Financing reproductive health services in Africa: The role of aid, insurance, user fees and general taxation

Financing Reproductive Health Services in Africa: The Role of Aid, Insurance, User fees and General Taxation Nana Enyimayew Without appropriate financial resources, scaling up effective reproductive health interventions in order to achieve the Millennium Development Goal for maternal health (MDG 5)1 will be virtually impossible. Yet little is known about how much is currently being invested in reproductive health services within African countries or whether levels of funding are changing. Estimates place the additional funding requirements to attain universal coverage at a minimum of US$7 billion per year. Other estimates suggest that even greater investments are needed. Irrespective of the precise figure, the conclusion is clear: the financing gap represents a substantial sum in relation to domestic budgets. Adequate, well-managed financing of public health systems in general continues to elude most countries. The difficulty is especially severe in low-income countries, most of which are in Africa, whose health systems struggle with meagre and inequitably distributed resources. Additionally, access to services for the most disadvantaged is usually very poor, further reducing the benefit of already scarce resources for those most in need. Success or otherwise of different health financing strategies is critical in determining the fate of such populations and therefore needs to be documented and presented to inform the development of right policies. Filling the information gaps requires appropriately designed and executed research. At minimum, reproductive health (RH) services may be defined as those activities whose primary purpose is to restore, improve and maintain the health of women and their newborns during pregnancy, childbirth and the seven-day postnatal period. This chapter provides an update of the current knowledge of financing of RH services in Africa and suggests a framework for further research in these areas. It also presents examples of national and regional efforts to adopt and implement financing policies that aim to address national objectives of access, equity, quality and appropriate utilisation of RH services to meet MDG 5 by 2015. Issues of exemptions, subsidies and efficiency are also discussed within the scope of financing RH services. A review of basic services is presented in Table 5.1. Reproductive Health, Economic Growth and Poverty Reduction in Africa 108 Table 5.1: Range of reproductive health services Category of care Interventions Antenatal care Basic antenatal care Management of severe anaemia Treatment of malaria Management of syphilis, gonorrhoea and Chlamydia Normal delivery care Clean and safe delivery Post-partum care Basic newborn care Essential obstetric care Management of eclampsia, sepsis, haemorrhage and abortion complications, plus provision of emergency caesarean section Family planning Family planning information and services Other Prevention and treatment of HIV/AIDS How Much Do Reproductive Health Services Cost? Information from various sources suggests that the per capita cost of providing a package of reproductive health services ranges between US$0.5 and US$6.0 (Weissman et al., 1999; World Bank, 1993). Global costs for reproductive health are estimated at US$7 billion dollars per year till 2015 while analyses done using the methodology of the UN Millennium Project suggest that family planning programmes in Africa alone would increase from US$270 million in 2006 to nearly US$500 million by 2015 (Cleland et al., 2006). A selection of per capita cost estimates is presented in Table 5.2. Table 5.2: Per capita cost estimates for reproductive health services Service Cost (US$) Mother and Baby package (1) 0.5 (current level of service provision) Uganda 1999 1.4–1.8 (standard level of service) WDR Global 1993 (2) 4.0 Making Motherhood Safe (3) 2.0–6.0 Range 0.5–6.0 Sources: (1) Weissman et al. (1999); (2) World Development Report (World Bank, 1993); (3) Ransom and Yinger (2002). Making Motherhood Safer. The wide range of costs reflects the practical difficulty facing service providers, researchers, policy makers and society in general in meeting the requirements for accurate estimates of reproductive health care costs. These include defining the boundaries of RH, and standardising the content and quality of a given package of care. Questions that continue to engage service providers and policy makers are; How much do reproductive health services at household, community and country level Financing Reproductive Health Services in Africa 109 cost? How much must governments and society spend on RH services to achieve national and global targets. What should be the minimum content of a standard package of care if countries in resource-constrained environments are to meet their targets? Global estimates provide a useful guide to...

Source: UG