Research
CPI supports research partnerships that bring together community-based and civil society organizations, academic institutions and governments to generate evidence to guide, assess and inform service planning, prioritization and program implementation, support advocacy and influence wider policy-making. We empower communities to set their own research agenda and lead participatory research initiatives that meet international standards and ethical principles.
Key Projects
Knowledge Broker Group - Myanmar
Period: April 2019 - June 2021
Donor(s): USAID Victims of Torture Program
Partner(s): The Johns Hopkins Bloomberg School of Public Health’s Applied Mental Health Research Group
Geographic Coverage: Myanmar
Community Partners International (CPI) and the Johns Hopkins Bloomberg School of Public Health’s Applied Mental Health Research Group are working in partnership to establish a functional Knowledge Broker Group in Myanmar to fill the health policy research gap using a sustainable, effective and inclusive approach. Through this initiative, CPI aims to help synthesize and generate national, regional and global evidence required by decision makers and key stakeholders for the development of key health policy documents.
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Period: April 2019 - June 2021
Donor(s): USAID Victims of Torture Program
Partner(s): The Johns Hopkins Bloomberg School of Public Health’s Applied Mental Health Research Group
Geographic Coverage: Myanmar
Community Partners International (CPI) and the Johns Hopkins Bloomberg School of Public Health’s Applied Mental Health Research Group are working in partnership to establish a functional Knowledge Broker Group in Myanmar to fill the health policy research gap using a sustainable, effective and inclusive approach. Through this initiative, CPI aims to help synthesize and generate national, regional and global evidence required by decision makers and key stakeholders for the development of key health policy documents.
View/Download the Project Fact Sheet: A4 Size | Letter Size
Voluntary Community Social Worker Pilot Project
Period: March 2019 - September 2020
Donor(s): UKAID
Partner(s): Myanmar Ministry of Social Welfare, Relief and Resettlement
Geographic Coverage: Waingmaw Township, Kachin State
This implementation research study aims to evaluate a new, evidence-based, culturally adapted, and community-based psychosocial program that can be delivered by trained voluntary community social workers (VCSWs). This is a task-shifting approach, in which lay, community-based case workers will address the most immediate psychosocial needs of community members and act as an entry point for a network of related services. The intervention package, in which case workers will identify, counsel, support, and refer cases using a case management approach will aim to restore an individual’s sense of functionality and ability to cope with psychosocial stressors, and to utilize existing social and other support networks. The location of the project, Waingmaw Township, has the highest number of internally displaced persons (IDPs) of all townships in Kachin State. This project will be implemented in IDP camps, IDP host communities and remote villages.
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Period: March 2019 - September 2020
Donor(s): UKAID
Partner(s): Myanmar Ministry of Social Welfare, Relief and Resettlement
Geographic Coverage: Waingmaw Township, Kachin State
This implementation research study aims to evaluate a new, evidence-based, culturally adapted, and community-based psychosocial program that can be delivered by trained voluntary community social workers (VCSWs). This is a task-shifting approach, in which lay, community-based case workers will address the most immediate psychosocial needs of community members and act as an entry point for a network of related services. The intervention package, in which case workers will identify, counsel, support, and refer cases using a case management approach will aim to restore an individual’s sense of functionality and ability to cope with psychosocial stressors, and to utilize existing social and other support networks. The location of the project, Waingmaw Township, has the highest number of internally displaced persons (IDPs) of all townships in Kachin State. This project will be implemented in IDP camps, IDP host communities and remote villages.
View/Download the Project Fact Sheet: A4 Size | Letter Size
Stop Hep B @ Birth in Peri-Urban Yangon
Period: July 2018 - June 2023
Donor(s): B. K. Kee Foundation, Tides Foundation,
Partner(s): Myanmar Liver Foundation, B.K. Kee Clinic
Geographic Coverage: Yangon
This five-year implementation research project aims to develop and implement a feasible community-oriented primary care model of disease prevention in low-resource settings with a focus on prevention of mother-to-child transmission (MTCT) of HBV. MTCT accounts for the majority of chronic HBV infections in Southeast Asia. The project will recruit a cohort of 110 HBV+ pregnant women and provide screening and comprehensive treatment of mothers and immunoprophylaxis to newborns to reduce the impact of the disease on their health and significantly reduce the risk of MTCT. In addition, HBV screening will be done for an estimated 550 household members of the HBV+ pregnant women. The complete HBV vaccination series will be provided to HBV negative household members, and systematic treatment will be provided to HBV positive household members according to the study treatment protocol based on WHO guidelines.
