Domestic Resource Mobilization: Connecting the Priorities of Sexual and Reproductive Health and Rights and Universal Health Coverage

At this week’s third annual UHC Financing Forum, over 30 country delegations from Ministries of Health and Finance in low- and lower-middle income countries, as well as other key decision-makers, will gather and explore how to create an equitable financing system for the health sector. The goal? Achieving universal health coverage (UHC). Domestic resource mobilization (DRM) will be the primary financing model for UHC. The forum will focus on various aspects of the core health financing components—revenue generation, pooling and purchasing—with an emphasis on domestic resources.

DRM is also a core priority of Family Planning 2020, the Global Financing Facility, and the broader sexual and reproductive health and rights (SRHR) community. Domestic resources for sexual and reproductive health (SRH), including family planning (FP), are urgently needed to fulfill unmet need for contraception, secure universal access and meet global targets. Currently, the majority of FP services are financed by donors and women and girls themselves (through out-of-pocket payments). With the volatile donor climate, prohibitive out-of-pocket payment barriers and overall funding gaps, governments must devise health financing systems grounded in DRM to ensure sustainable investment in women’s and girls’ access to SRH and other health services.

The SRH community should take note of forum deliberations because DRM efforts for family planning are shaped by and embedded in the broader context of efforts to finance the entire health system. Additionally, this group of decision-makers and their discussions at the forum will guide DRM conversations at the country level. Most importantly, these financing discussions affect women’s and girls’ access to FP and broader SRH services. These are the topics participants will explore and the implications for SRHR community priorities:

Revenue generation: Revenue generation involves modalities of raising funds for the health sector. Participants will exchange experiences of how countries transitioned to pre-payment for health services through tax-based and social health insurance models, examine which models are most equitable and discuss the role of donor assistance. Taxes and social health insurance represent two main domestic funding sources—the same revenue sources to domestically fund FP. No matter the ultimate form, it is most important that domestic revenue generation is achieved through progressive taxation and social health insurance models—not regressive models such as user fees. User fees negatively impact access to health care, particularly for poor women and girls. With the push to remove out-of-pocket spending and improve access to FP and broader SRH services, such policies are contrary to SRHR goals.

Pooling: Pooling risk and funds refers to the way collected revenue is grouped and who is covered. In many countries, this exists as fragmented health insurance programs. UHC Financing Forum participants will discuss the best grouping design—fragmented pools versus one unified pool, and mandatory versus voluntary enrollment—and how to reach those who are poorest through pooling. Universal access to SRH means that women and girls have access to the same set of health interventions no matter how much they get paid, where they work or where they live. This is why one unified, mandatory risk pool designed to meet the needs of the poor is the most equitable model for health care access. This pooling design implies everyone is guaranteed the same care, and a woman living in a rural part of her country and working in the informal sector has access to the same method mix as her counterpart in an urban, formal sector.

Purchasing: Purchasing determines which health services and commodities are bought and from whom, as well as how to pay facilities and providers using the pooled revenue. Purchasing is the responsibility of a designated purchasing authority—public or private, depending on the country. At the UHC Financing Forum, participants will primarily analyze designing benefits packages, but also allocating resources to health systems strengthening, and examining how facility and provider purchasing agreements can improve patient care and health outcomes. Comprehensive benefits packages should include FP and high-quality SRH services—including safe abortion-related care, pregnancy-related services, and STI prevention and treatment—which are delivered from primary through tertiary levels of care. Inclusion of FP and SRH in benefits packages would eliminate prohibitive out-of-pocket spending and ensure that these services are sustainably and domestically funded. Additionally, facility payment arrangements that support well-stocked FP and SRH supplies, as well as provider payment mechanisms that enable high-quality care, will pave the way toward meeting FP needs and achieving universal access to SRH services.

Tracking the ongoing DRM conversation as part of UHC financing efforts is important because of the convergent opportunity for increased FP and SRH domestic resources, as well as the implications for women’s and girls’ access to these services. The UHC Financing Forum marks a moment in time where delegates working on DRM for health examine health financing ingredients—revenue generation, pooling and purchasing—and come together to identify best policy practices for achieving UHC by 2030. It is incumbent upon SRH champions to ensure these financing decisions facilitate, rather than impede, universal access.