Information on type of financing mechanisms identified and/or tested and verification that it/they have been officially adopted.

Data Sources:

Documents and meeting minutes; pilot tests; study results; policies; strategies; and budgets and actual expenditure reports. A line item for FP and RH funding in expenditure budget documents should exist at all levels of health expenditure reports. Evidence of expenditures should also be available with invoices, staff rosters, etc. This indicator may involve a budget tracking exercise of FP and RH funds. Data sources can also include reports of donor funds that are allocated to FP and RH activities through implementing partners other than the government. Expenses incurred by the public in accessing FP and RH services through the private sector should also be measured.

Indicator Type:

Verified list

Purpose:

This indicator measures the breadth of types of financing allocated for the provision of FP/RH services. A mix of financing from a variety of sources is required to achieve predictable, adequate, and sustainable financing for FP (HIPs, 2018). In the face of declining government and donor funding for RH, new (alternative) financing mechanisms such as user fees and health insurance take on added importance. This indicator highlights the importance of financial resource mobilization as an essential component of a national plan or policy.

Issues:

This indicator does measure what percent of the total each type of funding mechanism contributes. To track this data, an additional indicator would be needed.

Not all new financing mechanisms are necessarily good. Adding a new mechanism like fee-for-service can be good if it increases available resources for FP/RH, or bad if it suppresses demand. Often economic barriers, such as high user fees or high transportation costs, restrict access to health services. On the other hand, charging nominal fees for certain FP/RH services may increase demand for such services, because people may associate better quality of services or a greater need for those services with having to pay for them.

National health budgets can demonstrate intentions, but expenditures may not be consistent with the budget. Expenditure data are, by definition, retrospective and there may be time lags of several years before accounts are reported and reconciled.

In terms of implementation, evaluators will need to distinguish between the testing of a new mechanism and the mechanism’s success at increasing revenues without unduly depressing demand. Organizational willingness to test a variety of financing mechanisms signals a positive policy environment, even if the organization ultimately adopts only one or two of the mechanisms.