheme is universal or restricted to those who contribute to the scheme. If entitlement is linked to contributions, as in social health insurance schemes, integration should not be considered.

Beware early financing decisions that ignore sexual and reproductive health and rights – they may be hard to undo.

Brendan Hayes, a Senior Health Specialist at the Global Financing Facility, picked this up in his comments; “UHC is not a scheme, it’s a series of goals we’re trying to achieve…It’s really important we’re keeping those goals front of mind, so we’re constantly sense checking the theory of change.” Initial decisions made by policymakers shape the pathway toward UHC.  If those decisions are based on the desire to raise revenue, for example through formal sector contributions to health insurance, they are unlikely to be responsive to the sexual and reproductive health needs of women and girls – and those initial decisions can inadvertently lock in certain priorities.  “Too often, we’re coming in at a later stage to reappraise those initial policy decisions,” said Brendan.

Poor women and girls rarely benefit from health insurance in sub-Saharan Africa.

In sub-Saharan Africa (SSA), countries are “turning to public contributory health insurance as a mechanism to remove financial barriers to accessing health care services,” explained Jacob Kuzungu, a Research Officer at KEMRI Wellcome Trust. Over the last 10 years, 38% of SSA countries have established national health insurance (NHI) schemes. In an analysis of 36 SSA countries, data shows that on average, only 8 in 100 people are covered by any health insurance, and only 4 of the 36 countries currently cover more than 20% of their population. Disparities exist across socioeconomic status, location, gender, and employment status – poor women and girls are amongst those least likely to be covered. Hence, SSA countries should reconsider voluntary contributory health insurance mechanisms, Kazungu argued. They should instead reorient health financing toward non-contributory tax-funded arrangements to increase coverage and reduce inequalities.

Indonesia has good health insurance coverage, but this hasn’t helped improve the uptake of FP.

In contrast to most of SSA, Indonesia’s national health insurance, JKN, covers 80% of the population. JKN began in 2014 with a comprehensive benefits package that includes FP. However, data shows that despite FP services offered, modern contraceptive prevalence rate has decreased since 2014, shared Prastuti Soewondo, a Special Advisor to Indonesia’s Minister of Health. Including FP in the benefit package did not solve the challenge of access to services. In Indonesia, injectable contraceptives are most used, often accessed through private midwives who are not contracted by JKN. The Government of Indonesia is committed to improving access to FP, incorporating more midwives into JKN, and clarifying the responsibilities of the national FP program (BKKBN) and JKN.

Translating health insurance cover into FP choice is complex and difficult.

“There are many challenges in terms of getting equitable coverage for national health insurance,” said Sophie Witter, Professor of International Health Financing and Health Systems at Queen Margaret University, Edinburgh. Only 45% of women are employed compared to 71% of men and 90% of employed women in SSA work in the informal sector, which poses huge challenges to countries where health care is based on formal employment status. Other barriers include age, education, religion, and refugee status. Even if someone is covered, can they access health services? The answer depends on many factors, but challenges in accessing benefits from formal insurance schemes include awareness of benefits, provider attitudes, stigma, safety, and practical issues like access to health insurance ID cards.

Financial protection is a key goal to UHC, every speaker emphasized. But a recent systematic review concluded that only 26 out of 46 studies of health insurance schemes showed there were improvements in financial protection for members. Financial commitment to health has been too limited to support equitable UHC in many settings. “When there is a mismatch between the promise and the reality, there is always a consequence to the user,” added Witter.

Community voices are needed to hold governments accountable, to ensure that national health insurance schemes benefit those most in need.

“One thing I haven’t heard yet is the role of communities and the end users of these services in holding governments accountable,” said Elisha Dunn-Georgiou, Vice President of Policy and Advocacy at PAI, in her reflection on the presentations. “Not in opposition to governments, but in partnership with them.” Insurance programs might have the potential to empower their members, but this can only work for women and girls if their voice is heard and their needs prioritized in the development of the schemes.

Better data, stronger evidence, and clearer messages are needed if health financing reforms are to benefit women and girls.

Nomi Rachael Fuchs-Montgomery, Deputy Director for Driving Impact at Scale at the Bill and Melinda Gates Foundation agreed that involving communities in decision-making processes, including in the development of insurance schemes, is an important piece of the puzzle. She added we must also push for better and more robust data in order to further understand FP integration and quality and equity issues, given the number of barriers women face. “When we decided to partner with ThinkWell, there wasn’t a collective effort to hone in on that evidence…. The information shared today is important to shedding light on providing access at scale,” said Fuchs-Montgomery.

