It was compiled by Matt Boxhall, Anooj Pattnaik and Nirmala Ravisankar, working on strategic markets for primary health care in Thinkwell. In this blog they revise family planning (FP) in Universal Health Coverage (UHC) programs and argue that the first question we need to ask is “will they reach those in the most in need?”
The World Community FP recently gathered with the banner “UHC: No without fp. “A virtual plenary of the International Family Planning Conference seemed to” show why the FP’s integration into UHC is essential for its success “.[1] In many countries-including sub-Saharan Africa-these plans are based on the escalation of National Health Insurance (NHI), promises a defined package of benefits to contributors. A lot of energy has been spent to ensure that FP services are included (and clearly defined) in these benefits. It has not been spent enough to ask who gets these benefits.
Before fighting for the inclusion of FP in benefit packages, we must ask if women and girls who need more high quality FP services are going to benefit from these “insurance -based UHC systems”. Unfortunately, if we look at sub -Saharan Africa, the answer to this question is a loud “no”. Only four countries in the region cover more than 20% of their population, although any kind of health insurance and which coverage remains extremely unfair[2]. In order for UHC corners to be that it must be, we must look beyond the rhetoric of “UHC systems” and find the most effective ways of financing services to reach those in the most in need.
To understand why the so -called UHC programs are not always the correct answer for FP, it is useful to reflect on the motives behind the programs. To ensure that everyone receives health services needed without financial difficulties, UHC requires concentration and redistribution of capital to those in need and so Health funding reform is UHC’s basic driving force. Governments in most low and medium -income countries operate traditionally National Health Servicewhere a government department generally has revenue through budgets based on inflows on a network of government health facilities to cover staff, medicines and operating expenses. Most also have “vertical” or special illness programs (including FP), which channels of goods and other supplies to providers. These purchase arrangements still represent the majority of government -based government spending on sub -Saharan Africa.
The challenges of the traditional approach to national health – including mismanagement, limited accountability and low productivity in the provision of services – are well known. To meet these challenges, region countries are introducing new market or payment arrangements, which are often referred to as “UHC systems” as they are wrapped in broader reforms related to the goal of achieving UHC. These systems usually lay in relation to traditional government funding.
The popup “UHC designs” in Africa are largely based on health insurance models. While there are Multiple reasons For this reason, a crucial guide that drives African governments to choose insurance approaches is simply the desire to create more domestic resources for health. Premiums seem to offer promise for additional funding for the sector (although in fact they are unlikely to succeed in extremely informal economies). A National Insurance Service may also appear an attractive way to create more flexible funds, which can be intended for health, other than the budget cycle, and may not be subject to all public management management requirements. And of course, political reasons are also important, both in terms of the attractiveness of offering health insurance voters and NHI’s concentration with the UHC world movement.
Thus, the “UHC systems” based on health insurance are multiplied. To one 2017 criticism14 of 32 countries across the sub -Saharan of Africa either had or developed some form of NHI, and others have since begun. These programs often record officials in the official sector, and many are also trying to enroll to the poor through the government’s subsidy. This follows the model of the Philippines or Indonesia, for example, where about half of the population benefits from subsidized members in NHI programs. However, if the justification for the system is to raise additional health funds and existing health budgets are “locked” for salaries, goods and other inputs, these subsidy efforts have quick problems. Kenya, for example, tried to subsidize the property Health Insurance Subdivision Program) again this year by investing in general revenue through the latest UHC initiative. But this new “UHC plan” is far from universal – target 1 million households (3.9 million people) in 2021, in a country where about 18 million people live below the national poverty line. While the government has declared an ambition to gradually expand the population cover, this is a costly proposal that will test Kenya’s fiscal capacity and will surely take time.
In summary, we find that throughout the sub -Saharan Africa, the budding NHI designs do not currently cover the poor. Seeking to deliver FP services through these programs will not only reach those who are in greater need, but because most beneficiaries are relatively good, this approach could undermine the legality of government funds to FP. There is even the risk that governments consider FP covered by NHI and reduce commitments through other, better targeted channels.
So, is there an alternative way to think about this? When it comes to targeting very specific population groups with services, it may be that input -based budgets and vertical programs are still the most effective mechanisms. However, this is not an argument for the status quo – we recognize that the health services funded in this way had limited success in the area. The impulse to be removed from bequests, where the channels of budget channels based on historical prior and independent performance is indeed desirable. World Health Organization defines the market as’strategic“When decisions on the distribution of funds are based on information on providers’ behavior and population health needs to maximize the objectives of the health system. It is not necessary to limit the market to registered members of an NHI to win the advantages of the most strategic market. Health authorities can still improve access, equality and quality by making smart decisions on what to buy, who will buy from (including private providers) and their payment method. Successful plans, such as Nacer plan In Argentina, which began focusing on a package of close benefits of the most important and cost -effective services, funded by government revenue and explicitly encouraging the recruitment and quality of services. THE Linda mama The Maternity System, which manages NHIF in Kenya, is in line with public and private providers to provide free global access to mothers, newborns and children’s health services and provides immediate coverage for all women. THE Regime Burkina Faso does the same – a specified service package for all is provided and the affiliated facilities are refunded based on the services they provide, including, from July 2020, family planning.
Finding the best approach for payment for FP services requires careful thinking in any context. Uhc, #Notwithoutfpabsolutely! But uhc is global Health coverage, not health coverage for some officials in the official sector recorded in a NHI system (and the small fraction of the poor whose coverage governments are able to subsidize). As a FP community, we know how critical it is to improve access to high quality FP and sexual and reproductive health services for marginalized women and girls and therefore we need to focus our efforts on shopping mechanisms that best suits those who need it. The NHI in which only members have the opportunity to benefit is unlikely to be this mechanism in low -income countries with extremely informal working markets. Finding the best solutions means collaborating with health funding experts and diving deep to understand what is practical in the local context. Together, we have to think carefully about the best way to direct our defense and technical support and not be trapped in thinking that the latest UHC project will deliver FP for those who are most interested in us.
[1] We use the word “plan” here, as it is used in sharing to mean a government program, which is different from the definition of health financing systems in the health account system.
[2] Edwine Barasa, Jacob Kazungu, Peter Nguhiu and Nirmala Ravisankar. Looking at the level and inequality in health insurance coverage in 36 sub -pacqu (unpublished manuscript).
Keep in mind that blog posts are not evaluated and do not necessarily reflect SRHM’s views as an organization.