View/Download the Project Fact Sheet: A4 Size | Letter Size
Period: July 2018 - June 2023
Donor(s): B. K. Kee Foundation, Tides Foundation,
Partner(s): Myanmar Liver Foundation, B.K. Kee Clinic
Geographic Coverage: Yangon
This five-year implementation research project aims to develop and implement a feasible community-oriented primary care model of disease prevention in low-resource settings with a focus on prevention of mother-to-child transmission (MTCT) of HBV. MTCT accounts for the majority of chronic HBV infections in Southeast Asia. The project will recruit a cohort of 110 HBV+ pregnant women and provide screening and comprehensive treatment of mothers and immunoprophylaxis to newborns to reduce the impact of the disease on their health and significantly reduce the risk of MTCT. In addition, HBV screening will be done for an estimated 550 household members of the HBV+ pregnant women. The complete HBV vaccination series will be provided to HBV negative household members, and systematic treatment will be provided to HBV positive household members according to the study treatment protocol based on WHO guidelines.
View/Download the Project Fact Sheet: A4 Size | Letter Size
Time Use of Village-Based Health Workers of Ethnic Health Organizations: Qualitative Research and a Time-Motion Study Protocol
Period: July 2018 - Ongoing
Donor(s): Access to Health Fund, Tides Foundation
Partner(s): Karen Department of Health & Welfare (KDHW)
Geographic Coverage: Kayin State
Ethnic and community-based health organizations (ECBHOs) in Myanmar are task-shifting to village-based health workers (VBHWs) to address critical shortages of providers, and moving away from vertical programming, towards more integrated models of care. However, services may be integrated without understanding the additional time required to complete all assigned activities, and this may exacerbate challenges for motivation levels, performance, and attrition. There is limited qualitative data available on the impact of service integration on workload and time use from the perspective of VBHWs, especially those working outside the public sector. During this study, 24 VBHWs who serve communities in KDHW’s catchment area will be observed using a pre-coded observation tool to record all of the activities they perform for 7 consecutive days. During these “working hours,” the start times and stop times of the VBHW’s activities will be recorded continuously from the first work-related task until the last work-related task. This mixed methods study aims to:
1) Understand perceptions of workload and factors that influence time use when providing health services from the perspectives of high-performing and low-performing VBHWs who support ECBHOs and,
2) Develop and test appropriate data collection and analysis tools and processes for conducting a time-motion study of VBHWs in Myanmar.
Period: July 2018 - Ongoing
Donor(s): Access to Health Fund, Tides Foundation
Partner(s): Karen Department of Health & Welfare (KDHW)
Geographic Coverage: Kayin State
Ethnic and community-based health organizations (ECBHOs) in Myanmar are task-shifting to village-based health workers (VBHWs) to address critical shortages of providers, and moving away from vertical programming, towards more integrated models of care. However, services may be integrated without understanding the additional time required to complete all assigned activities, and this may exacerbate challenges for motivation levels, performance, and attrition. There is limited qualitative data available on the impact of service integration on workload and time use from the perspective of VBHWs, especially those working outside the public sector. During this study, 24 VBHWs who serve communities in KDHW’s catchment area will be observed using a pre-coded observation tool to record all of the activities they perform for 7 consecutive days. During these “working hours,” the start times and stop times of the VBHW’s activities will be recorded continuously from the first work-related task until the last work-related task. This mixed methods study aims to:
1) Understand perceptions of workload and factors that influence time use when providing health services from the perspectives of high-performing and low-performing VBHWs who support ECBHOs and,
2) Develop and test appropriate data collection and analysis tools and processes for conducting a time-motion study of VBHWs in Myanmar.