“Repetition is very important. By the time members of parliament cannot hear the debate anymore, that’s probably when the general public is hearing the message for the first time,” said Caitlin Mazzilli, Senior Program Officer from the Bill & Melinda Gates Foundation in her closing remarks. It is important to repeat the message and continue educating others.

We need to work together to challenge the status quo and to find better solutions.

Several participants reiterated the need for the FP community and health financing specialists to work together to find solutions that will help women and girls access quality family planning services in the UHC era. We at ThinkWell could not agree more. We believe that health financing reform is a critical step on the road to UHC, and also for the sexual and reproductive health and rights that are an essential part of UHC. Improvements in the way that governments spend money to pay for services –making purchasing more strategic – is central to these reforms and can send strong signals to providers about the importance of offering high quality, rights-based family planning choices.  Purchasing reforms can also remove user fees for those most in need, and expand access by contracting private providers.

But if getting FP into nascent contributory health insurance schemes isn’t the best way to secure universal access to FP, then where does that leave us as we seek to use strategic purchasing to improve FP service delivery? And what is the right mix of purchasing approaches for FP services in countries with more mature NHI schemes like Indonesia?  Perhaps breaking the link between formal membership and benefits is an important step, and we can learn a lot from the UHC Law in the Philippines, which has made PhilHealth benefits a right for all.  What about other national schemes where benefits are universal for targeted population groups like pregnant women, or children under 5, but payments are linked to performance?  Schemes like Gratuité in Burkina Faso, or Linda Mama in Kenya hold important lessons.

One thing is for sure – to solve these puzzles we will need strong partnerships across different communities of practice, the openness to learn from each other, and the courage to examine evidence that challenges our own preconceptions.

The global family planning (FP) community gathered this February under the banner “UHC: not without FP” to demonstrate why integrating FP into universal health coverage (UHC) is essential for success. As passionate believers in the power of FP, we couldn’t agree more – but there is a trap here. Progress towards UHC is often wrapped up in rhetoric about “UHC schemes.” And many countries are choosing to rely on national health insurance (NHI) to deliver a defined package of benefits to contributors and pay providers based on outputs. Are NHI approaches best suited to reaching those most in need with quality FP services? Our webinar seeks to explore this important question.

We invite you to join our webinar on the latest research and best practices from a range of low- and middle-income countries actively undertaking purchasing reforms. This is the first webinar in the Counterpoint series, hosted by ThinkWell.

Speakers

Joe Kutzin, Coordinator for Health Financing, World Health Organization

Joe Kutzin leads the WHO’s health financing team in Geneva. In that capacity, he works closely with WHO’s six Regional Offices, addressing a diverse set of critical topics including fiscal sustainability, public financial management, strategic purchasing, financing of public goods, expenditure tracking, assessing progress on health financing reforms, and, most recently, the health financing dimensions of the COVID-19 response.

He is a health economist with 35 years’ experience, working in Africa, Asia, the Caribbean, Europe, and the United States. Since joining WHO in 1994, he has served as WHO policy advisor to the Ministry of Health of Kyrgyzstan, and also as the European Region’s Lead Advisor on Health Financing. Prior to that he worked at the World Bank and a private health foundation in the United States. He was a contributor to the World Health Report 2010 on financing for universal coverage and has published numerous conceptual and empirical articles on health systems, health financing and Universal Health Coverage.

Jacob Kazungu, Research Officer, KEMRI Wellcome Trust

A health economist with a keen research interest in health financing, choice modelling, economic evaluation of interventions, analytical modelling for decision making, economics of sex work, equity and inequalities in health and health systems strengthening. Jacob is also a NEMA licensed Lead Expert for Environmental Impact Assessment and Environmental Audits (NEMA Reg No: 8431).

 

Prastuti Soewondo, Special Advisor to the Minister of Health, Ministry of Health Indonesia

Prastuti Soewondo currently serves as Special Advisor to the Minister of Health at the Ministry of Health in Indonesia. Prior to that, Prastuti joined ThinkWell. Dr Soewondo was also an academic at the School of Public Health Administration and Health Policy, University of Indonesia.

