Family Planning in Universal Health Coverage Schemes: Key findings from a review of the literature
Around 2011, the global reproductive health community became interested in ways to effectively embed family planning (FP) services in the movements to expand access to care through universal health coverage (UHC). Since then, several initiatives have been funded, projects launched, and lessons learned. Commissioned by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) on behalf of the German Federal Ministry for Economic Cooperation and Development, Impact for Health conducted a purposeful review of the published literature on the incorporation of FP into UHC agendas. This review reveals challenges to incorporating FP into UHC agendas in five categories:
People: Many schemes do not cover the people the development community cares most about including the poor, vulnerable and adolescents.
Providers: In many countries the providers where people commonly seek FP commodities and services are not included in the health financing schemes.
Payment: Provider payment mechanisms and reimbursements often act as a disincentive to quality and choice.
Package: FP is often not included in the benefit packages of emerging insurance schemes. When it is included, the package may not cover the labor and commodity costs for the full range of methods. Additionally, communication around the package is often poor, creating confusion about what is covered by different mechanisms.
Politics: Pathways towards UHC that preference coverage of preventive and promotive commodities and services (like FP) for poor and vulnerable populations first may not be politically tenable, or appropriately respond to politicians’ practical considerations.
The recent literature also highlights several key lessons including:
Financing approaches must be context specific: approaches towards integrating FP in UHC must be crafted in response to country’s FP, health financing and political contexts;
Variation in financing mechanisms by method may be required: the diversity in FP methods suggests that optimal financing mechanisms for varying methods will be, out of necessity, different;
Financing for reproductive health should take a life course approach to address key barriers to access at each stage;
Financing mechanisms are best at addressing financial barriers. Non-financial barriers still exist for FP and will need to be addressed and financed separately. Quality should be financed effectively throughout all approaches; and
A clear and compelling economic argument for governments to shift FP financing from its current supply-side approach to demand-side mechanisms has not been made.
In response to these learnings, we recommend programming by global health actors be flexible enough to respond to both countries’ maturity levels and the political windows of opportunity that arise to move a progressive UHC agenda forward. Organizations that are able to respond nimbly with financing and programming are likely to be able to capitalize on opportunities to advance the integration of FP in progressive UHC agendas in a scalable fashion.