Using the Policy Implementation Assessment Tool to help put reproductive health and HIV policies into practice: Experiences from Guatemala, El Salvador, and India

Countries the world over have adopted FP/RH, HIV, and maternal health policies. However, policies are not always implemented as envisioned and do not necessarily achieve intended results. The USAID | Health Policy Initiative has designed an approach and tool for assessing policy implementation. The Policy Implementation Assessment Tool (PIAT) comprises two questionnaires (for policymakers and implementers/other stakeholders) that consider seven dimensions: (1) The policy, its formulation, and dissemination; (2) Social, political, and economic context; (3) Leadership; (4) Stakeholder involvement; (5) Planning and resource mobilization; (6) Operations and services; and (7) Feedback on progress and results. The tool enables stakeholders to gather information about a multifaceted process in a systematic, user-friendly manner. With this evidence, they can better understand what is and is not working, explore root causes, and begin to devise solutions to identified barriers. To date, multisectoral, in-country teams have adapted and used PIAT to assess implementation of national-level RH and HIV policies in Guatemala; the National HIV/AIDS Strategic Plan in El Salvador; and the State Health and Population Policy for Uttarakhand, India. Policymakers have also used PIAT to inform decisionmaking as they consider new policies on diverse topics (e.g., RH, male circumcision, task shifting). Whether seeking to renew FP commitment or ensure effective HIV program scale-up, use of PIAT has inspired dialogue and action. For example, in March 2008, Guatemala's Congress created a national board to monitor RH and HIV policy implementation and advocate for increased funding. As of early 2009, stakeholders in Uttarakhand are revising the state's policy based on the PIAT assessment, latest health data, and results of innovative RH interventions. PIAT has proven to be useful because it brings together partners from various sectors; identifies barriers to implementation; encourages dialogue and consensus on country-owned solutions; and results in concrete action items to improve implementation. The tool can be adapted for use in other countries, at different levels (e.g., state, district), and for various health policy issues. A guide on using the tool, including the questionnaires and data collection spreadsheets, is available. Guidance on adding supplementary issues (stigma, gender, poverty) and creating focus group discussion guides (for clients and community-level workers) is also available.