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Published Date: 
Wednesday, March 27, 2019


Upcoming ICFP virtual dialogue on FP, UHC, & COVID-19

Looking forward to joining the two-day virtual dialogue on family planning, universal health care, & COVID-19 that ICFP is hosting on February 2-3, 2021! You can find more information and register here, to learn more and share successes about keeping FP financing a priority. ICFP’s UHC resource page can be found here. Additional background information about UHC and FP can be found here.

Financing continued access to affordable, quality modern FP services during COVID-19

The COVID-19 pandemic has affected access to and use of essential health services globally, and modern family planning (FP) is among these. Reasons include community lockdowns and stay-at-home orders which prevent access to a client's preferred provider, self-protection and avoidance of travel, and closed healthcare facilities. The magnitude of this effect on use of modern FP services is not known, but several estimates have been made of what reductions in use could mean. One study by the Guttmacher Institute (found here) suggests that if use of short and long-acting reversible contraception dropped in lower middle-income countries (LMIC) by 10%, then this would mean 49 million women would face unmet need for modern FP and there would be an additional 15 million unintended pregnancies in 2020.


This is significant because progress made from 2012 to mid-2019 in the 69 FP2020 countries was an additional 53 million users. This is towards the goal of a 120 million additional users of modern FP by 2020. Therefore, it seems that even with the conservative estimates of a reduction in low- and lower-middle income countries like the one made by Guttmacher, the gains of the last 7-8 years could be substantially undone. The true scale of the reduction in access to and use of modern FP services is currently not known - it could be more than 10%. What happens in a specific health system will depend on the size of the COVID-19 epidemic, the policy measures taken to control spread and mitigate the impact, and the responses of providers and individuals to the ongoing situation where it comes to avoiding risk to themselves and to others.


However, access to high-quality, preferred methods is necessary for a lot of users to continue spacing or limiting births, and it is essential that health systems provide options while COVID-19 continues to pose challenges. The Guttmacher Institute study made several recommendations, to which I add here.


1. Modern FP and reproductive health services should be considered essential services if they are not already for the health system in question, and this will mean providing options to access services and contraceptives, as well as provision of travel passes, where it is safe to do so, for clients to get to providers in their community.


2. Strengthening supply chains and finding new/alternative suppliers so that commodities are in stock at decentralized locations closer to communities and at more diverse providers than before, to reduce need to travel and be exposed to risk. This means engaging the private sector and introducing additional products to providers who may not have previously offered them. This may mean public-private partnerships and financing mechanisms to expand affordable access to contraceptives to a wider range of outlets.


3. Reduce barriers to get contraceptives, such as easing prescription requirements for contraception in systems where this is a feature, and using additional delivery mechanisms to get short-acting and hormonal contraceptives to users alongside telemedicine for counseling and client support. Contraceptives can be delivered, with multi-month stock, using courier and postal services, where possible.


COVID-19 is posing other, more systemic challenges to the financing of affordable access at scale for modern FP, including reduction of the fiscal space for government budget-funded provision of primary healthcare, commodity procurements, and payment of health providers. The most vulnerable in society, as well as those in proximate socioeconomic groups, are threatened with livelihood loss and closure of providers and outlets where they could receive affordable services and products. Adolescents and younger women, unmarried women in certain cultural contexts, and the poor and marginalized, who already faced challenges in meeting their need for FP, are probably more severely impacted now with the overall reduction in choices imposed by the pandemic. It's important that the need to finance continuous access to modern FP is not obscured in the current push to scale other healthcare services and responses - which are also important. It's also important that health systems put in place resilient systems that allow users themselves to find innovative solutions and to adapt to the conditions which may not ease soon.


I look forward to hearing more from other users of the FP Financing Roadmap CoP community on how your healthcare system contexts are coping with COVID-19 and how you think we can continue to make affordable and quality modern FP services available to all.


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Good points. Unfortunately this recent study from Population Council focusing on Rahim Yar Khan, Punjab in Pakistan noted “women reported significant disruptions in reproductive health and family planning services, which has led to increased reliance on less effective traditional methods of contraception.” Financial constraints and a lack of community health worker visits were cited as the main reasons.


I’ll mention just a few other resources on this topic in addition to what Arin shared. The Reproductive Health Supplies Coalition noted financing-related (and other) "asks" for governments, donors, and the private sector -- including for governments to:


“- Allow re-allocation of funding and swift disbursement towards the redistribution of supplies across all levels of the supply chain and at health facilities to prevent stockouts with the surpluses already at hand.


