Opinion: Ensuring access to reproductive health supplies in the context of universal health coverage

Later this month at the meeting of the General Assembly in New York, the United Nations is hosting the Sustainable Development Summit 2015 to launch the Sustainable Development Goals (SDG). Within these goals, Draft Target 3.8 calls for the achievement of universal health coverage (UHC), including “financial risk protection, access to quality essential health-care services, and access to safe, effective, quality and affordable essential medicines and vaccines for all.”  

More than 100 countries are in the process of adopting or embarking on UHC but despite the momentum, 400 million people lack access to one or more of seven lifesaving health services including reproductive health (RH), according to a recent World Bank-WHO progress report on UHC.

Within the Reproductive Health Supplies Coalition (RHSC), we have created a Steering Team on UHC to address access to RH supplies appropriately. Reliable provision of health services and commodities depends on the availability of high-quality, affordable essential medicines and associated supplies. We know that UHC and RH commodity security are closely intertwined and built on shared values. UHC is rights-based and furthers the principles of equity, access, and quality.

But how do we make sure RH supplies are considered in the UHC reforms and that policies and supply chain infrastructure are effectively implemented to ensure availability?

Although there are very few documented examples of the inclusion of RH supplies in UHC programs, we have learned some basic lessons:

1. Family planning is cost-effective and plays a critical role in the realization of UHC. A growing number of low- and middle-income countries are embarking on this complex -- and often overwhelming -- health financing reform. When confronted with finite resources and competing priorities, RH supplies, particularly contraceptives, can be left behind when countries are prioritizing programs and defining health packages. We have seen this happen during past health reforms such as Sector-wide Approaches (SWAp) and decentralization and integration of health services. Let’s apply the lessons that we have learned in the past as we navigate the future to make sure that:
   • RH supplies are part of the basic packages included in UHC reforms and that implementation and monitoring of the strategies are effective.
   • Health reforms strengthen the policies and systems (supply chains) that ensure widespread availability of RH supplies.
2. All stakeholders working on RH have important roles to play in advocating, planning for, implementing, and monitoring the availability of RH supplies in the context of UHC. This includes donors, policymakers, advocates, as well as service providers and supply chain managers in the public, private, and nongovernmental organization (NGO) sectors. In particular, country governments must serve as stewards of the reforms and in ensuring the availability of high-quality RH supplies. Their roles are decisive in guiding, shaping, and overseeing the policy direction and required financial, operational, and regulatory systems. They are responsible for leveraging and coordinating the diverse stakeholders to ensure RH supplies are well positioned in the reforms and that they will be available to those who need them.
3. UHC presents the RH community with the opportunity to make the case for a total market approach for RH supplies. In virtually any low- or middle-income country, the successful realization of UHC will require multiple service-delivery channels and supply chains to reach all segments of the population. As countries embark on UHC, their governments will need to make difficult decisions, such as which RH services and commodities will be provided and which population segments will be prioritized for coverage within the public sector. Governments will also need to develop, support, and/or enable service-delivery solutions in collaboration with the private and/or NGO sectors to ensure that the RH needs of the entire country’s population are met

The UHC reform process may be challenging to navigate and it may be difficult to identify entry points for RH supplies stakeholders. But, given the role that UHC will play in the new SDGs and the number of countries now embarking on this process, we are at a critical time for the RH supplies community. We must seize the opportunities UHC holds for strengthening RH commodity security, while we also proactively mitigate any potential risks it poses. Just as there is no one single best path to UHC, there is no silver bullet/single solution to ensure availability/access to RH supplies. We will need to be opportunistic and flexible in adapting to each country’s trajectory.

Find out more here, and stay tuned for additional blogs on UHC and its implications for RH supplies

Safia Ahsan, JSI
Fabio Castano, MSH
Suzanna Dennis, PAI
Chinonso Nnorom, PAI
Leslie Patykewich, JSI
Beth Yeager, MSH

¹ Reproductive Health Supplies Coalition.  “Strategy 2015-2025.”  Page 2.  http://www.rhsupplies.org/fileadmin/uploads/rhsc/Documents/RHSC_Strategic_Plan_2015_re.pdf