Integrated Biological and Behavioral Surveillance Survey among Migrants in Kawkareik, Myanmar
Period: June 2018 - Ongoing
Donor(s): University of California - Los Angeles Center for AIDS Research/AIDS Institute
Partner(s): Karen Department of Health & Welfare, National AIDS Program of the Myanmar Ministry of Health and Sports, University of California – Los Angeles
Geographic Coverage: Kawkareik Township, Kayin State
There is limited data on the prevalence of HIV infection among migrant populations in Myanmar. Many countries, including Myanmar, recognize migrants as a priority population potentially at elevated risk for HIV and related infections but tools are lacking to assess HIV risk and behaviors in these diverse and dispersed populations. This study will use Respondent Driven Sampling (RDS) methods and Integrated Biological and Behavioral Surveillance (IBBS) surveys to characterize the burden of HIV, hepatitis B (HBV), hepatitis C (HCV) and syphilis, and their associated risk factors, among inbound and outbound migrant populations in Kawkareik Township, Myanmar. It will assess HIV-related knowledge, attitudes, and stigma; measure gaps in the continuum of care and treatment for HIV and HCV (e.g., diagnosis, linkage, anti(retro)viral treatment); and enhance local capacity to conduct IBBS among migrants and other priority populations. The first phase of the study consists of survey development; and a pre-surveillance assessment to adapt RDS methods for the migrant population in Kawkareik. In the second phase, CPI will conduct the IBBS survey among 700 migrants. The study will also increase the capacity of ethnic and community-based health organizations (ECBHOs) to participate in HIV surveillance, and will establish a new HIV focus for collaborative research by teams at UCLA, CPI, the Myanmar Ministry of Health and Sports and the Karen Department Health and Welfare.
Period: June 2018 - Ongoing
Donor(s): University of California - Los Angeles Center for AIDS Research/AIDS Institute
Partner(s): Karen Department of Health & Welfare, National AIDS Program of the Myanmar Ministry of Health and Sports, University of California – Los Angeles
Geographic Coverage: Kawkareik Township, Kayin State
There is limited data on the prevalence of HIV infection among migrant populations in Myanmar. Many countries, including Myanmar, recognize migrants as a priority population potentially at elevated risk for HIV and related infections but tools are lacking to assess HIV risk and behaviors in these diverse and dispersed populations. This study will use Respondent Driven Sampling (RDS) methods and Integrated Biological and Behavioral Surveillance (IBBS) surveys to characterize the burden of HIV, hepatitis B (HBV), hepatitis C (HCV) and syphilis, and their associated risk factors, among inbound and outbound migrant populations in Kawkareik Township, Myanmar. It will assess HIV-related knowledge, attitudes, and stigma; measure gaps in the continuum of care and treatment for HIV and HCV (e.g., diagnosis, linkage, anti(retro)viral treatment); and enhance local capacity to conduct IBBS among migrants and other priority populations. The first phase of the study consists of survey development; and a pre-surveillance assessment to adapt RDS methods for the migrant population in Kawkareik. In the second phase, CPI will conduct the IBBS survey among 700 migrants. The study will also increase the capacity of ethnic and community-based health organizations (ECBHOs) to participate in HIV surveillance, and will establish a new HIV focus for collaborative research by teams at UCLA, CPI, the Myanmar Ministry of Health and Sports and the Karen Department Health and Welfare.
Impact of Local AIDS Committees on Levels of Stigma against People Who Inject Drugs in Kachin State
Period: February 2019 – February 2020
Donor(s): U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through UNAIDS Myanmar
Partner(s): Metta Development Foundation
Geographic Coverage: Kachin and Shan States
In cities in Kachin State, HIV prevalence among people who inject drugs (PWID) is nearly 50%, largely due to unsafe practices such as needle sharing. Metta Development Foundation works with Local AIDS Committees (LACs) for HIV prevention at project sites in Kachin State and Shan State. Metta supports LACs to develop action plans to sensitize communities on issues related to harm reduction approaches to drug use and HIV/AIDS. LACs implement community mobilization and engagement activities with a goal of reducing stigma against PWID and barriers to services related to HIV/AIDS and/or drug dependency. Stigma is considered one of the most significant obstacles to preventing and controlling HIV/AIDS at local, national, and global levels. This study aims to generate evidence to:
Period: February 2019 – February 2020
Donor(s): U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through UNAIDS Myanmar
Partner(s): Metta Development Foundation
Geographic Coverage: Kachin and Shan States
In cities in Kachin State, HIV prevalence among people who inject drugs (PWID) is nearly 50%, largely due to unsafe practices such as needle sharing. Metta Development Foundation works with Local AIDS Committees (LACs) for HIV prevention at project sites in Kachin State and Shan State. Metta supports LACs to develop action plans to sensitize communities on issues related to harm reduction approaches to drug use and HIV/AIDS. LACs implement community mobilization and engagement activities with a goal of reducing stigma against PWID and barriers to services related to HIV/AIDS and/or drug dependency. Stigma is considered one of the most significant obstacles to preventing and controlling HIV/AIDS at local, national, and global levels. This study aims to generate evidence to:
- Better understand the extent of stigma and discrimination experienced by PWID in communities where LACs are operating.
