Evidence-based Advocacy to Mobilize Financial Resources for FP/RH in Jordan: An Application of National Family Planning Accounts

Publication date: 2006

Evidence-based Advocacy to Mobilize Financial Resources for FP/RH in Jordan: An Application of National Family Planning Accounts Suneeta Sharma Ph.D., MHA, Margaret Rowan M.P.H., C.P.A., Carol Shepherd S.c.D., M.S., and Basma Ishaqat M.A., Constella Futures, LLC 7KH�¿QGLQJV�IRU�WKH�)3�$FFRXQWV�VWXG\�ZHUH�SUHVHQWHG�LQ�ODUJH�VWDNHKROGHU�PHHWLQJV�DQG� LQIRUPHG�WKH�GHYHORSPHQW�RI�WKH�FRQWUDFHSWLYH�VHFXULW\�VWUDWHJLF�SODQ��7KLV�VWXG\�UDLVHG�WKH�LVVXH� RI�IXWXUH�IXQGLQJ�RI�WKH�IDPLO\�SODQQLQJ�SURJUDP�LQ�GLVFXVVLRQV��PHHWLQJV��DQG�ZRUNVKRSV�WKDW� ZHUH�RUJDQL]HG�WR�GHYHORS�WKH�-RUGDQ�&RQWUDFHSWLYH�6HFXULW\�6WUDWHJ\��&66������������� 7KH�IROORZLQJ�WDEOH�VXPPDUL]HV�RWKHU�PDMRU�¿QGLQJV� Conclusions 7KH�SXUSRVH�RI�WKLV�VWXG\�LV�WR�HYDOXDWH�WKH�VRXUFHV�DQG�XVHV�RI�PRQH\�H[SHQGHG�LQ�WKH�IDPLO\� SODQQLQJ�SURJUDP��7KH�REMHFWLYHV�RI�WKLV�VWXG\�DUH�WR� 1. Provide information that may be used by Jordanian policymakers to design better policies relating to family-planning efforts; 2. Provide information for the strategic planning process related to Contraceptive Security; ��� 3URYLGH�SROLF\�PDNHUV�ZLWK�LQIRUPDWLRQ�WR�DVVHVV�WKH�DGHTXDF\�RI�¿QDQFLDO�UHVRXUFHV� available for family-planning activities; ��� 3URYLGH�NQRZOHGJH�DERXW�ZKR�¿QDQFHV�IDPLO\�SODQQLQJ�DFWLYLWLHV��DQG 5. Provide data regarding how funds are distributed across various components of the family planning program. Objectives ,Q�0D\�������-RUGDQ�LQLWLDWHG�DQ�HYLGHQFH�EDVHG�PXOWL�VHFWRUDO�SODQQLQJ�SURFHVV�WR�PRYH�WRZDUG� FRQWUDFHSWLYH�VHFXULW\�LQ�DQWLFLSDWLRQ�RI�GRQRU�SKDVH�RXW�DQG�DQ�DODUPLQJO\�KLJK�SRSXODWLRQ� JURZWK�UDWH��7KH�FRXQWU\�LQWHQGV�WR�DFKLHYH�DQ�DGHTXDWH�OHYHO�RI�IXQGLQJ�WR�PDNH�FRQWUDFHSWLYHV� DYDLODEOH�WR�DOO�WKRVH�ZKR�QHHG�DQG�ZDQW�WKHP��)DPLO\�3ODQQLQJ�$FFRXQWV�VWXG\�SURYLGHG�FUXFLDO� LQIRUPDWLRQ�IRU�WKH�*RYHUQPHQW�RI�-RUGDQ�LQ�LWV�HIIRUWV�WR�DGGUHVV�IXQGLQJ�IRU�IDPLO\�SODQQLQJ� DFWLYLWLHV� 