The United Nations Population Fund (UNFPA) estimates that U.S. $17 billion will be needed to fund reproductive health care in developing countries by the year 2000, about U.S. $10 billion of it for family planning.1 Currently, about half of the estimated funds needed for family planning is being spent, less than U.S. $5 billion.
Because of limited resources, major donors are focusing on fewer countries. The U.S. Agency for International Development (USAID) is planning to phase out support for family planning in such countries as Jamaica and Brazil because these countries' programs have advanced sufficiently. USAID may shift resources to other countries with more pressing needs.
The UNFPA also makes decisions based on country needs. "Working with national program managers, we allocate resources at the macro level - how much resources go for commodities, for training and for other areas," says Dr. Richard Osborn, senior technical officer at UNFPA.
The developing country governments themselves are hard-pressed to fill the gap. Currently, about two-thirds of family planning funds spent worldwide come from developing country governments, although most of this is accounted for by seven countries (China, India, Indonesia, Mexico, South Africa, Turkey and Bangladesh).2
Programs in many countries are now grappling with how to sustain existing programs, much less add new services. Programs are considering various types of user fees and public-private partnerships. Worldwide, consumers currently provide about 14 percent of family planning funds, but the portion is higher in most Latin American countries. In a few countries, insurance, social security and other public-private arrangements contribute.
Among the types of new approaches being considered are expanding social marketing programs, making retail sales easier by removing constraints on prescriptions and prices, and improving the quality of services so that clients may be more willing to pay for contraceptives.3
Governments are also attempting to understand how family planning funds fit into their overall health-care budgets. But currently, planners at the national level cannot easily estimate how much they are spending on family planning or reproductive health services.
"Standard rules of thumb are needed so that expenditure estimates can be made quickly and at low cost," says Dr. Barbara Janowitz of FHI. FHI is attempting to develop guidelines that can be used to compare spending for family planning and reproductive health in different countries. Studies in Bangladesh, Ecuador, Ghana, Mexico and the Philippines seek to determine how much of a country's resources are being spent on family planning services and for what type of function, such as training, administration, service delivery and information. The Evaluation Project at the Population Center at the University of North Carolina and in-country organizations are assisting with this research.
-- William R. Finger
Footnotes
- United Nations Population Fund. Background note on the resource requirements for population programmes in the years 2000-2015, July 1994. Unpublished paper.
- Population Action International. Financing the future: Meeting the demand for family planning, 1994.
- Lande RE, Geller JA. Paying for family planning. Population Reports 1991; Series J, No. 39.
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