Fulfilling Our Promises: Securing Financing for Future Family Planning
By Tom Fagan
If we truly want to secure access to family planning for future generations, the time to start considering how those services are going to be paid for in the long term is now. The theme of this year’s International Conference on Family Planning (ICFP), “Investing for a Lifetime of Returns,” highlights not only the range of health, social, and economic benefits of providing women and their partners with reliable and affordable access to family planning methods, but also our commitment to ensuring this access for current and future generations. Tying into this theme, youth have played a central role in this year’s conference, with more than 700 young family planning advocates participating in the largest ever youth forum. Youth leader and plenary speaker Jane Nyathi—a leading family planning advocate in Zimbabwe—emphasized the importance of access to family planning methods to empower young women everywhere to make decisions about pregnancy, schooling, and their own futures. She launched a common refrain echoed throughout the conference: “the future begins now.” However, when we talk about financing for family planning, we seem to be stuck in the past.
Many low and lower-middle income countries continue to be heavily reliant on external financing to provide family planning. In these countries, development partners directly provide or pay for the majority of—if not all—commodities, as well as for provider training, procurement/supply chain services, and demand creation activities. Many countries have made commitments to mobilize new domestic resources for family planning as part of their FP2020 goals, but, as Ms. Nyathi reminded us all, most have not fulfilled these promises. In addition to stagnant domestic financing, external funding for family planning has exhibited a sharp decline over the past few years. At the same time, there is an increasing number of modern contraceptive users globally, and growing demand. It’s clear that to maintain the current level of access to family planning information and services, we will need to find additional sources of funding.
From what I have seen and heard at the conference, financing has not yet made it to the forefront of the conversation about family planning access. The focus remains on building upon impressive progress made in expanding family planning access and uptake rather than how we sustain these gains. Strategies and investment cases for family planning, now a mainstream practice, still focus too much on what can be funded through external resources; mobilizing domestic resources seems to be an afterthought. Even those speakers focusing on the role of family planning in national, social, or community-based health insurance schemes have focused on the value of strategic purchasing in ensuring quality and choice in services and downplayed the potential to mobilize new domestic resources through these schemes. There is a pervasive myth—or misunderstanding—that because family planning is currently donor funded it is “free” and therefore not a financial priority or concern. While donor money may be today’s reality for many programmers, we are in desperate need of financing solutions for tomorrow—which is coming very quickly.
Much of the work that Health Policy Plus has presented at ICFP has focused on promoting the conversation around domestic resource mobilization and sustainable family planning financing. Our work on how to integrate family planning into new health financing schemes and the potential benefits of doing so, both to uptake and financing, has provoked much needed conversation about moving away from the external and vertically-financed family planning programs toward integrated and sustainable health financing schemes. Presenters from Ghana and Ethiopia helped to deepen our understanding of how this integration might be put into practice in a way that promotes both method choice and financial sustainability. Presenters from Cambodia, Lao People’s Democratic Republic, and Timor-Leste provided key lessons and recommendations for successful financing transitions, particularly the need for strong and uniform agreement about the need for country ownership and financing of family planning.
Developing consensus and political will is critical to further the discussion around transitioning family planning financing to sustainable, domestic sources. While it has become common knowledge among the international development community that family planning is a “best buy”—with every dollar spent generating significant returns both in short-term healthcare savings and long-term economic benefits—we have struggled to translate these estimates to greater domestic investments in family planning. We will need to double down on our advocacy efforts to ensure that governments increase their budget allocations to programs and commodities and fulfill their FP2020 promises. Doing so must be a central focus of our collective work going forward. Only with sustainable, domestic financing for family planning can we continue to ensure that it remains free and affordable and that women, particularly the young women of today and tomorrow, are able to access family planning and invest in their own futures.