GLOBAL FINANCING FACILITY CONSULTATION KENYA

GLOBAL FINANCING FACILITY CONSULTATION KENYA All hands on deck: Technical Brief 20 January 2015 Reproductive Health Supplies Coalition Rue Marie-Thérèse, 21, 1000 Brussels, Belgium T. +32 (0)2 21 00 222 F. +32 (0)2 21 93 363 www.rhsupplies.org

GLOBAL FINANCING FACILITY CONSULTATION KENYA All hands on deck: Technical Brief KENYA CONSULTATION Compared to its neighbors Kenya has performed modestly where child and maternal mortality are concerned. The consultation Delivering Universal Health Coverage and Promises for Mothers and Children of Kenya focuses on Kenya s commitment to universal health coverage (UHC) and the MDGs to sustain gains made, mobilize additional domestic resources for reduction of child and maternal health mortality and establish a road-map for achieving UHC. The Global Financing Facility (GFF) - which is to support UHC - is being developed in coordination with many stakeholders, including countries, UN agencies, civil society organizations, and more. A consultative process with a very fast turn-around has been set-up, and the community has been given the opportunity to provide feedback during the consultative period and the Kenya consultation (21-23 Jan 2015) is part of this effort. The Coalition s Advocacy and Accountability Working Group (A&A WG (A&A WG) has put together this technical brief so that by joining our voices we send a clear and compelling message. The brief covers Universal Health Coverage, the Global Financing Facility and makes the connection to sexual and reproductive health and rights and voluntary family planning (SRHR/FP). SAFEGUARDING SRHR/FP BY PARTAKING IN THE GLOBAL DIALOGUE Recent global developments including the FP2020 movement have provided a much-needed impetus to our work. Dedicated attention is required to ensure gains made are not lost. We have learnt from the MDG process that we cannot be complacent and assume SRHR/FP to be automatically addressed in the wider framework of improving maternal health. After years, and at great human cost, SRHR and FP were acknowledged when MDG5b was put in place. UNIVERSAL HEALTH COVERAGE (UHC) UHC implies that all people have access, without discrimination, to nationally determined sets of needed preventive, promotive, curative and rehabilitative basic health services and to essential, safe, affordable, effective and quality medicines, while ensuring that the use of these services does not expose the user to financial hardship, with special emphasis on the poor, vulnerable, and marginalized segments of the population. i Numerous countries have adopted or are embarking on UHC as a social objective to ensure political commitment to and investment in the expanded availability and accessibility of primary health services to improve health outcomes among the most marginalized populations. UHC success stories include Rwanda, Bangladesh, Mexico Thailand and India (Kerala and Tamil Nadu). These countries all made access to SRHR / FP a priority. Low-income countries must learn from these examples and start with modest but high-impact services. UNIVERSAL HEALTH COVERAGE AND SRHR/FP There remain some 215 million women who wish to protect themselves from unintended pregnancy, but do not use modern contraception. Fulfilling the unmet need for FP alone would prevent 150,000 maternal deaths and 640,000 newborn deaths globally each year. In Kenya 6000 women die yearly due to preventable pregnancy related causes. Child and maternal health should be at the forefront of the health agenda, including SRHR/FP. FP should be non-negotiable and included in even the most frugal UHC plans. A core package of RMNCAH services driven by community health workers provides the logical cornerstone of UHC plans. Ensuring universal access to SRHR/FP is, without doubt, one of the most cost-effective investments in health and development. Every dollar spent on SRHR/FP can save up to seven dollars in direct health costs. ii Moreover, a failure to invest in prevention will ultimately drive the need for an even higher investment in curative care for reproductive, maternal, newborn, child and adolescent health (RMNCAH). 1

