Christian Aid’s research in Malawi, Sierra Lone, Kenya and Nigeria has supported the view that public financing is the most reliable and sustainable way to secure access to health services and particularly to sexual and reproductive health for marginalised women and girls.
Public financing helps to spread the risks of economic and health shocks as well as reduce out-of-pocket health expenses that have a disproportionate impact on people living in poverty.
The findings of our research are summarised in our new briefing, Bridging the Gap.
The need for public financing
The need for public financing is even more critical now that the Covid-19 pandemic has increased poverty and widened inequalities.
In poorer countries especially, women, adolescent girls and marginalised communities have been particularly hard-hit, not only by reduced access to services including maternal and child health and family planning, but also by increased needs resulting from associated risks such as poor health, loss of income, early marriage and increased unpaid care responsibilities.
One element of Sexual and Reproductive Health and Rights (SRHR) is access to modern family planning services which, according to recent estimates by UNFPA, may have been reduced for up to 23 million women and girls in low and middle income countries, resulting in up to 2.7 million unintended pregnancies during 2020.
Economic impacts of the pandemic
UNFPA’s estimates are much lower than some earlier predictions - among 70 countries it surveyed, 41 reported that they had managed to maintain facility-based family planning services at pre-COVID-19 levels, with only 30 reporting interrupted services during 2020.
However, many poorer countries now face longer-term economic impacts of the pandemic, even as they are still awaiting sufficient vaccinations to protect their citizens. Many health risks remain, and increased burdens of public debt and austerity measures loom, at a time when populations, and particularly women and girls living in poverty, are at their most vulnerable.
Participatory and gender-responsive budgeting processes
In this context, it is very important that financing of health and particularly for SRHR is not only maintained but increased and also utilised in a way that is effective and fair.
Even before the pandemic, many gaps remained in the range, quality and reach of services and in the realisation of rights in key areas, including the prevention of sexual and gender-based violence and other harmful practices, sexual and reproductive rights and maternal and child health. Within national health budgets, SRHR was often found to have been a low priority.
Our research points to a need for more participatory and gender-responsive budgeting processes to improve accountability and responsiveness to SRHR needs.
Tackling tax dodging and cancelling unfair debt
At the international as well as national levels, the conditions must also be put in place to ensure sufficient revenues can be raised for financing health, for example, by taking action to tackle tax dodging by multinational companies and cancelling unfair debt.
None of the countries that were the focus of Christian Aid’s research had managed to meet targets to allocate 15 percent of their national budgets to universal health coverage.
Now, these countries are likely to be facing additional fiscal constraints at a time when financing for health and other aspects of public spending, such as for social protection, critical to address the increased needs and inequalities generated by the pandemic.
On 5 May, Christian Aid brought together a panel of experts to discuss what’s needed to bridge the gaps in financing for sexual and reproductive rights and services, what the barriers are, and what international action is needed to ensure poorer countries can generate the resources they need.
Watch the panel discussion
On 5 May, Christian Aid brought together a panel of experts to discuss what’s needed to bridge the gaps in financing for sexual and reproductive rights and services, what the barriers are, and what international action is needed to ensure poorer countries can generate the resources they need.
Watch the panel discussion on the importance of fiscal justice for women and girls’ access to Sexual and Reproductive Health Rights.