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Webinar Reading Time: 7 minutes

UHC Demand: Getting it Right to Ensure We #LeaveNoOneBehind

Third and final part of the UHC webinar series

Knowledge SUCCESS, FP2030, Population Action International (PAI), and Management Sciences for Health (MSH) partnered on a three-part collaborative dialogue series on universal health coverage (UHC) and family planning. Our third conversation focused on achieving UHC through people-centered reforms. Recaps of Part 1 (Theory Vs. Reality in UHC and Family Planning) and Part 2 (UHC and Family Planning Financing Schemes: Innovations and Integrations) are also published.

On October 18th, Knowledge SUCCESS, FP2030, Population Action International (PAI), and Management Sciences for Health (MSH) hosted the final of three conversations on universal health coverage (UHC) and family planning (FP). The series engages participants and speakers to inform a position paper on this timely issue, to be shared later this year.

The third 90-minute dialogue featured:

  • Moderator: Amy Boldosser-Boesch, Senior Director & Practice Area Lead for Health Policy, Advocacy & Engagement, and Integrated Health Care, Management Sciences for Health (MSH) Secretariat, Civil Society Engagement Mechanism (CSEM), UHC2030
  • Dr. Nuzrath Narsodeen, Deputy Director, Family Planning Association of Sri Lanka and Representative SRHR and Gender Alliance on UHC
  • Prof. Rizal M. Damanik, Deputy for Training, Research, and Development of the National Population and Family Planning Board of the Republic of Indonesia (BKKBN)
  • Adebiyi Adesina, Director of Health Financing and Systems Strengthening, PAI

Full Summary:
Below, we’ve included a comprehensive recap that links to exact segments within the full recordings (available in English or French).

Amy Boldosser-Boesch: Policy design and implementation of family planning and UHC with the goal of leaving no one behind

Watch: 6:24

Amy Boldosser-Boesch framed the conversation by emphasizing the importance of leveraging community engagement from civil services organizations and government health ministries to integrate family planning into UHC policy design and implementation.

To read the recap of the two previous conversations in the series, check out Part One and Part Two.

Objectives of the third dialogue:

  1. Explore examples of engaging communities to integrate family planning (FP) into UHC.
  2. Discuss and ensure inclusive access to services, centering norm shifting and a gender-transformative lens.
  3. Share lessons on how to expand FP access as a component of UHC to ensure we are leaving no one behind and reaching the furthest behind first.

Question 1 (for Dr. Nuzrath Narsodeen and Prof. Rizal M. Damanik): Can you reflect on the importance of emphasizing family planning and sexual and reproductive health when we talk about universal human rights and achieving universal access?

Watch: 11:39

Dr. Nuzrath Narsodeen spoke about the importance of including FP to achieve gender equality, improve sexual and reproductive health (SRH), and reach UHC. These ideas have been codified in the U.N. political declaration on UHC in 2019, which includes family planning services as an essential element of UHC.

Watch: 15:00

Prof. Rizal M. Damanik elaborated on actions the Indonesian government has taken to reduce maternal mortality, infant mortality, and other health issues included in UHC. For example, in 2018, FP services were included in Indonesia’s national health insurance (known as JKN) financing scheme (Traditional Regulation 82/2018). He also referred to the impact of Indonesia’s Presidential Regulation Number 18, which laid out a national medium-term development plan that, among other areas, supports the provision of family planning and reproductive health.

Question 2 (for Dr. Narsodeen): Please talk about your work ensuring that all communities receive high-quality health services, even when experiencing financial hardships. Who decides what services are needed?

Watch: 22:30

Dr. Narsodeen reiterated that in order to achieve UHC, it is critical to take into account the diverse needs of all communities. Oftentimes, this means that gaps are based on ethnicity, financial status, sexual orientation, or marital status. For instance, in Sri Lanka, FP service gaps have been found in highly industrial areas and in places where tea estate workers congregate. As a result, her organization has opened SRH clinics in these neglected regions.

