The USG International Family Planning Landscape: Defining Approaches to Address Uncertainties in Funding and Programming - Discussion Summary

Summary

Background

The international family planning community has made impressive gains in increasing global access to high-quality, voluntary family planning services. As of July 2017, 309 million women and girls in 69 FP2020 countries were using a modern method of contraception, representing an increase of 38.8 million users since 2012.¹ However, significant challenges remain with maintaining current support and meeting the growing need projected for family planning services and commodities across low- and middle-income countries (LMICs). A key challenge is the uncertainty surrounding future funding for such efforts from international donors in particular, but also from host country budgets. These concerns are further exacerbated by the political landscape in the United States—the largest single donor to global family planning efforts—including proposals to significantly cut the US international family planning budget as well as other policy changes. Given the current climate, a forward-looking agenda to address the potential implications of increasing unpredictability in future funding as well as policy shifts for family planning programs is more important than ever.

Purpose of Retreat

Brief from @KaiserFamFound & @CGDev highlights key issues for international #familyplanning efforts, including need to measure & mobilize local country resources

Through their respective analytic work tracking funding and policy trends in family planning and linking those changes to larger global health and development paradigms, the Center for Global Development (CGD) and Kaiser Family Foundation (KFF) identified a need to discuss the implications of uncertainty in the global family planning landscape for policy, programs, and people. To this end, CGD and KFF convened a family planning leadership retreat on January 18-19, 2018, that brought together a range of stakeholders from the international family planning space, as well as the broader global health and development community. Participants included US government officials, other donors and international organizations, NGOs, and the private sector.

The meeting was designed to identify practical strategies and approaches going forward. Three interconnected focus areas were identified as high priority:

I. Financing and Policy Changes: Uncertainty of future donor support and financing implications of policy changes;

II. Country Transitions: Acceleration of country transition timelines and realistic assessment of domestic resource mobilization opportunities; and

III. Commodities: Possible decreases in support for commodities and country supply chains.

The retreat included overview presentations in each of these three focus areas followed by related break-out sessions to more specifically identify strategies for further consideration.

Retreat Outcomes

The retreat’s discussions yielded several cross-cutting themes across the three focus areas: 1) improve donor alignment; 2) measure and mobilize domestic resources; 3) fill data gaps; 4) support integration while maintaining a focus on family planning; and 5) recognize that uncertainty also provides opportunity. These are discussed in more depth below. In addition, concrete ideas for potential approaches and strategies in each of the three focus areas are provided in Table 1 and in individual discussion overviews.

1. IMPROVE DONOR ALIGNMENT: The need for enhanced donor alignment of family planning investments is not new, but it has taken on increased urgency in the current environment.² In particular, participants identified improved alignment around country selection and prioritization for funding, with a focus on which countries or sub-regions might be most vulnerable to short-term funding reductions, as an urgent need. Coordination around longer-term planning as countries transition from aid eligibility is also needed. Participants also discussed the need to examine and reduce donor inefficiencies at the country and global levels (e.g., addressing parallel supply chains). Short-term strategies can be designed with the goal of serving as a bridge to longer-term strategies for sustainable funding and program self-sustainability.
2. MEASURE AND MOBILIZE DOMESTIC RESOURCES: Participants identified a critical need to better understand the landscape of domestic resources for family planning, including current spending levels by national governments, fiscal space for additional spending, and political will. Such assessments should be pragmatic and will need to consider the difficulties in tracking family planning-specific expenditures within national budgets and challenges around accounting transparency more generally. It is also important to be cognizant of the fact that countries may be experiencing multiple aid transitions in areas beyond family planning, as well as other overarching development challenges, magnifying budget pressures. Furthermore, considerations of fiscal space for family planning should recognize that national governments have competing priorities both within and outside the health sector. Understanding each country’s fiscal space and political will can help donors program resources most effectively. In addition, building capacity in such areas as contracting, developing insurance schemes, and financial tracking will be an important component of efforts to ensure greater government self-sufficiency.
3. FILL DATA GAPS: Participants identified several areas where critical data gaps limit the ability of policymakers, implementers, and other stakeholders to plan effectively. These include the lack of data on:

• Relative effectiveness of key investments
• Overall projected cost to meet family planning need across both the public and private sectors
• Improved understanding of family planning service costs
• Current domestic expenditures for family planning³
• Measures of fiscal space

Working to fill these data gaps will be important for informing planning and decision-making going forward.

