Historical Context

Many low- and middle-income countries have relied heavily on donor financing for FP and other health areas despite the necessity for domestic allocations and expenditures for health (USAID, 2018). Health expenditure data from 2010 – 2013 show that in 12 countries the government was the smallest funding source for reproductive, maternal, neonatal, and child health, at only 21 percent of overall funding in each country (Lie, Soucat, and Basu, 2015).

In 2012, at the London Summit on FP, more than 150 leaders from low‐ and middle‐income countries, donor organizations, international technical assistance agencies, civil society, foundations, and the private sector united to make a global commitment to provide an additional 120 million women and girls in the world’s poorest countries access to voluntary contraception services, information and supplies by 2020 (Lissner, et al., 2016). The key to achieving this goal would be strong national capacity and will to mobilize and spend the necessary financial resources to implement sustainable FP programs. Family Planning 2020 (FP2020), which was launched during the Summit, built on these partnerships and aimed to ensure that all partners worked together to achieve and support the goals and commitments announced at the Summit.

However, in 2020 the COVID-19 pandemic diverted funding from essential FP services and strained national health budgets, reinforcing the critical need to finance sexual and reproductive health services in times of crisis. A WHO survey of 105 countries found that 90 percent had health service disruptions due to the pandemic and 68 percent reported disruptions to FP services (UNFPA, 2022).

Despite several pledges to women’s and children’s health on the world stage, this funding has not necessarily materialized at the country level. Household expenditures dwarf the contributions of both domestic and international funding sources, covering 49 percent of FP financing (Lie, Soucat, and Basu, 2015). FP2030, which builds on the work of the FP2020 partnership in tracking country resources and commitments, estimates that donor governments now account for approximately 40 percent of total funding for FP in low- and middle-income countries (FP2030). While this is a positive shift, household expenditures are still high. Future efforts to reduce unmet need for FP must consider consumers’ out-of-pocket costs, programmatic cost-effectiveness, and diverse sources of funding (WHO/RHR, 2018).

Current FP Financing Priorities

From 2020-2030, the total investment needed to end the unmet need for FP in 120 countries is estimated at US$68.5 billion. Donors are currently projected to provide US$8.6 billion of this financing between 2020 and 2030, leaving a US$59.9 billion funding gap. Total resources must increase from around US$6.3 billion annually in 2020 to around US$10.8 billion annually by 2030 (UNFPA, 2022). Although this investment would not address all unmet need since there are some individuals who do not want a pregnancy but are also reluctant to use modern contraception, it would substantially increase contraceptive uptake and decrease unintended pregnancies.

According to FP2030, the focus for the future of FP financing “should be on building sustainability, with diversified funding streams and efficient use of resources. A combination of country-led domestic resource mobilization, broadly supported universal health schemes, greater private sector involvement, co-financing development opportunities, and cross- sectoral partnerships, together with donor funds targeted to the neediest countries and programs, will create a more stable and holistic approach to family planning financing” (FP2030).

Tracking FP Financing

Financing is one of the five focus areas of the FP2030 Agenda. The FP2030 partnership is committed to fostering resilient and sufficient funding for FP, with countries increasingly able to finance their own FP programs. (FP2030). The Track 20 project, launched in tandem with FP2020, was designed to work directly with governments to collect, analyze, and use data to monitor progress in achieving FP targets. Track20 developed the Family Planning Spending Assessment (FPSA) methodology to monitor the flow of resources and expenditures for the implementation of FP programming in a country. The FPSA includes the indicator, annual expenditure on FP from government domestic budget (US$) (Track 20, n.d.).

The key indicators presented here track various aspects of FP financing, such as budget allocations, budget expenditures, funding sources, private sector investments, and financing mechanisms. Many of the indicators are from the FP Financing Roadmap, a USAID-developed resource to support sustainable financing of FP programs in developing countries. The indicators are aligned with other partners like the World Bank and the World Health Organization and have been reviewed by the FP Financing Reference Team technical working group.

References

FP2030. The Transition to FP2030: Measurement Report 2021. https://fp2030.org/sites/default/files/Data-Hub/FP2030_DataReport_v5.pdf

Lie GSS, Soucat ALB, Basu S. 2015. Financing women’s, children’s, and adolescents’ health. BMJ 351: suppl1, pp 53 – 55. https://pubmed.ncbi.nlm.nih.gov/26371223/

Lissner CL, Ali M, Bajracharya A, et al., 2016. Systematic Reviews of Mechanisms for Financing Family Planning: Findings, Implications, and Future Agenda. (v4f). https://www.researchgate.net/publication/311559632_Systematic_Reviews_of_Mechanisms_for_Financing_Family_Planning_Findings_Implications_and_Future_Agenda

Track 20. n.d. https://www.track20.org/

UNFPA, November 14, 2022. Ministers commit to increase investments in sustainable financing for family planning through landmark agreements with UNFPA. [Press release]. https://www.unfpa.org/press/ministers-commit-increase-investments-sustainable-financing-family-planning-through-landmark

United Nations Department of Economic and Social Affairs, Population Division. 2022. World Family Planning 2022. Meeting the changing needs for family planning: Contraceptive use by age and method. https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/2023/Feb/undesa_pd_2022_world-family-planning.pdf

USAID, April 2018. High Impact Practices in Family Planning (HIPs). Domestic public financing: Building a sustainable future for family planning programs. https://www.fphighimpactpractices.org/briefs/domestic-public-financing

WHO/RHR, 2018. Family Planning Evidence Brief – Ensuring adequate financing of family planning commodities and services. Geneva, WHO. https://www.who.int/publications/i/item/WHO-RHR-18.26