Follow-Up Question (for Dr. Narsodeen): Is there engagement between the marginalized communities you are serving and government officials who are shaping what is available in public health facilities?

Watch: 29:33

Dr. Narsodeen described how her organization works to complement government services with its own clinic offerings when there are coverage gaps in remote communities.

Question 3 (for Prof. Damanik): How do we make health systems and services more people-centered in alignment with UHC values?

Watch: 31:34

Prof. Damanik described Indonesia’s actions to achieve UHC, including the financing scheme that has implemented SRH in all levels of the healthcare system. He also described the importance of engaging with all levels of government to ensure UHC values are achieved. For instance, a law passed in 2014 mandated that certain healthcare facilities provide free contraceptive supplies to all couples of reproductive age.

Question 4 (for Adebiyi Adesina): How can we get adolescents and youth involved in UHC?

Watch: 46:09

Adebiyi Adesina said one of FP2020’s key lessons was the importance of youth participation. There are now youth FP2030 Focal Points in each country and at the global level. However, organizations must continue to offer financial resources and development opportunities to adolescents.

Question 5 (for Prof. Damanik): How does the government ensure that comprehensive SRHR services are available during disaster responses? Is there any kind of commitment from the government for disaster response planning?

Watch: 51:44

Prof. Damanik highlighted that the National Population and Family Planning Board of the Republic of Indonesia (BKKBN) has long been concerned about providing family planning resources to disaster victims, such as those impacted by the 2004 tsunami. To do so, the government sends health workers to refugee centers to provide SRHR services. BKKBN also has a directorate that focuses on handling FP services specifically in underdeveloped, remote areas, including disaster-affected areas, and a resource guide exists for SRHR service delivery in these regions.

Question 6 (for Dr. Narsodeen): Do you see market segmentation in the private sector, with the commercial private sector addressing economically advantaged segments and the Family Planning Association of Sri Lanka addressing those that are left out? To what extent is there an overlap between these sectors?

Watch: 53:55

Dr. Narsodeen explained that the Family Planning Association (FPA) of Sri Lanka is committed to providing services to those who may be left behind. Through a social marketing program, the association has been able to receive subsidized commodities from suppliers. This unique pricing model creates sustainable financing mechanisms for contraceptives, making reproductive health services more affordable. FPA also has several policies to increase access for those who cannot afford private-sector services but do not qualify for free/subsidized government services.. These include a non-refusal policy, opportunities for subsidized fees, and free outreach service.

Question 7 (to all panelists): For youth who are on their parents’ insurance and thus may not have access to care, are we seeing a movement to include comprehensive sexual and reproductive health education in UHC or in a multi-sectoral effort?

Watch: 57:00

Mr. Adesina discussed a key piece of PAI’s work: ensuring that FP services and comprehensive SRH programs, including programs for youth, are included as part of UHC benefits packages. He highlighted the many countries working to reform the definition of comprehensive SRH services, ensure that clients are aware of the benefits available to them, and create a level of privacy for youth services.

Dr. Narsodeen added that in Sri Lanka, while FPA does offer youth-friendly services, accessing these services is a challenge due to cultural barriers and taboos. However, a new hotline service through FPA, the Happy Life Call Center, aims to provide confidential information to youth and expand information and access to SRH services for youth populations.

Question 8 (for all panelists): Given the current trends in migration and displacement, how do we ensure access to these populations on the move, including young people?

Watch: 1:03:37

Mr. Adesina acknowledged the challenge that exists in generating government funding for SRH resources during times of conflict. He also emphasized that the COVID-19 pandemic has left many governments in an economic downturn, further complicating the issue. However, one strategy is to ask the international community for funding and mechanisms to deliver resources.

Prof. Damanik highlighted a successful government program in Indonesia that aims to bring information to youth populations experiencing displacement. This program ensures that youth receive family planning information in advance of getting married.