 

Sophie Witter, Professor of International Health Financing and Health Systems, Queen Margaret University of Edinburgh

Professor Sophie Witter (BA, MA, PhD) is a Professor of International Health Financing and Health Systems in the Institute for Global Health and Development. She is also a member of the Institute for Global Health and Development Research Centre. She is a health economist specializing in health financing policy and health systems research in low and middle income countries. She has 30 years experience in these areas, working first in development agencies and then in the universities of York, Aberdeen and QMU Edinburgh.

Discussants

Brendan Hayes, Senior Health Specialist, Global Financing Facility, World Bank

Brendan Hayes is a sexual and reproductive health expert currently working as a Health Specialist with the World Bank and the Global Financing Facility secretariat. He has 10 years experience in Southern and East Africa working on health and development programs including 4 years in Malawi working on HIV prevention and family planning service delivery in the private sector.

Prior to joining the World Bank, he was a Channel Development Director working for Marie Stopes International with responsibility to design and implementation of private-sector RH service delivery through in-country support in Philippines, Pakistan, Vietnam, Kenya, Uganda, Ethiopia, Ghana, Senegal, Mali, Madagascar, Swaziland, Zambia, and Zimbabwe.

Originally from upstate-NY, Brendan has a BA from St. Lawrence University and a MSc from University College Dublin.

Elisha Dunn-Georgiou, Vice President of Policy and Advocacy, PAI

Elisha oversees the programmatic work of PAI, ensuring that the organization’s research and advocacy agendas are in alignment with PAI’s mission and strategic plan. Elisha has more than 15 years of experience in the fields of sexual and reproductive health and international development.

She holds a master’s degree in epidemiology and a JD from the State University of New York at Buffalo. Elisha is also a returned Peace Corps volunteer, having served in Morocco.

Nomi Fuchs-Montgomery, Deputy Director for Driving Impact at Scale, Bill and Melinda Gates Foundation

Nomi Rachel Fuchs-Montgomery, is a Deputy Director for Driving Impact at Scale, for the Family Planning strategy team at the Bill and Melinda Gates Foundation. In this capacity, she is responsible for leading the downstream initiatives of the family planning strategy, collaborating with country and regional offices, and fostering partnerships with a wide range of actors across the family planning and reproductive health ecosystem.

Nomi joined the Bill and Melinda Gates Foundation in January 2015, initially serving as the Deputy Director leading the Contraceptive Technology and Evidence and Innovation Initiatives, as well as providing oversight for the family planning team’s approach to adolescents and gender equitable programming. Prior to joining the Foundation, Nomi was the Director of Global Partnerships & US Country Director for Marie Stopes International-US (MSI-US), where she was responsible for the launch and development of MSI’s US office and growing global partnerships.  Nomi has over 24 years of professional experience in the field of reproductive health, family planning and HIV/AIDS. She has extensive experience collaborating with international bilateral donors, private foundations, UN agencies, leading NGOs, feminist and youth lead organizations, the World Bank and other finance partners.  Her first professional assignment was as a Peace Corps volunteer in south east Nigeria, where she worked on guinea worm eradication and developed a passion for public health.

Moderators

Matt Boxshall, Program Director, ThinkWell

Matt Boxshall joined ThinkWell to drive forward work on strategic purchasing for primary health care. Building from frontline service delivery experience in Africa and Asia, Matt has become increasingly involved in policy and health financing, and is passionate about unlocking the potential of systems to deliver quality care to those most in need.  Matt is a director on the Strategic Purchasing for Family Planning project for ThinkWell.

Nirmala Ravishankar, Program Director, ThinkWell

Nirmala Ravishankar is a health systems specialist with over 15 years of experience in Africa, Asia, and Latin America. She has worked on a range of health financing and health systems strengthening projects, including leading a research initiative to measure development assistance for health at the Institute for Health Metrics and Evaluation; managing a technical assistance program at Abt Associates to assist country governments measure and analyze health spending; and coordinating a multi-partner initiative to link the delivery of primary care services through franchised private providers with government health insurance in Kenya.

Nirmala joined ThinkWell in 2018 to lead a project to improve financing for primary healthcare services.  She has a PhD in political science from Harvard University, but picked a career in global health over psephology.

Closing Remarks

Caitlin Mazzilli, Senior Program Officer, Bill & Melinda Gates Foundation

Caitlin Mazzilli is a senior program officer at the Bill & Melinda Gates Foundation in the Health Systems team, managing a portfolio of grants to advance strategic purchasing of health services and service delivery innovation. She works closely with the Maternal Newborn Child Health and Family Planning teams to support integration within primary health care delivery.

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