Sexual and reproductive health must be at the forefront of the health agenda. Despite family planning being the most cost-effective public health and development intervention, significant challenges remain in making access to services and commodities a reality for all. 225 million women in developing countries want to avoid pregnancy but are not using modern contraceptives. Fulfilling the unmet need for family planning alone would prevent 150,000 maternal deaths and 640,000 new-born deaths globally each year.
Every dollar spent on family planning can save up to seven dollars in direct health costs according to global think tank the Copenhagen Concensus. Delivery of family planning services should be non-negotiable and included in even the most frugal universal health coverage plans. A core package of Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) services is needed to improve the health and well-being of women and girls. A failure to invest in prevention will ultimately drive the need for an even higher investment in curative care. Why put women and girls in need of curative services unnecessarily?
The Global Financing Facility (GFF), announced at the UN General Assembly in September 2014 by the World Bank Group and governments of Canada, Norway, and the US, aims to scale up support for RMNCAH as a key component of universal health coverage for all. The GFF presents real opportunities to make change happen by mobilising additional international and domestic resources for scale up of sexual and reproductive health services, as well as the prioritisation of funding for these areas at the national level.
The Sexual and Reproductive Health and Rights (SRHR) community has highlighted potential implications of the GFF for SRHR, including for family planning services and supplies. Given the breadth of sub-sectors the GFF will be funding, there is a risk that funding across RMNCAH will become competitive and funding for sexual and reproductive health may become politicised.
There is also a potential danger that donor funds may, instead of adding to global health funding, be transferred from existing programmes and there is uncertainty as to how the GFF will interact with current RMNCAH financing architecture. That is why AFP Jhpiego, IPPF and the Reproductive Health Supplies Coalition have been calling for the GFF to deliver additional investment and for there to be no gap in funding for SRHR, or interruption to supply chains for reproductive health commodities, while the GFF is operationalised. Moreover, the GFF’s current focus on low-income countries ignores the reality that many of the poorest people live in middle-income countries.
Within discussions on sexual and reproductive health, there is often an exclusive focus on maternal health. This approach ignores the sexual and reproductive health needs of all people; of adolescent girls, older women, men and transgender people. We must use the GFF architecture as an opportunity to serve the needs and protect the rights of marginalised groups. Countries’ investment cases should be agreed based on their coverage of the sexual and reproductive health and rights of marginalised groups. Time is of the essence to make sure the GFF is fit for purpose, as it will be launched at the UN’s Financing for Development conference in Addis Ababa, Ethiopia, in July.
The SRHR community has been calling for official involvement of civil society in both the design and implementation of the GFF, including in the creation of national plans and financing maps. A business planning group is rapidly developing design and implementation plans and in-country consultations in Kenya, Tanzania, Ethiopia and the Democratic Republic of Congo are underway. We wait to see how sexual and reproductive health will be prioritised in the consultations and what this will mean for increasing national financing in these areas.
The World Bank and the donor community must ensure that there is a transparent and robust system in place to monitor progress and track resources at both the national and the global levels. The GFF and the universal health coverage framework must include strong SRHR indicators to assess need and measure progress. Clear targets and indicators support accountability efforts but in what other ways will governments be held to account? Accountability goes beyond simply counting, monitoring and registration.
The GFF should support countries to achieve their commitments by helping them to strengthen their health systems holistically, to deliver a range of high-quality supplies and services with no further perpetuation of siloed programing. The GFF financing architecture therefore should not discourage any country from supporting all aspects of SRHR. Simply put, we must invest in SHRH. We cannot afford not to.
by Angeline Mutunga Regional Programme Advisor, AFP Jhpeigo Kenya, and Preethi Sundaram, International Planned Parenthood Federation with additional input from Halima Sharif, Country Director, Advance Family Planning Tanzania