7KH�VWXG\�JHQHUDWHV�LQIRUPDWLRQ�DQG�NQRZOHGJH�DERXW�WKH�PDMRU�VRXUFHV�RI�¿QDQFLQJ�IRU�IDPLO\� SODQQLQJ�DFWLYLWLHV��WKH�GLVWULEXWLRQ�RI�IXQGV�DFURVV�YDULRXV�FRPSRQHQWV�RI�WKH�IDPLO\�SODQQLQJ� SURJUDP��DQG�WKH�UHVRXUFH�JDSV�WKDW�H[LVW�EHWZHHQ�ZKDW�LV�DYDLODEOH�DQG�ZKDW�LV�UHTXLUHG�WR� DFKLHYH�&RQWUDFHSWLYH�6HFXULW\� Context 7KH�VWXG\�LQYROYHG�DQ�DJJUHJDWLRQ�RI�WKH�ÀRZ�RI�UHVRXUFHV�XVHG�IRU�IDPLO\�SODQQLQJ�DFWLYLWLHV�LQ� -RUGDQ�GXULQJ�WKH�FDOHQGDU�\HDU�������7KH�PHWKRGRORJ\�XVHG�WR�FRPSLOH�WKH�GDWD�LV�VLPLODU�WR� WKDW�XVHG�WR�GHWHUPLQH�1DWLRQDO�+HDOWK�$FFRXQWV��ZKLFK�ZDV�FRQGXFWHG�IRU�-RUGDQ�LQ������DQG� XSGDWHG�LQ������E\�WKH�86$,'�IXQGHG�SURMHFW�3DUWQHUVKLSV�IRU�+HDOWK�5HIRUP��3+5���8QOLNH�WKH� 1DWLRQDO�+HDOWK�$FFRXQWV�VWXG\�LQ�-RUGDQ��ZKLFK�LQFOXGHG�UHVRXUFH�ÀRZV�UHJDUGLQJ�WKH�HQWLUH� KHDOWK�VHFWRU��WKH�FXUUHQW�-RUGDQ�)DPLO\�3ODQQLQJ�$FFRXQWV�6WXG\�LV�D�VXE�DQDO\VLV�IRFXVLQJ� RQO\�RQ�IDPLO\�SODQQLQJ�DFFRXQWV�� 7KH�VWXG\�LQFOXGHV�WKH�IROORZLQJ�IDPLO\�SODQQLQJ�DFWLYLWLHV� • Family planning service delivery; • Outpatient services (counseling, IUD insertions, injections, implants); • Inpatient services (counseling, IUD insertions, female and male surgical sterilization); • Sales of contraceptives (oral pills, condoms, injectables, implants, IUDs, spermicides etc); • Support services such as Information, Education and Communication, Training, Research, Evaluation, Administration, etc.; and • Fertility counseling, fertility drugs, or procedures are excluded. 7KH�VWXG\�LQYROYHG�H[WHQVLYH�GDWD�FROOHFWLRQ�IURP�YDULRXV�PLQLVWULHV��GRQRUV��SXEOLF�SULYDWH� SURYLGHUV��DQG�LQGXVWU\�JURXSV��SULYDWH�LQVXUHUV�DQG�SKDUPDFHXWLFDO�FRPSDQLHV���WR�WUDFN�DOO� IDPLO\�SODQQLQJ�H[SHQGLWXUHV�IURP�WKH�WRS�OHYHO�IXQGLQJ�VRXUFHV�WKURXJK�WR�WKH�H[SHQGLQJ� RUJDQL]DWLRQV��:H�LQWHUYLHZHG�DERXW�����'LUHFWRUV�DQG�)LQDQFH�0DQDJHUV�IURP���� RUJDQL]DWLRQV�IRU�GDWD�FROOHFWLRQ� 7KH�VWXG\�DQDO\]HV�WKH�FROOHFWHG�LQIRUPDWLRQ�XQGHU�WKH�IROORZLQJ�FDWHJRULHV� • Financing sources: Where does the money come