Knowledge SUCCESS, FP2030, Population Action International (PAI), and Management Sciences for Health (MSH) have partnered on a three-part collaborative dialogue series on universal health coverage (UHC) and family planning. The first 90-minute dialogue explored high-level UHC commitments and specific UHC policies in several different contexts.
On June 28, Knowledge SUCCESS, FP2030, Population Action International (PAI), and Management Sciences for Health (MSH) hosted the first in a three-part collaborative dialogue series on universal health coverage (UHC) and family planning. The series engages participants and invited speakers in dialogues to inform a position paper on UHC and family planning. The paper will be shared at the International Family Planning Conference (ICFP) later this year.
The first 90-minute dialogue featured:
Speakers explored lessons learned and best practices, moving from high-level UHC commitments into specific UHC policies in several different contexts.
Are you pressed for time? These are the top insights from the dialogue.
Amy Boldosser-Boesch: Framing family planning within the history of international UHC conversations and policies
Ms. Boldosser-Boesch set the tone for the dialogue series with an overview of how the UHC policy discussion has evolved globally and where family planning fits in. She introduced and defined the concepts of UHC and family planning.
In 2019, the United Nations hosted the first UN meeting on UHC. World leaders set an ambitious and comprehensive declaration on UHC, and the agenda continues to be implemented and localized across various countries in different ways. Below is an overview of the upcoming 2023 UN High-Level Meeting (HLM) on UHC Provisional timeline that will be used to prepare countries and the UN General Assembly to host another high-level meeting on UHC.
What are the key lessons learned from your role supporting civil society in shaping policymaking on UHC and family planning at the national and sub-national level?
Mr. Adebiyi Adesina responded to this question by mentioning the Bill & Melinda Gates Foundation-funded UHC Engage project. PAI launched this project in 2019 with civil society partners in Burkina Faso, Ghana, Kenya, Nigeria, Uganda, and Zambia to ensure the inclusion and sustainability of family planning in UHC.
Three main lessons learned from this work:
Civil society partners in the UHC Engage project used the SMART advocacy framework to understand their contexts, create key short-term and long-term goals, and map out UHC decision-makers to compose their policy audience and engage them accordingly.
Civil society partners in the six countries created broad coalitions. They first engaged key governmental agencies that are fundamental to UHC then brought in stakeholders from non-governmental organizations (NGOs), professional groups, the private sector, and other CSOs from key demographics including youth-led groups. Coalitions evolved into technical working groups and advisory groups to shape the fundamental aspects of a country’s UHC policy proposal.
Partners worked with experts to implement an evidence-based approach (the learning forums mentioned earlier) to transition policy discussion into formal policy planning platforms. This approach to develop policy proposals reinforced the credibility of the advocacy.
“I like to use the analogy of a marathon relay race to this process for getting to UHC. A committed relay team will be built on people with the ability for speed and endurance, and in that same sense achieving the goal of UHC will need advocacy to get the runners up and going and as well as accountability to keep runners on track. Who better exemplifies these qualities than CSOs?”
What are the gaps and opportunities for integrating family planning in UHC during the design of UHC policies in your country and context?
Poonam Muttreja outlined several challenges and opportunities for UHC in India’s primary health system. UHC is not just about ensuring access to services, but it also includes empowerment and choice to address unmet need for family planning. Strengthening the entire health system is critical.
Specific gaps and opportunities include:
A lack of understanding of the social determinants of health, especially among political leaders, policymakers, and health functionaries and providers.
Funding allocations that impact family planning services and access. Investing in health education and behavior change, communication to promote self-care, individual, and community capacities is important. Investing in expanding choice, especially for long-acting modern methods, continues to represent a large gap given the large number of young people and people of reproductive age in the country.
Having a robust data management system that supports evidence-based learning for family planning and programing is essential to achieving UHC.
Lack of community awareness of services, their entitlements, and rights to access care.
Family planning is not just a women’s issue—it is a men’s issue, and it is a societal issue.
As in many contexts around the world, misinformation is easily shared through digital platforms. Provider and community biases can impact people’s awareness and access to services.
Population Foundation is leading the charge to advocate against these policies and advocate for a rights-based approach.
“We must accept that we cannot solve a problem if we cannot understand it.”