4. SUPPORT INTEGRATION WHILE MAINTAINING A FOCUS ON FAMILY PLANNING: The importance of integrating family planning with other global health and development programs, where possible, was highlighted. Indeed, for the past several years, PEPFAR has sought to increase integration of family planning and HIV programs, and currently, USAID is seeking greater integration across global health programs. At the same time, participants discussed the need to ensure that family planning efforts do not get diluted or minimized through integration, particularly given the often-politicized nature of debates about US family planning efforts.
5. RECOGNIZE THAT UNCERTAINTY ALSO PROVIDES OPPORTUNITY: Although discussions focused largely on the challenges that accompany donor uncertainty, participants identified several important opportunities. There was emphasis on transition as an opportunity to better understand countries’ progress and needs and to strengthen implementation of, and achieve efficiencies in, international family planning assistance. Moreover, increased downward pressure on budgets also presents an opportunity to better harmonize investments across donors and channel available resources to areas of greatest need.

TABLE 1: KEY IDEAS AND PROPOSALS BY FOCUS AREA

I. Financing and Policy Changes

1. Vulnerability Assessment: Support a more systematic assessment of country vulnerabilities to changes in external financing, including identifying factors/ indicators that could be used to help predict vulnerability.

2.  Country Prioritization: Re-examine the methodology used for prioritizing USAID family planning countries to set the stage for enhanced donor coordination.

3.  Stakeholder Involvement: Identify ways in which the larger family planning community can support a USG country prioritization process and vulnerability assessment in the context of funding uncertainty.

4.  Contingency Planning: With the reinstatement and expansion of the Mexico City Policy (MCP), renamed Protecting Life in Global Health Assistance (PLGHA), the USG and/or other stakeholders could develop a process to identify where gaps in family planning access are most likely to occur and, where gaps exist, identify other sources of funding and/or alternate implementers.

5.  Donor Coordination: The main family planning financing actors could more proactively engage in assessing and responding to family planning aid vulnerabilities and prioritizing allocations using existing fora.

6.  Domestic Resource Tracking: Enhance efforts to track domestic resources for family planning, including assessments of fiscal space and political will needed to support increased domestic investment.

7.  Innovative Financing: Utilize innovative financing instruments, where appropriate, to incentivize sustainability.

II. Country Transitions

1.  Transparency: Enhance transparency as a strategy to reduce uncertainty and increase the likelihood of success.

2.  Transition Criteria: Revisit criteria to be used at different points along the transition continuum for family planning programs.

3.  Domestic Resources: Increase domestic spending on family planning, especially in lower-middle-income countries and/or top transition candidates.

4.  Total Market Approach: Take a “total market approach” to transition.

5.  Lessons Learned: To reinforce and build upon lessons from previous experiences, set up a project, initiative, or clearinghouse on transition (or build this into FP2020).

6.  Broader Transition Strategies: Reconsider and strengthen broader approaches and strategies to transition.

III. Commodities

1.  FP-Specific Challenges: While challenges around procurement and distribution of family planning commodities are relevant to other global health areas more broadly, some complexities are unique to family planning.

2.  Resource Allocation Collaboration: Enhance collaboration around strategic resource allocation for family planning commodities, over the short-, medium-, and long-term.

3.  Country-level Planning: Identify opportunities for global actors to further harmonize structures and planning at the country level for family planning commodities—and explore opportunities for synergies with other health commodities.

4.  Assess Existing Landscape: Support assessments to better understand the overall commodities landscape and identify potential gaps and possible efficiencies.

5.  Procurement Coordination: Enhance procurement coordination across public and private sectors to further improve pricing and ensure contraceptive supply security as demand grows.

6.  Global Planning Summit: Explore the possibility of a “global planning summit” on family planning commodities.