Reproductive health financing and utilization: Using National Health Accounts (NHA) and Demographic and Health Survey (DHS) data to assess trends

Background:

This comparative paper looks at financing and utilization patterns in six African countries to examine recent reproductive health (RH) and Family Planning (FP) service delivery models. The study offers insights into how utilization is changing relative to household expenditures on RH/FP, and where women go for services.

Methods:

The study looks at Reproductive Health sub-account data from National Health Accounts, a WHO-endorsed health resource tracking methodology. It assesses changes in financing patterns for family planning and reproductive health between 2002 and 2007 in Malawi, Rwanda, and Tanzania – and in Uganda, Kenya, and Ethiopia for 2007. Financing data are paired with utilization information obtained from Demographic and Health Surveys during comparable time periods.

Results:

Households and donors bear the lion's share of reproductive health expenses in study countries. Most household RH/FP funds are spent at private, for-profit providers. Although governments will continue to play a dominant role in delivering RH services, private providers are particularly salient as sources for FP commodities. Private informal providers are also an important source of treatment for sexually transmitted diseases and obstetric care for the majority of women who deliver at home.

Conclusions:

Households are increasingly using scarce health funds to purchase FP commodities, providing policymakers and advocates further evidence that there remains an unmet need for FP commodity services. This calls for increasing donor and public sector involvement in RH/FP Programs, as well as leveraging the private sector to promote access to contraceptives and quality RH care in a sustainable, effective manner.