- Allocate additional resources to expedite customs clearance to get essential RH supplies into the central warehouses and distributed rapidly as they arrive at port.


- Ensure that adequate funding is provided for alternative transportation mechanisms when freight options are limited.


- Extend humanitarian tax exemptions to RH supplies in all settings while the emergency for the pandemic last.”


This GHSP article shares additional useful points (not as financing oriented), including the enhanced need to:


“- Train for and offer self-injection of Sayana Press (DMPA-SC), where available, for women desiring injectable contraception.


- Where possible, initiate or continue counseling and access to immediate postpartum contraception before hospital discharge, particularly as access to postpartum visits becomes limited.”


Resources to explore are plentiful, some of which can be found via FP2020's hub of COVID-19 information here and Knowledge Success's here.

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Charlotte S.
Sarah R.
Sarah S.

HP+ is developing a framework for countries to use to identify laws, policies and regulations that enable or inhibit the integration of family planning into UHC. We've been looking at national level laws, policies and regulations that affect how family planning services are purchased, how family planning services are provided and how people access family planning. What are some of the major legal or regulatory barriers that you've found are most inhibiting to financing family planning and including it in UHC-oriented schemes?

The framework and corresponding checklist Elise mentioned previously are complete! You can find the finalized guide here: http://www.healthpolicyplus.com/pubs.cfm?get=17403 Many countries are now embarking on health sector reforms aimed at achieving UHC. In the Philippines for example, the new UHC Bill was signed into law in March 2019, with the corresponding implementing rules and regulations released this past October. The law targets the roles and responsibilities of key actors including DOH and PhilHealth, which will in time influence the way family planning services are funded and delivered. The intention is that the framework and guide aim to support countries such the Philippines, who are pursuing these health sector reforms and/or scale-up of health financing schemes aimed at achieving UHC in such a way that changes to the health financing arrangements also benefit universal access to high-quality family planning services.


What other countries undergoing similar health sector reforms? How are these countries integrating family planning into these UHC related reforms?

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Andrew Carlson
Pascal Saint-Firmin

The Senegalese Universal Health Coverage Agency (ACMU, in French) included family planning services in its Essential Benefits Package (PMA) recommended to mutuelles to offer in mutuelles’ community-based health benefits packages. Because mutuelles operate independently from the ACMU, the ACMU cannot mandate that mutuelles offer services in the PMA, including family planning. With support from Health Policy Plus (HP+), the Senegalese government identified health facilities affiliated with mutuelles but which do not accept insurance cards for FP services or which limit patients to a fixed number of insurance card uses per month, which in turn discourages enrollees from using their insurance cards on FP as FP is cheaper than most covered services. The legal, regulatory, and policy framework mentioned above would be highly useful for the Senegalese government to leverage its existing PMA document and explore other policy solutions geared to remove barriers to health insurance enrollees’ access to FP services.


My colleagues and I will be facilitating an upcoming discussion in French on this topic as well as other forms of FP integration into UHC-oriented schemes – stay tuned for more details!

Here is the invitation to the French-language meeting Andrew mentioned that FP2020 and HP+ are hosting on July 9. French speakers who are interested are welcome to participate.

Thank you to everyone who participated in the lively French-language discussion on integrating FP into UHC and health insurance schemes. 


Highlights included meeting participants sharing about determining which FP methods to select for inclusion in health insurance, and discussing regulatory issues, the importance of demand generation at the community level, and arguments to make to decision makers about including FP in health insurance.


The recording, presentations, and a FAQ document (all in French) can be found here.

HP+ conducted an analysis to determine the extent to which family planning goals and priority interventions were aligned across Costed Implementation Plans (CIPs) and Global Financing Facility (GFF) - supported RMNCAH-N investment cases. The results indicate that there has been relatively strong alignment of family planning goals and priorities and that FP stakeholders and GFF stakeholders are often in close communication during the development process. We did find that family planning policy, M&E and financing is more rarely included in investment cases and that while commodities are included in the budget, they are not always mentioned in the text of the investment case document. We will be publishing the report soon which also provides recommendations, particularly for new GFF countries, for aligning FP goals and priorities during the development of these strategic documents. We are also planning a webinar for May 30th, stay tuned!

You can find the finalized report with recommendations for how to align FP priorities across CIPs and GFF investment cases here: http://www.healthpolicyplus.com/pubs.cfm?get=13333-13610