HUMAN RIGHTS BASED AND WOMAN-CENTERED Any UHC operation must have a solid human-rightsbased (HRB) foundation. The global community must safeguard the right of women to be able to access a range of high-quality FP methods of their choice. HRB approaches are characterized by a focus on the underlying social determinants of health and an emphasis on the principles of accountability, meaningful participation, transparency, equality and non-discrimination. Women often bear the greatest share of the economic costs associated with their families health, UHC can also have a proportionally greater effect on women by dramatically reducing their out-of-pocket costs and offering financial protection. Women also play a central role in the delivery of health care and spreading of knowledge. We therefore need to underline the importance of utilizing a woman-centered agenda to operationalize UHC. A GLOBAL FINANCING FACILITY IN SUPPORT OF RNMCAH AND UHC In support of Every Woman Every Child, the Global Financing Facility (GFF) aims to: mobilize support for developing countries plans to accelerate progress on the health-related Millennium Development Goals and bring an end to preventable maternal and child deaths by 2030. The GFF for RMNCAH was announced at the UN General Assembly in September by the World Bank Group and governments of Canada, Norway, and the US. We rally behind the vision of a continuum of care across a person s life-span which RMNCAH embodies. From its aim and focus (increasing financing, results based financing, iii sustainability and accountability iv ) it is clear how the GFF may contribute to UHC. PRIORITIZING SRHR/FP Despite its proven effectiveness, SRHR/FP remains controversial and rarely is seen as a vote-winner. In addition, the GFF should support national progress towards universal coverage of SRHR/FP. SRHR/FP is preventative and prevention loses out when curative needs clamor for attention in the RMNCAH sphere. Recent experience from the UN Commission on Life Saving Commodities has shown how national level curative care repeatedly takes precedence over the long-term positive impact of investing in SRHR/FP. GFF funding needs to strike a balance between shorterterm health interventions and medium/long term investments that promise to yield savings across other parts of the continuum of care. COMMITMENTS AND COUNTRY OWNERSHIP Work carried out under the Coalition s Commitments Initiative has surfaced explicit SRHR/FP commitments by more than 73 low and middle income countries over the past decade. We believe the global community is responsible for supporting countries to achieve their commitments by helping them to strengthen the systems and services needed to deliver a range of high-quality supplies and services to the women, girls and men who demand them. MARKET PERSPECTIVE AND EQUITY Equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically. Market development is crucial in this discussion. Decision makers should recognize and enhance the redistributive nature of health care systems by emphasizing five policy goals: universal coverage; public financing; absence or near-absence of user fees for public services; access to a comprehensive range of services; and a private-sector role that clearly and equitably complements the public sector. V HEALTH SYSTEMS STRENGTHENING SRHR/FP brings a key contribution to HS strengthening and supporting FP distribution systems has been crucial in the past for other areas (HIV to Malaria). These include models of community outreach, youth programming, sustainability, supply, etc. that hold many solutions. UHC and the GFF should consider substantial investments in further strengthening health systems that work for RH supplies and FP, addressing barriers to contraceptive use and deliver high impact interventions at high enough coverage levels, at the right time, to the right populations (e.g. underserved groups such as adolescents). Investments in HS strengthening should be targeted towards scaling up the health workforce needed to deliver SRHR/FP services, including logisticians and supply chain managers, as well as enhancing health information systems and ensuring equitable and sustainable access to SRHR/FP medical products and technologies. In 2013, the WHO estimated a global deficit of 7.2 million doctors, nurses and midwives needed to deliver an essential package of health services. In addition the geographical distribution of health workers and the distribution of tasks among different cadres of workers must addressed. 2