from? � ±�LGHQWL¿HV�HQWLWLHV�WKDW�SURYLGH�IDPLO\�SODQQLQJ�IXQGV� • Financing Agents: Who manages and organizes the funds? � ±�LGHQWL¿HV�HQWLWLHV�WKDW�FKDQQHO�WKH�IXQGV�SURYLGHG�E\�¿QDQFLQJ�VRXUFHV��IRU�IDPLO\� planning services, commodities, and activities • Providers: Who uses the money to provide services and commodities? � ±�LGHQWL¿HV�WKH�HQG�XVHUV�RU�¿QDO�UHFLSLHQWV�RI�IDPLO\�SODQQLQJ�IXQGV • Functions: How is the money used? – refers to the family planning services or activities delivered by providers 7KH�DQDO\]HG�LQIRUPDWLRQ�LV�RUJDQL]HG�LQ�D�EDVLF�VHW�RI�QDWLRQDO�DFFRXQWV�WDEOHV�WKDW�LOOXVWUDWH� WKH�ÀRZ�RI�UHVRXUFHV��IURP�¿QDQFLQJ�VRXUFHV�WR�¿QDQFLQJ�DJHQWV��¿QDQFLQJ�DJHQWV�WR�SURYLGHUV�� ¿QDQFLQJ�DJHQWV�WR�IXQFWLRQV��DQG�SURYLGHUV�WR�IXQFWLRQV�� 3. The Structure of Financial Flows in the Family Planning Sector -RUGDQ¶V�IDPLO\�SODQQLQJ�V\VWHP�LV�PDGH�XS�RI�SXEOLF��1*2��DQG�FRPPHUFLDO�HQWLWLHV�DQG� SURYLGHUV��7KH�SXEOLF�DQG�SULYDWH�VHFWRU�SOD\�HTXDOO\�LPSRUWDQW�UROHV�LQ�WKH�SURYLVLRQ�DQG� ¿QDQFLQJ�RI�IDPLO\�SODQQLQJ�VHUYLFHV�� Method of Analysis Figure 1: Flow of funds in Jordan’s family planning system. Sources Financing Agents Providers Uses Functions Service Delivery Training IEC/BCC Research & Evaluation Expense Line Items Salaries Contraceptive Recurrent Capital MOF MOH Facilities Private Hospitals HPC/DOS NGO Clinics Pharmacies OB/GYNs & GPs RMS/JUH Facilities JAFPP Facilities MOH RMS/JUH Public Firms CAs JAFPP Other NGOs UNRWA Households Other Ministries USAID Other Donors Households Figure 2: Total Health FP Expenditures and Share to GDP, 2002 GDP JD 6,258 million FP Expenditure JD 25.5 million 4.3% Health Expenditure FP Expenditure JD 597 million 9.5% Health Expenditure 7DEOH���VKRZV�WKH�SHUFHQWDJH�EUHDNGRZQ�UHJDUGLQJ�WKH�VRXUFHV�DQG�XVHV�RI�IXQGLQJ�IRU�IDPLO\� SODQQLQJ��7KH�JRYHUQPHQW¶V�PRQH\�LV�PDLQO\�XVHG�LQ�GHOLYHULQJ�VHUYLFHV�DQG�SURGXFWV�������� IROORZHG�E\�WUDLQLQJ����������UHVHDUFK���������DQG�%&&�,(&�������'RQRU�IXQGV�DUH�VSHQW�RQ� VHUYLFH�GHOLYHU\�DQG�FRQWUDFHSWLYHV