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 series engages participants and speakers to inform a position paper on this timely issue. The paper will be shared at the International Family Planning Conference (ICFP) later this year. Our second conversation, which was held on August 23, focused on financing schemes and innovations for UHC and the integration of family planning.
The second 90-minute dialogue featured:
Closing remarks: Nabeeha Kazi Hutchins, President and CEO of PAI
Are you pressed for time? Here are the key insights from the discussion.
Amy Boldosser-Boesch framed the conversation on financing UHC and emphasized the importance of integrating family planning, which requires innovation and effort on the part of both the public and private sectors. (To read the recap of the first conversation, click here.)
Dr. Kaba highlighted the three steps Guinea is taking on the path to UHC and the integration of family planning services.
Three important steps on the path towards Guinea’s integration of FP into UHC:
Women’s empowerment and family planning awareness campaigns to generate demand and knowledge about FP services
Mr. Boxshall emphasized the difficulty of addressing sustainable resourcing for FP, and detailed three considerations to keep in mind when looking for solutions:
Mr. Boxshall emphasized that countries can only achieve UHC by examining their health systems as a whole. Regarding the second and third points, he highlighted several countries in which insurance schemes barely cover a fifth of the population. The critical problem with these types of insurance schemes is the use of premiums—that is, the price that individuals pay to the insurance company. Countries must focus on who benefits from a particular insurance scheme and whether or not only those who pay premiums can access benefits.
Dr. Bellows outlined four hazards to avoid in any innovative process:
He noted that the goal of innovation is to create universal tools that focus on delivering high-quality care at low or no cost to beneficiaries. When considering FP integration, programmers must keep the self-care approach in mind. Dr. Bellows explained that 1:1 chat-enabled marketplaces, such as Nivi, can help generate awareness and service uptake as they help connect individuals in the health system with consumers.
Elaborating on her discussion of Guinea’s path to UHC, Dr. Kaba further emphasized the importance of starting with primary healthcare. She noted the importance of using new technology to increase access and awareness in rural areas and to encourage self-care. However, the challenge is creating digital tools that can transmit information to the most isolated users in a language that is accessible to them. Tackling these barriers will require contributions from all levels of government and the community to improve access and ensure no one is left behind.
Mr. Boxshall noted that successful FP integration requires strategic purchasing. The realm of UHC is on the verge of creating a virtuous cycle where purchasing is linked to data in order to improve and optimize spending.
Strategic purchasing involves improving the way we spend money on critical services by directing funds where they are most needed based on data findings.
Mr. Boxshall highlighted several countries that offer important lessons for integrating FP into insurance schemes. Kenya uses a capitation system, in which a doctor or hospital is paid a fixed amount per patient by an insurance association, but access has not increased significantly. Other countries—for example, the Philippines and Indonesia—offer an incentive to providers who ensure a broad method mix.
Mr. Boxshall highlighted that one of the great advantages of utilizing the private sector in health insurance financing models is that insurance agencies are often better positioned to contract with providers than Ministries of Health.
Solutions to bolster trust and engagement between providers and government:
““If financing models can subsidize services supplied by private providers, then the choice and quality of services that consumers can access will increase.””
Dr. Bellows stressed the need for marketplaces that can generate a financial return as well as a social and public health impact.
Dr. Kaba emphasized that to improve contraceptive uptake among youth, access to services must first be improved. Dr. Bellows shared the success of Nivi in reaching young people where they are—online. Tools for digital counseling are finding more users each day.
Guinea’s commitment to increasing financing for family planning services: Guinea has recently included youth in its FP2030 commitment. Since 2018, 50% of FP needs have been financed by the national development budget. In order to reach the level of free service delivery, Guinea has committed to increasing the budget by 10% each year.
Dr. Kaba emphasized that in order for communities to accept services, they must be included in dialogue from the very start. Developing initiatives with input from communities is critical to understanding their needs and desires.
Mr. Boxshall described several models that address FP costs, with varying levels of efficacy:
““Pay for choice. In a more digital environment, it’s possible to ask consumers questions about how they are allowing their customers choice. Pay for the world we want, not the world we’ve got.””
Ms. Hutchins emphasized the importance of a collective mission to achieve UHC access for comprehensive sexual and reproductive health. She reiterated an important theme highlighted throughout the conversation: Prioritizing community-based engagement and innovative solutions to financing family planning services with particular consideration of those most in need. This theme is at the core of PAI’s work and its collaborations with peer civil society organizations (CSOs). Currently, PAI is working with local CSOs and youth organizations on a Universal Health Coverage Initiative, and looks forward to sharing with and hearing more from partners at the upcoming International Conference on Family Planning (ICFP).
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