Innovative approaches are required to ensure increased access to SRHR/FP supplies and services. WITH REGARD TO THE GFF AND UHC WE STRONGLY BELIEVE THAT: 1. Any UHC operational plan and the GFF should explicitly recognize FP s special nature and contribution to public health. 2. The GFF should include a dedicated financing window or separate initiative for SRHR/FP to achieve universal access by 2030. In terms of health systems, financing is necessary but not sufficient for ensuring UHC. There will be no UHC without an adequate health workforce, safe and accessible health services, quality and sustainable medical products, and reliable information for decision making. a. Funding must support ALL aspects of SRHR and ensure increased funding for commodities. SRHR/FP is the most cost- effective public health and development intervention and should be included as a best buy intervention. We need to ensure that national restrictions of donor countries will not apply to the fund as this will have major repercussions for SRHR/FP. b. Existing programs at the national level like the Global Programme should not be affected. c. The GFF must deliver additional investment. d. There must be no gap in funding for SRHR/FP, or interruption to supply chains, while the GFF is operationalized. e. No country should be discouraged from supporting all aspects of SRHR/FP by the GFF financing architecture. 3. GFF and UHC mechanisms, including results-based financing approaches, must be equitable and put client rights at the centre. 4. Civil society must be afforded a formal role in the design and establishment of the GFF and UHC, and in the design of national plans, financing maps, and accountability efforts. Civil society involvement must be integral to the development and validation of country RMNCAH plans and financing roadmaps. 5. The GFF and UHC framework must have strong SRHR/FP indicators such as Contraceptive Prevalence Rate and those included in IDA. Clear targets and indicators support accountability efforts but what else is envisioned? Accountability goes beyond counting and registration. How can the community contribute to data gathering? 6. The SRHR/FP community must be allowed adequate time to weigh in on GFF-related provisions for commodity procurement, and other operational areas in which the community possesses technical expertise. 7. Donors shifting funds via the GFF should continue to track Official Development Assistance (ODA) for SRHR/FP to ensure it furthers FP2020 Summit and World Bank commitments. Concerns over shift towards loans and impact on SRHR/FP. 8. There is a significant gap in funding SRHR/FP in the region of Asia and the Pacific. The funding gap to reach the commitments of the ICPD agenda is estimated to reach 7 billion by 2015, and results in increasing inequality in between and within the countries of this region, and a high unmet need for FP. To have the greatest impact, interventions must target the most marginalized and vulnerable groups. As well, the majority of the worlds poorest are in middle income countries, while concurrently these are the same countries which are experiencing freezing or declining levels of bilateral and international assistance. 9. Coverage can t be universal if some services and service users are routinely left off the list. Financial protection packages (i.e. prepaid health services under universal health coverage schemes) often exclude essential and routine SRH services, such as delivery and emergency obstetric care, FP, and safe abortion. VI 10. Where SRH care is offered, it often exclusively focuses on maternal health and doesn t address the needs of adolescent girls, older women, men and trans people. How do we protect marginalized groups? 3

Advocacy and Accountability (A&A) WG The Advocacy and Accountability (A&A) WG of the Reproductive Health Supplies Coalition organized the sign-on to raise awareness on the Global Financing Facility, and ensure that the feedback from the FP/SRHR community was consolidated and fed into the consultation process. The position paper was endorsed by the GFF advisory group of the Coalition consisting of FP2020, EFP, IPPF, PAI, MSI, AFP, RHSC, and UNFPA. 269 Individuals, from 166 different organizations (NGOs, public and private sector, foundations, and academia), from 57 countries signed in support of the A&A WG position paper on the GFF. The Reproductive Health Supplies Coalition supports an advisory group on the GFF, a GFF work stream led by the A&A Working Group and a steering group on RHS and UHC. For more information please contact Lou Compernolle lcompernolle@rhsupplies.org. i WHA Resolution 58.33 Geneva: WHO; 2005. United Nations General Assembly. Resolution. A/67/L.36 (6 December 2012) ii Ensure universal access to sexual and reproductive health for all/ PHENOMENAL/ Robust evidence for benefits more than 15 times higher than costs. Copenhagen Consensus: http://www.copenhagenconsensus.com/publication/preliminary-benefit-costassessment-12th-sessionowg-goals iii Nigeria is an example where results based financing led to an impressive increase in contraceptive prevalence. iv On the Shaping the Future for Healthy Women and Children website, you will find additional information on the GFF http://www.who.int/ pmnch/gff/en/ v Gilson L, Doherty J, Loewenson R, Francis V, with inputs and contributions from members of the Knowledge Network. Challenging Inequity through Health Systems: Final Report, Knowledge Network on Health Systems, WHO Commission on Social Determinants of Health. Geneva: WHO Commission on Social Determinants of Health; 2007; http://www.who.int/social_determinants/resources/csdh_media/hskn_ final_2007_en.pdf vi MHTF/Ten arguments for why gender should be a central focus for universal health coverage advocates, Jan 12 2015 4