����������%&&�,(&��������WUDLQLQJ��������DQG�UHVHDUFK� ��������7KH�YDVW�PDMRULW\���������RI�UHYHQXH�IURP�KRXVHKROGV�LV�XVHG�IRU�SURYLGLQJ�VHUYLFHV� DQG�FRQWUDFHSWLYHV��7KH�QHFHVVLW\�IRU�JUHDWHU�JRYHUQPHQW�H[SHQGLWXUH�LV�IXUWKHU�HPSKDVL]HG�E\� WKH�LPSHQGLQJ�ZLWKGUDZDO�RI�IRUHLJQ�LQYHVWPHQW�LQ�)3��7DEOH���VKRZV�WKDW�%&&�,(&�DQG�UHVHDUFK� DFWLYLWLHV�DUH�PDLQO\�VXSSRUWHG�E\�GRQRU�IXQGLQJ� Figure 3: Sources of Financing for Family Planning USAID 23% Other Donors 3% Ministry of Finance 45% Private / Households 27% Other Ministry 2% Sources (Percentages %) Functions Government Donors Households Total Service Delivery 84.9 58.6 99.5 82.2 Training 12.6 13.9 0.5 9.7 BCC/IEC 0.9 22.0 0.0 6.0 Research 1.7 5.5 0.0 2.2 Total 100 100 100 100 Sources (Percentages %) Expense Line Items Government Donors Households Total Salaries 57.0 29.3 23.5 41.2 Contraceptives 0.6 4.5 36.4 11 Recurrent 30.9 57.7 26.1 36.3 Capital 11.5 8.6 14.0 11.4 Total 100 100 100 100 Indicators Value in US$ Total FP expenditures $35.8 million Percentages (%) FP expenditures as a % of GDP .4% FP expenditures as a % of total health spending 4.3% Sources of FP Financing: • Public • Private • Donors (USAID – 88.5% of total) 47% 27% 26% 7KH�*RYHUQPHQW�RI�-RUGDQ¶V�SODQ�WR�WDNH�WKH�86$,'�UROH�LQ�VXSSO\LQJ�PRGHUQ�FRQWUDFHSWLRQ�WR� WKHVH�RUJDQL]DWLRQV�ZDV�LQWHJUDWHG�LQ�WKH�-RUGDQ�&66������������7KH�JRYHUQPHQW�RI�-RUGDQ� GHFODUHG�WKDW�FRQWUDFHSWLYHV�ZHUH�D�³SXEOLF�JRRG´�DQG�WKDW�WKH\�ZRXOG�WDNH�UHVSRQVLELOLW\�IRU� SURYLGLQJ�WKH�IROORZLQJ�RUJDQL]DWLRQV�ZLWK�FRQWUDFHSWLYHV�XVLQJ�SXEOLF�IXQGV��02+�FOLQLFV��506� FOLQLFV��815:$�FOLQLFV��-$)33�FOLQLFV��-RUGDQ�8QLYHUVLW\�KRVSLWDO��DQG�RWKHU�1*2V��7KHVH� RUJDQL]DWLRQV�DUH�FXUUHQWO\�VHUYHG�XQGHU�WKH�QDWLRQDO�)3�ORJLVWLFV�V\VWHP�XPEUHOOD�� 