Zambia Has Family Planning Covered

By Amos Mwale, executive director of the Centre for Reproductive Health and Education, and Lethia Bernard

The Zambian government’s recent launch of a new nationwide health insurance scheme — its financing policy reform toward universal health coverage (UHC) — and introduction of a new benefits package that includes family planning, key sexual and reproductive health services and abortion is a monumental win for Zambian women and girls, a model for the region and a testament to the power of advocacy.

Over the past two years, the Zambian government has been preparing to launch its first-ever National Health Insurance Scheme (NHIS) as a key step toward UHC. Central to advancing this policy reform was determining the services, medicines, supplies and facilities the health insurance scheme would cover at primary through tertiary facilities nationwide.

Along the runway, sexual and reproductive health and rights advocates worked tirelessly with government counterparts to ensure family planning and sexual and reproductive health and rights were included in the benefits package so that family planning method choice would be available and affordable at all NHIS facilities — and to make progress toward family planning being funded domestically through the National Health Insurance Management Authority fund, which will finance the full benefits package once fully operational.

This is only one of many steps to delivering equitable and quality-assured health care to Zambians, but a foundational one that marks a major step toward domestically financed family planning, addressing unmet need and progress on Family Planning 2020 goals. As the government implements coverage through a nationwide health insurance scheme, Zambian women will receive covered family planning methods at all accredited facilities in the program. Zambia is the first country to introduce UHC financing reforms in sub-Saharan Africa that cover a range of family planning methods, including contraceptive pills, implants, injectables, intrauterine devices, emergency contraception, sexual and reproductive health services and abortion. This is also the first major country-level advocacy win for sexual and reproductive health and rights following the 2019 United Nations High-Level Meeting on UHC. This sets a strong precedent for the current wave of countries rapidly introducing UHC policy reforms to meet 2030 sustainable development goal targets and serves as an example that evidence-based advocacy targeted at the country level works.

Over the past 18 months, PAI has partnered with the Centre for Reproductive Health and Education (CRHE) and Zambian sexual and reproductive health and rights advocates as they worked hard to ensure family planning was prioritized in the UHC financing sphere. Sexual and reproductive health and rights advocates have served as constructive partners to policymakers — sharing evidence for family planning investment, forging strategic partnerships with counterparts beyond family planning by working with health financing colleagues and leveraging their positions as brokers between the community and government to help disseminate information at the local level. Following a kick-off advocacy strategy session, leaders from the Zambia Medical Association and academic colleagues helped identify advocacy entry points and developed an advocacy strategy with technical assistance from health economists. With this anchor, CRHE and partners catalyzed activities over the next 18 months to step into the policymaking process, engage with key decision-makers and showcase evidence of the cost-effectiveness of family planning and related preventive health care services and supplies.

What this experience most highlights is the power of what’s possible when civil society organizations and key allies come together and create a foundation to engage with government in UHC policy development and ensure policies facilitate women’s and girls’ access to sexual and reproductive health and rights, including family planning. When this journey started, we held finite pieces of information and advocates were not privy to the policy process, proactively consulted by the government or certain of how to get a seat at a table typically occupied by health financing experts. But, by recognizing the implications for sexual and reproductive health and rights and leveraging advocacy expertise, existing networks and other strengths, advocates and colleagues proactively teamed up to chart a way forward, gain a collective understanding of unfamiliar technical health financing and UHC territory and forge a relationship with new decision-makers. Doing so catalyzed a strong partnership and yielded open space for dialogue with policymakers and action toward universal access to sexual and reproductive health and rights.

And it will be this type of collective action that will propel us on the road ahead. While it’s a significant win, there is more to do along the trajectory toward universal sexual and reproductive health and rights access in the context of national health insurance. As the Zambian government moves from policy to implementation, advocates must remain steadfast to ensure policies translate to tangible results for women and girls. Advocates know major health policy change is difficult to get right the first time. UHC policies will be iterative over the next several months and years, and monitoring this process is crucial. Sexual and reproductive health and rights advocates will continue to leverage the existing partnership with policymakers and carry key information forward through opportunities to influence the refinement of the policies, especially through government-led, six-month national health insurance review meetings.

The current COVID-19 pandemic highlights the need to get major health policy reform like this right so that governments can sustain sexual and reproductive health and rights gains as well as ensure health systems can withstand turbulent times and continue delivering for women and girls.

As the collective work progresses, we will continue to leverage our strengths to adapt to uncharted territory and maintain the power of civil society to engage with government and champion policies that meet the needs of women and girls and make progress toward universal access to sexual and reproductive health and rights.

Read PAI’s brief, Leading the Charge: Insight into Country-level Sexual and Reproductive Health Advocacy in Zambia’s Universal Health Coverage Financing Reforms.