- Characterize the impact that LAC community mobilization and engagement activities can have in addressing the stigma and discrimination associated with drug dependency and HIV/AIDS.
- Inform programs and interventions to reduce stigma experienced by PWID and enhance their social reintegration and rehabilitation within their communities.
Maternal and Child Cash Transfer Survey
Period: April 2019 - October 2019
Donor(s): Livelihoods and Food Security (LIFT) Fund
Partner(s): Civil Health and Development Network, Karen Department of Health and Welfare
Geographic Coverage: Kayah and Kayin States
In April 2019, CPI was selected to manage a Maternal and Child Cash Transfer (MCCT) survey of 2,648 households in 14 townships in Kayah and Kayin States (1,860,700 population coverage) funded by the Livelihoods and Food Security Fund (LIFT). The MCCT initiative was launched by the Ministry of Social Welfare, Relief and Resettlement (MoSWRR) in Kayah and Kayin States in October 2018. Once approval is received from the protocol review committee and ethical review committee, CPI will launch the survey, with a projected start date of July or August 2019. The aims of the survey are to validate the design of this nationally-led cash transfer program that aims to address sub-optimal nutrition practices and to improve nutritional outcomes for children and families in Myanmar. The survey will cover all 7 townships of Kayin State and all 7 townships of Kayah State and will sample both urban and rural areas in both government-controlled areas (GCA) and non-government- controlled areas (NGCA). It will incorporate representative household surveys to measure nutrition, infant and young child feeding (IYCF), and health-seeking behaviors;
village profiles to assess village-level demographics, assets and conditions; and township profiles developed by analyzing township-level data and conducting key informant interviews with key stakeholders. treatment protocols for PMTCT of HBV.
Period: April 2019 - October 2019
Donor(s): Livelihoods and Food Security (LIFT) Fund
Partner(s): Civil Health and Development Network, Karen Department of Health and Welfare
Geographic Coverage: Kayah and Kayin States
In April 2019, CPI was selected to manage a Maternal and Child Cash Transfer (MCCT) survey of 2,648 households in 14 townships in Kayah and Kayin States (1,860,700 population coverage) funded by the Livelihoods and Food Security Fund (LIFT). The MCCT initiative was launched by the Ministry of Social Welfare, Relief and Resettlement (MoSWRR) in Kayah and Kayin States in October 2018. Once approval is received from the protocol review committee and ethical review committee, CPI will launch the survey, with a projected start date of July or August 2019. The aims of the survey are to validate the design of this nationally-led cash transfer program that aims to address sub-optimal nutrition practices and to improve nutritional outcomes for children and families in Myanmar. The survey will cover all 7 townships of Kayin State and all 7 townships of Kayah State and will sample both urban and rural areas in both government-controlled areas (GCA) and non-government- controlled areas (NGCA). It will incorporate representative household surveys to measure nutrition, infant and young child feeding (IYCF), and health-seeking behaviors;
village profiles to assess village-level demographics, assets and conditions; and township profiles developed by analyzing township-level data and conducting key informant interviews with key stakeholders. treatment protocols for PMTCT of HBV.