2Q�-XQH�����������WKH�*RYHUQPHQW�RI�-RUGDQ�PDGH�D�IRUPDO�FRPPLWPHQW�WKURXJK�WKH�2I¿FH�RI� WKH�3ULPH�0LQLVWHU�WR�FRQWLQXH�WR�DVVXPH�¿VFDO�DQG�DGPLQLVWUDWLYH�UHVSRQVLELOLW\�IRU�D����������� SKDVH�RYHU�SODQ�IRU�WKH�SURYLVLRQ�RI�PRGHUQ�FRQWUDFHSWLYHV�WR�FOLHQWV�LQ�WKH�SXEOLF�VHFWRU�DQG�WR� RWKHU�FOLHQWV�ZKR�DUH�FXUUHQWO\�EHQH¿FLDULHV�RI�86$,'¶V�FRQWUDFHSWLYH�SURFXUHPHQW�SURJUDP�IRU� -RUGDQ��$FFRUGLQJO\��DV�RI�WKH�EHJLQQLQJ�RI�������LW�LV�DQWLFLSDWHG�WKDW�WKH�*RYHUQPHQW�RI�-RUGDQ� ZLOO�KDYH�DVVXPHG�WRWDO�UHVSRQVLELOLW\�IRU�DOO�IRUPHU�86$,'�FRQWUDFHSWLYH�SURFXUHPHQWV��$V�SHU� D�0HPRUDQGXP�RI�8QGHUVWDQGLQJ�WR�EH�VLJQHG�EHWZHHQ�WKH�0LQLVWU\�RI�+HDOWK��02+��RI�WKH� +DVKHPLWH�.LQJGRP�RI�-RUGDQ�DQG�86$,'�-RUGDQ��WKH�02+�DOORFDWHV�DQ�HVWLPDWHG�WRWDO�DPRXQW� RI�������������������-RUGDQLDQ�'LQDU��WR�FRYHU�FRQWUDFHSWLYH�SXUFKDVHV�IRU�WKH�JRYHUQPHQW¶V� ¿VFDO�\HDUV������WR������ -RUGDQ�KDV�EHHQ�VXFFHVVIXO�LQ�PRELOL]LQJ�WKH�QHFHVVDU\�IXQGLQJ�IRU�FRQWUDFHSWLYHV��$�QXPEHU� RI�IDFWRUV�FRQWULEXWHG�WR�WKLV�VXFFHVV��WKH�LQYROYLQJ�RI�WKH�02)�IURP�WKH�YHU\�EHJLQQLQJ�RI�WKH� VWUDWHJLF�SODQQLQJ�SURFHVV��FRQGXFWLQJ�D�¿QDQFLDO�VRXUFHV�DQG�XVHV�DQDO\VLV��EXLOGLQJ�WKH�FDSDF� LW\�RI�D�PXOWL�VHFWRUDO�JURXS�LQ�FRVWLQJ�DQG�EXGJHWLQJ��FRVWLQJ�WKH�SODQ��DVVHVVLQJ�WKH�¿QDQFLDO� IHDVLELOLW\�DQG�GHYHORSLQJ�¿QDQFLQJ�DQG�UHVRXUFH�DOORFDWLRQ�RSWLRQV��VHOHFWLQJ�KLJK�LPSDFW�DQG� ORZ�FRVW�DFWLYLWLHV��LGHQWLI\LQJ�VRXUFHV�RI�IXQGLQJ��DQG�GHYHORSLQJ�¿QDQFLDO�PRQLWRULQJ�LQGLFDWRUV� 1) Contraceptive security exists when every person is able to choose, obtain, and use quality contraceptives whenever she/he needs them. 2) For a detailed description of national health accounts methodology, see Guide to producing national health accounts: with special applications for low-income and middle-income countries, 2003. References 4. Family Planning Accounts $FFRUGLQJ�WR�WKH�3+5�1DWLRQDO�+HDOWK�$FFRXQWV��������VWXG\��-RUGDQ�VSHQGV������RI�LWV�*'3� RQ�KHDOWK��)DPLO\�SODQQLQJ�LV�DSSUR[LPDWHO\������RI�WKH�WRWDO�KHDOWK�H[SHQGLWXUH��6HH�)LJXUH����� Table 1: Sources and Uses of Funds for Family Planning–Functions ([SHQGLWXUH�E\�W\SH�RI�¿QDQFLQJ�VRXUFH� 7KH�JRYHUQPHQW�RI�-RUGDQ�LV�DQ�LPSRUWDQW�VRXUFH�RI�¿QDQFLQJ�IRU�WKH�FRXQWU\¶V�)3�SURJUDP��,W� FRQWULEXWHV�DERXW�����RI�WKH�IXQGV��IROORZHG�E\�SULYDWH��KRXVHKROGV��������DQG�GRQRUV�������� 