Opinion: Healthy Marketplaces Are Critical for Universal Health Coverage

On December 12, 2015, a coalition of more than 600 global partners will mark Universal Health Coverage Day, the three year anniversary of the unanimous adoption of a UN General Assembly resolution that counseled governments to provide universal health coverage to their people. As this date draws near, we see greater numbers of countries pursuing universal health coverage reforms, and we want these reforms to result in reliable access to high-quality reproductive health commodities for all women.

A Healthy Family Planning Marketplace is Diverse

Over the years, we have learned that reliable access to reproductive health commodities depends on a healthy marketplace and women’s equitable access to this marketplace. Research conducted with DHS data over the years illustrates that large numbers of women around the world seek reproductive health commodities from the private sector (including the private commercial, NGO, and social marketing channels). Research additionally shows us that it is amongst the lowest wealth quintiles where dependence on the private sector is the greatest.

A healthy marketplace therefore must be diverse and offer choice: choices between public and private-sector source; choices between visiting a pharmacy/drug seller or health facility; choices between a range of family planning methods; and choice between innovator and generic products. These choices must be affordable and equitable, and include high-quality counseling, services, and products. Also, all segments of the population must have access, including adolescents, unmarried women, and those living in rural settings and urban slums.

A Healthy Marketplace Promotes UHC for family planning

A healthier marketplace for family planning will directly support progress toward the Sustainable Development Goal (SDG) Target 3.8, which calls for access to high-quality essential health care services as well as safe, effective, high-quality, and affordable essential medicines for all.

Public Sector stewardship is Critical

A healthy  marketplace for family planning includes public-sector health facilities and pharmacies; private NGO and social franchise networks; private health facilities; private pharmacies and drug sellers; and retail and nontraditional outlets. SThis really can only be realized with ongoing, capable stewardship from the public sector. As noted in “Ensuring Access to Reproductive Health Supplies in the Context of Universal Health Coverage” (the first post in this blog series), this stewardship is indispensable because governments must guide, shape, and oversee policy as well as the necesarry financial, operational, quality assurance, and regulatory systems. Stewardship is critical for success in UHC, and vital to creating and maintaining a healthy family planning marketplace.

A UHC Program Can Support Creation of a Healthy Family Planning Marketplace

When designing a UHC program, total market considerations—the needs and preferences of actors in the different market sectors as well as those of all population segments —must be taken into account.  These considerations should be applied when designing comprehensive packages of health services and commodities, including afull range of providers; efficient procurement and pricing policies; and financing and reimbursement mechanisms. This approach not only makes sense pragmatically but rights-based principles underlying it can help resolve the often difficult decision associated with limited resources and capacity constraints when developing a UHC program.  

If the countries implementing UHC reforms act with a total market perspective, and effective stewardship from the public sector, we can and will see healthy family planning marketplaces evolve.

Safia Ahsan, Technical Advisor at John Snow, Inc.

This post is part of an occasional series of articles written by members of the RHSC’s universal health coverage (UHC) steering team. The series explores different perspective and topics on the role of supplies in UHC policies.