Question 9 (for Dr. Narsodeen): Are there any specific programs or success stories from Sri Lanka on increasing access for marginalized groups such as LGBTQ+ people, people living with HIV, and those with disabilities?

Watch: 1:11:33

Dr. Narsodeen highlighted that FPA’s involvement with the Global Fund has made their clinics well equipped to care for HIV patients. For those with disabilities, FPA started a new program during the COVID-19 pandemic that allows for home delivery and home visits as well as community-based distribution of resources. FPA hopes to incorporate more screenings, as well as sign language interpretation, into future programs.

Question 10 (for Prof. Damanik): Could you touch on the sustainability efforts for family planning and SRHR in UHC?

Watch: 1:14:54

Prof. Damanik shared that the government of Indonesia allocates the budget for contraceptives at the district level through collaboration with the Badan Penyelenggara Jaminan Sosial (Social Insurance Administration Organization), health professionals, and healthcare organizations to ensure that family planning services are covered. The government currently has guaranteed FP continuity by including these services in the government’s long-term budget development plan.

Question 11 (for all panelists): In incorporating SRHR into UHC, have your governments run into challenges with existing laws and regulations that don’t align with human rights standards, or are there laws and regulations already in place that enable gender-transformative UHC?

Watch: 1:18:05

Mr. Adesina highlighted laws preventing comprehensive SRH education at certain levels. For example, one of the keys to ensuring access to services is through youth education in the school environment. However, certain countries prohibit SRH education in schools.

Regarding legislation and regulations in Indonesia, Prof. Damanik shared that under Indonesian law, contraceptives are only intended for married women and couples. However, the government recognizes that other groups, such as youth, may need contraceptives. In such cases, he indicated that non-governmental organizations, civil society organizations, and nonprofit groups work to address these needs.

Closing Remarks: Amy Boldosser-Boesch

To close the third and final session of the UHC Webinar Series, Ms. Boldosser-Boesch thanked the panelists for engaging in the discussion and answering the challenging questions presented to them. She thanked the organizers and interpreters for the webinar as well for their help in allowing all participants to take part in this important conversation. Finally, Ms. Boldosser-Boesch encouraged everyone on the call to continue these important discussions about SRHR and family planning in the UHC agenda and expressed her hope to see everyone at ICFP in Thailand.

Want to stay engaged?

  • Look out for the policy paper informed by these conversations to be presented later this year.
  • Become an FP2030 commitment maker: Within your government or organization, pledge to take specific actions to increase rights-based contraceptive access.

Looking to get involved in the lead-up to the next UHC UN high-level meeting?

  • Subscribe to the CSEM newsletter for updates on how to participate in the process of refining key asks for the high-level meeting.
  • Participate in the country-level consultations hosted by CSEM to contribute to UHC2030’s State of UHC Commitment Review, which monitors country commitments to UHC. Twenty country consultations will be organized in 2022; those working across different health sectors are encouraged to attend.
  • Add your perspectives to the CESM survey that will be used to inform the country profiles of the State of UHC Commitment Review.
  • Amplify and engage with UHC post-ICFP on World UHC Day in December.
A female health worker sits at a table organizing the sale of health care products as part of a community outreach program in Rwanda.
Rogan Zangari

Intern, FP2030

Rogan Zangari is an intern with the United Nations Foundation Family Planning 2030 team and is a Senior at Georgetown University majoring in Health Care Policy and Management. At Georgetown, he is the Chair of the Student Affairs Committee in the Student body Senate. Prior to interning at UNF, he interned at the White House Office of Management where he worked on Medicaid policy. As a native Seattleite, he enjoys rooting for the Seattle Seahawks, playing soccer, and taking hikes.

Elizabeth Kayzman

Intern, FP2030

Elizabeth Kayzmanis an intern at FP2030. She assists the organization with communications, administrative tasks, data projects, and partnership engagement. She is currently studying to receive her Bachelor of Science in Neuroscience and Global Health from Duke University.

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