86$,'�LV�WKH�PDLQ�GRQRU�LQ�WKLV�ODVW�JURXS��FRQWULEXWLQJ�����RI�WKH�IXQGV��6HH�)LJXUH���� $�GHWDLOHG�DQDO\VLV�RI�86$,'�H[SHQGLWXUHV�RQ�FRQWUDFHSWLYH�FRPPRGLWLHV�UHYHDOV�WKDW�86$,'�LV� VSHQGLQJ�QHDUO\�86����������RQ�FRQGRPV��PRVW�RI�ZKLFK�DUH�GLVWULEXWHG�WKURXJK�02+�IDFLOLWLHV�� DQG�WR�D�OHVVHU�H[WHQW�815:$�DQG�-$)33�FOLQLFV��86$,'�DOVR�VSHQGV�QHDUO\�86���������RQ�RUDO� FRQWUDFHSWLYHV�RI�ZKLFK�WKH�PDMRULW\�DUH�GLVWULEXWHG�WKURXJK�02+�IDFLOLWLHV��1RUSODQW�UHFHLYHV�WKH� ORZHVW�VKDUH�RI�86$,'�PRQH\�DQG�LV�RQO\�GLVWULEXWHG�LQ�02+�IDFLOLWLHV��506�IDFLOLWLHV��DQG�-$)33� FOLQLFV��2I�WKH�DSSUR[LPDWH�86����������86$,'�LQYHVWV�LQ�FRQWUDFHSWLYH�FRPPRGLWLHV�LQ�-RUGDQ�� 02+�IDFLOLWLHV�UHFHLYH�RYHU�KDOI��IROORZHG�E\�815:$�FOLQLFV��DQG�-$)33�FOLQLFV�$Q�DQDO\VLV�RI� H[SHQVH�OLQH�LWHPV��7DEOH����VKRZV�WKDW�JRYHUQPHQW�IXQGV�DUH�XVHG�WR�SD\�VDODULHV�������DQG� WR�PHHW�UHFXUUHQW�������DQG�FDSLWDO�H[SHQVHV����������'RQRU�PRQH\�LV�XVHG�WR�PHHW�UHFXUUHQW� H[SHQVHV�UHODWHG�WR�FRPPRGLWLHV��WUDLQLQJ��%&&�DQG�UHVHDUFK����������DQG�VDODULHV�������� +RXVHKROGV�ZKR�XVH�SULYDWH�VHFWRU�IDFLOLWLHV�VSHQG�D�ODUJH�DPRXQW�RI�PRQH\���������RQ�FRQWUD� FHSWLYHV��DQG�VSHQG�������RQ�VDODULHV�DQG�������RQ�UHFXUUHQW�H[SHQGLWXUHV��2YHUDOO��VDODULHV� DEVRUE�WKH�ODUJHVW�SRUWLRQ�RI�IXQGLQJ��������IROORZHG�E\�UHFXUUHQW�FRVWV����������&RQWUDFHSWLYHV� UHFHLYHG�DERXW�����RI�WRWDO�IXQGLQJ� Table 2: Sources and Uses of Funds for Family Planning – Expense Line Item )LJXUH���VXPPDUL]HV�WKH�ÀRZ�RI�IXQGV�WKURXJK�ERWK�WKH�SXEOLF�DQG�SULYDWH�FRPSRQHQWV�RI�WKH� -RUGDQLDQ�)DPLO\�3ODQQLQJ�V\VWHP��,W�GLVWLQJXLVKHV�EHWZHHQ�WKH�VRXUFH�RI�IXQGV��¿QDQFLQJ� DJHQWV��HQG�XVHUV��SURYLGHUV��DQG�¿QDO�XVH�RI�IXQGV��0DQ\�IXQGV�GR�QRW�SDVV�GLUHFWO\�IURP�WKH� VRXUFH�WR�WKH�DFWXDO�SURYLGHUV�RI�VHUYLFHV��,QVWHDG��D�VLJQL¿FDQW�SURSRUWLRQ�SDVVHV�IURP�RQH� RUJDQL]DWLRQ�WR�DQRWKHU�EHIRUH�LW�LV�¿QDOO\�XVHG�WR�SURYLGH�IDPLO\�SODQQLQJ�VHUYLFHV� Table 3: Summary of FP Sub-analysis Findings

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