Kathy Doherty l Palladium - Oct 28 2022
What Was Health Policy Plus and Why Does it Matter?

Suneeta Sharma speaks at the HP+ closing reception. 

Suneeta Sharma led the Health Policy Project (HPP) for two years and the Health Policy Plus (HP+) project for seven more years.

Suneeta Sharma is instinctively positive. She values and empowers her team. She is calm, solution-driven, and action-oriented. She also is focused on the future and can envision what it might look like and energises her team to help her get it done.

And for the past nine years, Sharma has led two projects—the Health Policy Project (HPP) and, from 2016 to September 2022, the Health Policy Plus (HP+) project—both funded by the U.S. Agency for International Development (USAID).

Having an eye toward results while envisioning the future helped her lead HP+ to develop, implement, finance, and advance 204 government policies—43 of which were in response to COVID-19 and six more to ensure access to essential health services in countries where health systems struggled to deal with the pandemic. Among these policies, 22 of them were standard operating procedures or clinical guidelines for health services, 78 were aimed to achieve gender equity in health, 53 were multisectoral policies that are meant to integrate health into broader policy, and 19 were fully costed implementation plans for family planning in 14 countries.

“I like to say that policy matters,” she says, “but I also always say that, without implementation and financing, policy is just words.” In her mind, the magic happens when policy, financing, and governance come together to deliver outcomes. For HP+, those outcomes included supporting governments to implement and operationalise new policies that ensure reproductive health rights, access to family planning health services, free maternity healthcare, and more.

For example, a free maternity healthcare program in Kenya exists because HP+ worked with government to find a way to lower the maternity mortality rate. Linda Mama, which means “protect mother” in Swahili, was created after HP+ helped government develop a policy that maternity care should be free to everyone. And then HP+ took the crucial step to analyse how to finance the idea and helped Kenya set up the program within its national health insurance.

Implementing HP+, Sharma knew, would take an evidence-driven, engaging, inclusive, and collaborative process. The project’s implementation is no less impressive than its results. It worked with 1,800 partners in 50 different countries with stakeholders who speak 38 languages. To get work done, it mobilised US$465 million in domestic health resources and US$1.4 billion from donors. It shared its work and impact through over half a million downloads of project publications, countless conference presentations, and speaking engagements.

The “Why” and What it Takes

“I enjoy reflecting on what has been done and the difference it made,” she says. “HP+ ran for seven years and got a lot of things done.”
And the future? That’s what kept Sharma focused on the “why.”
For her, the why of HP+ is the future state the project was working towards, which fit well with her personal qualities. “I’m practical and I’m all for data but

I really believe in action,” she says. “I needed a high-level goal like reducing poverty. I live more in the future because I think ‘this can happen, this can happen.’ I think ‘this can help,’ I’m optimistic.”
Sharma, who grew up in India, says she came to the development field because, from her early years, she witnessed a lot of poverty. It bothered her to see people treated badly without the dignity and respect they deserved.

“When I see that behaviour, I want to get into action. I was aiming at a high level of education and, as I went, I came to focus on health and international development,” she explains. Sharma studied economic administration, financial management and development economics and, in 1992, she turned toward health. Her PhD dissertation was about health policy and that set her on the path to development projects and to Palladium.

Better health policy seemed to be the answer to many global problems.
“I have seen the power of policy. I see that policy can improve the quality of life. Affordable healthcare for everyone? Policy can have an impact there; and the proof is in the data that shows performance,” she says. The HP+ mandate was to improve the environment that can foster equitable and sustainable health services and supplies, and the means to deliver them. Political economic analysis is essential to understand the realities in a particular country and how to align what HP+ does to that situation.

Sharma notes that policy cannot act alone. Governments need to find financing for putting programs in place to enact policy. HP+ supported countries to elevate health financing, engaging ministries of finance, strengthening public financial management systems and health financing strategies. Along with that, Sharma adds, “we explored blended financing opportunities and strategic purchasing procedures that helped increase health access, improve service quality, and reduce out-of-pocket expenses for people.”

She adds that another essential is to have a good framework to track results and always to ask the so-what question with specificity to each country so that the work fits.

For Sharma, that country fit is like a puzzle—as are the problems that inevitably arise. “I love the technical puzzle of what to do and I love the management,” she adds. “I like working with different stakeholders and with the people who will benefit. I don’t get concerned if there’s a problem because it’s not personal, it’s just a problem. I turn to action. I look for solutions.”

“I like to say that policy matters, but I also always say that, without implementation and financing, policy is just words.”

And What About that Future?

With HP+, Sharma says she wanted to focus attention on a goal that wasn’t necessarily money for family planning or money for HIV but was money for the entire health sector, especially primary healthcare. “That’s going to be very important in the future so it’s a good thing that, globally, people are thinking that way. The goal of health programs and health policy programs should be to stand up primary healthcare,” she says. “But fragile settings and shocks are real. COVID-19 was real, and it was hard.”

She credits her team’s dedication and hard work for the quick response that ensured HP+ could continue its regular work but also to pivot quickly to provide emergency response in the pandemic and in turn, save lives. “Our very capable, highly committed local staff continued to achieve results in policy, advocacy, financing, and governance, and still provided support to countries during COVID-19,” she says, adding that HP+ proved equally effective in the emergency situation as in its policy work.

Another fundamental for Sharma is persistence and passion. “You do not stop just because something happens, like COVID-19,” she says. “You’re always thinking, but it’s not draining for me. It’s energising and exciting. I don’t get tired.”

What Comes Next

As HP+ came to a close in September, Sharma visited several countries to celebrate HP+ accomplishments. From Malawi and Kenya to Guatemala, government and health officials were asking how the work will go forward to build on USAID investments and the HP+ legacy. Sharma isn’t worried. “Most of the time, the work will continue because it’s now a policy and is sustainable,” she says. “But a few things that need to be done are to align policies at different levels, not just one sector like health, not just one level like national government. More thought is needed about how policies link to a financing framework and to accountability.

“Another big task for the future is work toward an enabling environment with true country stewardship,” she says. That stewardship would put countries in control of leading policy reform and taking a strategic approach to delivering healthcare to citizens. “I would like to see that health and finance ministers are looking at dashboards and considering all different things while they make decisions. I’d also like to see in-country universities helping to design approaches; researchers and decisionmakers coming together,” Sharma says.

And, of course, she’d like to see more attention paid to financing for healthcare and policies to ensure it is equally provided to everyone.
Her view of the future that delivers what she sees speaks to the collective impact that is Sharma’s focus at work. Although she is hands-on, she values her team and doesn’t get in their way. Teamwork—whether in headquarters or in each country where work happens—is what turns health policy into reality.

“I passionately believe in teamwork. That’s how you get things done, make things run, and make them effective. If you wonder what I treasure most about HP+, I can say with certainty that it is gratitude for our team,” she says.

And, as HP+ has now closed shop, what are her thoughts? “It’s a big responsibility. Policy work needs to be done in a very thoughtful way. We need to give the best advice. We need to ask so-what questions. It’s an obligation.”

It can’t have been an accident that the HP+ team performed. It turns out, having an eye toward results while “seeing” the future is a pretty good formula for policy work across the globe. It worked for HP+.

For more, read 'Palladium Wins Flagship USAID Health Program - PROPEL Health' and contact info@thepalladiumgroup.com.