Findings from five WHO-commissioned systematic reviews on financing mechanisms for contraceptive programmes were published today as a special supplement of Studies in Family Planning.
The need to provide cost-effective contraceptive programmes that expand access, reduce unmet need, and consider the specific needs of the poor and marginalized population is central to the achievement of a number of the Sustainable Development Goals. The 2012 London Family Planning summit and the FP 2020 initiative as well as the UN Secretary-General‘s Global Strategy for Women’s, Children’s and Adolescents’ Health, 2016–2030 all put the provision of quality contraception services as central and critical components of success.
As a result of this strengthened focus on contraception, discussions between bilateral, multilateral, and private foundation donors outlined strategies to identify knowledge gaps in areas that could best be addressed through collective action. On such gap is around policy and financing mechanisms for contraception. The scientific evidence available on the effectiveness of the various financing mechanisms for contraception is extremely limited. Some approaches to financing contraception, such as those involving financial incentives, raise concerns around free choice, are difficult to research, and there is no evidence as to whether they are effective or not. Further, the large number of descriptive studies in this area may have discouraged researchers from engaging in more robust designs that would enable generalizability and scalability of approaches.
To address some of these issues, a WHO-led Research Initiative on Financing Mechanisms for Family Planning and Contraception was established. The overall goal is to develop and strengthen the evidence base on financing mechanisms, in turn, leading to the development of effective, quality contraceptive programmes with financing mechanisms that expand access, increase uptake, reduce unmet need, and consider the specific needs of the poor and marginalized populations. The five systematic reviews provide insight on the strength of the evidence base relating to various financing mechanisms and based on the identified gaps, a new research agenda. The studies used a common protocol that was jointly developed. A number of funding agencies were involved at the early stages as well as at a review of the results in order to increase the likelihood of follow-up work.
Main findings
The studies looked at 5 intervention groups:
- Social protection programmes that provided a voucher subsidy to disadvantaged clients
- Introduction of community financing and community-based health insurance
- Introduction of conditional and unconditional cash transfers
- Introducing, removing or changing out of pocket payments or user fees
- Results-based financing including all interventions involving payment for performance that have a supply-side component
The most striking finding from all the reviews was the lack of strong evidence on contraceptive financing; out of 17000 articles identified, only 38 studies met the eligibility criteria and after analysis, it was not deemed possible to make strong recommendations on financing contraception in any of the 5 intervention groups. The reviews identified a total of 38 research questions for future research, of which 10 were identified as high priority.
A discussion of the findings with funding agencies concluded that in order to show evidence of the impact and effectiveness of these mechanisms on family planning outcomes it would be essential to include a strong evaluation component in future programmes exploring financing mechanisms. The need to ensure that contraceptive financing systems also avoid the risk of coercion and ensure patient safety were also highlighted, particularly when financing mechanisms involving incentives. The discussions also highlighted the importance of reaching vulnerable and hard-to-reach populations, as well as engaging with the private sector to ensure sustainable change.