Young Men Who Have Sex with Men (YMSM) Online Survey
Period: January 2019 – July 2019
Donor(s): Tides Foundation, Youth Lead
Partner(s): Myanmar Youth Stars
There is an HIV crisis among young men who have sex with men (YMSM) in ASEAN, with some of the highest reported rates in Yangon and Mandalay in Myanmar. Men who have sex with men (MSM) make up 13% of all HIV cases in Myanmar, and the percentage is increasing each year. However, there is insufficient data on sexual behaviors of YMSM aged 15-24 years at regional, national, and sub-national levels, and this hampers the design of HIV prevention activities that are suited to the specific behavioral characteristics of YMSM. Traditional offline approaches to accessing YMSM networks for research purposes have been hampered by stigma. Information on syndemic conditions (e.g., homophobia, bullying, and resilience) of HIV risk behaviors, which have been shown to facilitate HIV vulnerability among MSM, have not been described for YMSM. Because of perceived anonymity and the emergence of safe online spaces, the internet has become a key platform for facilitating sexual networking among MSM. The internet provides a unique opportunity to engage with YMSM in Myanmar and gather epidemiological behavioral data. The goal of this survey is to generate Myanmar-specific epidemiological and behavioral data on YMSM through online channels. This data can be used to inform the design of innovative prevention and intervention strategies, as well as to advocate for evidence-based public policies. YMSM will be recruited to participate in the survey via websites, MSM-specific mobile apps, and other social media apps. The specific objectives of the survey are:
Period: January 2019 – July 2019
Donor(s): Tides Foundation, Youth Lead
Partner(s): Myanmar Youth Stars
There is an HIV crisis among young men who have sex with men (YMSM) in ASEAN, with some of the highest reported rates in Yangon and Mandalay in Myanmar. Men who have sex with men (MSM) make up 13% of all HIV cases in Myanmar, and the percentage is increasing each year. However, there is insufficient data on sexual behaviors of YMSM aged 15-24 years at regional, national, and sub-national levels, and this hampers the design of HIV prevention activities that are suited to the specific behavioral characteristics of YMSM. Traditional offline approaches to accessing YMSM networks for research purposes have been hampered by stigma. Information on syndemic conditions (e.g., homophobia, bullying, and resilience) of HIV risk behaviors, which have been shown to facilitate HIV vulnerability among MSM, have not been described for YMSM. Because of perceived anonymity and the emergence of safe online spaces, the internet has become a key platform for facilitating sexual networking among MSM. The internet provides a unique opportunity to engage with YMSM in Myanmar and gather epidemiological behavioral data. The goal of this survey is to generate Myanmar-specific epidemiological and behavioral data on YMSM through online channels. This data can be used to inform the design of innovative prevention and intervention strategies, as well as to advocate for evidence-based public policies. YMSM will be recruited to participate in the survey via websites, MSM-specific mobile apps, and other social media apps. The specific objectives of the survey are:
- To characterize HIV risk behaviors and the HIV care cascade among YMSM who use the internet and reside in Myanmar.
- To examine the association of syndemic conditions on HIV risk behaviors and HIV care cascade among young MSM.
- To adapt the Asia Internet MSM Sex Survey (AIMSS) and pilot test it among YMSM aged 15-24 years in Myanmar.
Demonstration Project on Assessment of Simplified Antiviral Treatment Strategy for Hepatitis C in Myanmar
Period: June 2017 - September 2018
Donor(s): The U. S. President's Emergency Plan for AIDS Relief (PEPFAR), USAID, EQUIP
Partner(s): Right to Care, Myanmar Liver Foundation, Boston University, University of California – Los Angeles, Ministry of Health & Sports (Myanmar)
Geographic Coverage: Yangon, Mandalay and Kachin States/Regions
Through this study, CPI built evidence for a simplified hepatitis C virus (HCV) testing and treatment care model that integrated HCV and HIV testing to improve access to care among at-risk populations, including people who inject drugs (PWID), and to enhance antiretroviral therapy (ART) initiation and adherence in HIV-HCV co-infected populations. The study evaluated the treatment outcomes and cost-effectiveness of the simplified care model. The study recruited 800 patients through community clinics and civil society groups. Patients were screened for HCV and HIV, treated with highly curative direct acting anti-HCV agents (DAAs) for 12 weeks, and followed up at 4, 8 12, and 24 weeks to measure Sustained Viral Load. In addition to assessing cure rates at 12 and 24 weeks, the study compared the cost of low-cost HCV viral assay platforms against existing standard models of care, assessed rates of ART initiation and virologic suppression of HIV-infected persons within the HCV program, and the impact of HIV co-infection in participants on the HCV treatment outcomes of sustained virologic response at 12 weeks. Results of the study will be published in 2019 to support the scaling up of routine testing to diagnose HCV infection as part of HIV services to increase access to DAAs.