Could you give us three entry points and practical examples on integrating or creating a dedicated focus on family planning in UHC policy design?
Dr. Gifty Addico shared that in UNFPA’s experience working with partners in-country, three entry points come up:
It’s important we have disaggregated and accurate data to provide investor health coverage. UNFPA and Avenir Health have built a family planning opportunity database for priority-setting and advocacy. UNFPA also has a Population Data Portal that can inform program design for UHC by providing open-access data.
Building capacity and encouraging task-shifting policies are important. UNFPA is working in over 30+ countries with community health workers who provide DMPA-SC injections. People such as community health workers are a vital part of the health workforce that can offer family planning services. UNFPA has worked with in-country partners to build the capacity of midwives. Over 90 midwifery schools have been trained at providing long-acting reversible contraceptives.
UHC can be implemented through the government, but there are other approaches like insurance vouchers and total market approaches. Ghana has successfully integrated family planning commodities into the national health insurance thanks to strong advocacy efforts from all partners. Ghana’s stakeholders and UNFPA learned that while there may be an initial cost to including family planning in national health insurance plans, citizens can feel the benefits via maternal health savings and improved health outcomes for mothers and infants. In Uganda, UNFPA and Marie Stopes Uganda used vouchers to implement family planning services. The partnership worked through village health teams in regions with high unmet family planning needs.
“Resource sourcing requires knowing what resources we need, where they are needed, for whom, and when.”
Most of the time, the full spectrum of family planning methods are not included in a benefits package of a social health insurance scheme, for example. How can we ensure the inclusion of FP from the outset?
Mr. Adesina mentioned Marie Stopes Ghana’s generating evidence for financing family planning. This included showing how availability of a range of methods contributed to family planning access overall. In addition, advocacy messages can help communicate the evidence about the impact of comprehensive family planning services on access and affordability.
Are there any high-impact practices to get voluntary family planning to marginalized communities? Are we using the right approach to engage those who are most vulnerable (such as those with disabilities) in accessing family planning?
Ms. Muttreja provided the example of the Indian government program MPV, which was launched five years ago in 140 districts. These locales had the highest fertility rates, high levels of gender inequality, and other poor indicators. Ms. Muttreja characterized the initiative as an effective and comprehensive UHC approach to family planning. Population Fund of India has also developed a soap opera to address social norms and behavior change. The program included a significant focus on family planning, among other topics.
What can we learn from the UNFPA investment studies?
To answer this question, Ms. Boldosser-Boesch invited Dr. Addico’s colleague, Howard Freidman, to respond. Investing in family planning is not only a human rights issue, but it makes good economic sense. UNFPA has partnered with different groups in-country to develop a tool to identify costs, impacts, and benefits of scaling up family planning services.
Related to supply-side investments around providers and commodities, are there experiences in how parallel support was provided in both the demand and supply side to ensure there are family planning providers who meet minimum quality standards where people can access insurance coverage?
Mr. Friedman shared that UNFPA has worked with countries to understand data around service delivery locations and population accessibility. Sometimes reducing the number of facilities in a given area can actually help improve services and logistics because there are fewer facilities that aren’t being used.
Ms. Muttreja added that in India and other parts of Africa, there is a supply-side failure that really needs to be fixed. She sees this as a management failure; it’s something that governments should bring in professional help to deal with.
Mr. Adesina provided a CSO perspective from PAI’s work with CSO partners in India working at the local level to ensure that gaps are identified, elevated, and addressed. He sees the position of CSOs as perfect examples of how demand and supply sides can come together.
Closing Remarks: Dr. Samukeliso Dube, Executive Director, FP2030
Dr. Dube provided closing remarks. He emphasized the economic benefits of family planning in UHC and the rights-based aspects of providing family planning. FP2030 offers a unique mechanism to advance the dialogue around UHC and family planning and hold the FP/RH community accountable for these goals. The partnership is working on spawning conversations through this UHC dialogue series and partner meetings. She encouraged participants to consider FP2030 commitments as ways for countries to develop their goals and strategies for UHC and family planning implementation and accountability.
“Family planning is essential in achieving universal health coverage … In my mind, I call it “effective coverage”… because universal health coverage where we are including effective family planning then becomes effective universal health coverage … Universal health coverage provides financial protection [for family planning].”
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