Period: June 2017 - September 2018
Donor(s): The U. S. President's Emergency Plan for AIDS Relief (PEPFAR), USAID, EQUIP
Partner(s): Right to Care, Myanmar Liver Foundation, Boston University, University of California – Los Angeles, Ministry of Health & Sports (Myanmar)
Geographic Coverage: Yangon, Mandalay and Kachin States/Regions
Through this study, CPI built evidence for a simplified hepatitis C virus (HCV) testing and treatment care model that integrated HCV and HIV testing to improve access to care among at-risk populations, including people who inject drugs (PWID), and to enhance antiretroviral therapy (ART) initiation and adherence in HIV-HCV co-infected populations. The study evaluated the treatment outcomes and cost-effectiveness of the simplified care model. The study recruited 800 patients through community clinics and civil society groups. Patients were screened for HCV and HIV, treated with highly curative direct acting anti-HCV agents (DAAs) for 12 weeks, and followed up at 4, 8 12, and 24 weeks to measure Sustained Viral Load. In addition to assessing cure rates at 12 and 24 weeks, the study compared the cost of low-cost HCV viral assay platforms against existing standard models of care, assessed rates of ART initiation and virologic suppression of HIV-infected persons within the HCV program, and the impact of HIV co-infection in participants on the HCV treatment outcomes of sustained virologic response at 12 weeks. Results of the study will be published in 2019 to support the scaling up of routine testing to diagnose HCV infection as part of HIV services to increase access to DAAs.
Health Systems Situation Analysis for Six Ethnic Health Organizations and Community-Based Organizations
Period: October 2017 – June 2018
Donor(s): Three Millennium Development Goal Fund (3MDG)
Partner(s): Civil Health & Development Network, Kachin Baptist Convention, Karen Department of Health & Welfare, Mon National Health Committee, Pa-Oh Health Working Committee, Shan State Development Foundation
Geographic Coverage: Kachin, Kayah, Kayin, Mon and Shan States
In 2018, CPI started new phase of a long-term process of strengthening ethnic and community-based health organizations (ECBHOs) to develop, lead and manage health services with particular focus on the implementation of the Essential Package of Health Services (EPHS) and the wider components of the National Health Plan. The goal of this research project was to define service availability and ECBHO readiness for implementation of universal health coverage (UHC) by 2021. CPI conducted assessments with six ECBHOs in five states and regions of Myanmar, using a systems approach to planning, financing, and health service provision to ensure integrated, high-quality, and universally available health care. CPI worked with partners to conduct 84 facility assessments according to WHO guidelines, 12 focus group discussions with community members, and a series of key informant interviews with ECBHO leaders. CPI collected outcome indicators on “tracer” health service indicators, which are used globally to reflect the adequacy of coverage of a given health system because they represent primary health services from which all individuals should benefit. After concluding the assessments, CPI used an inclusive, participatory, and evidence-based approach to co-create Plans of Action with each ECBHO to strengthen their health system and increase their likelihood of success of moving towards UHC.
Period: October 2017 – June 2018
Donor(s): Three Millennium Development Goal Fund (3MDG)
Partner(s): Civil Health & Development Network, Kachin Baptist Convention, Karen Department of Health & Welfare, Mon National Health Committee, Pa-Oh Health Working Committee, Shan State Development Foundation
Geographic Coverage: Kachin, Kayah, Kayin, Mon and Shan States
In 2018, CPI started new phase of a long-term process of strengthening ethnic and community-based health organizations (ECBHOs) to develop, lead and manage health services with particular focus on the implementation of the Essential Package of Health Services (EPHS) and the wider components of the National Health Plan. The goal of this research project was to define service availability and ECBHO readiness for implementation of universal health coverage (UHC) by 2021. CPI conducted assessments with six ECBHOs in five states and regions of Myanmar, using a systems approach to planning, financing, and health service provision to ensure integrated, high-quality, and universally available health care. CPI worked with partners to conduct 84 facility assessments according to WHO guidelines, 12 focus group discussions with community members, and a series of key informant interviews with ECBHO leaders. CPI collected outcome indicators on “tracer” health service indicators, which are used globally to reflect the adequacy of coverage of a given health system because they represent primary health services from which all individuals should benefit. After concluding the assessments, CPI used an inclusive, participatory, and evidence-based approach to co-create Plans of Action with each ECBHO to strengthen their health system and increase their likelihood of success of moving towards UHC.
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