Analyzing and improving the financing for family planning service delivery in humanitarian crises

May 26, 2022
May 26, 2022

This report is originally posted on the Health Policy Plus website, a projected funded by USAID through Palladium. Plan International is a partner on the project and contributed to the report.

Authors: Patrick Pascal Saint-Firmin (Palladium), Erin DeGraw (Plan International USA), Anamika Sinha (Palladium) and Arin Dutta (Palladium), all with the Health Policy Plus project.

 

Globally, an estimated 1 out of 70 people are affected by a humanitarian crisis with approximately 132 million people across the world in need of assistance. Due to natural or man-made emergencies disrupting the functioning of communities and causing widespread human, material, economic or environment loss, affected people cannot cope using their own resources and need national or international assistance. While such investments have increased significantly, there are substantial funding gaps for humanitarian aid. These funding limitations have restricted humanitarian response efforts, leaving large numbers of displaced individuals without adequate health care services. Approximately a quarter of those facing internal and cross-border displacement are women and girls of reproductive age representing a large population in need of critical basic reproductive healthcare services, including family planning. Yet, despite clear evidence of demand for family planning within humanitarian crises, response efforts suffer from several challenges linked to humanitarian funding dynamics.

In light of these challenges, the U.S. Agency for International Development-funded Health Policy Plus (HP+) project conducted a review of the humanitarian crisis response planning processes, cases and associated literature to understand how family planning needs are managed and financed across humanitarian crisis contexts. This report presents the critical challenges, key lessons learned and possible opportunities that HP+ has identified to help improve financing for family planning as part of humanitarian response efforts.

Tigist was forced to flee her home when fighting broke out nearby, and she now is living at a temporary center for displaced people. Ethiopia is facing multiple crises at one time.
Tigist was forced to flee her home when fighting broke out nearby, and she now is living at a temporary center for displaced people. Ethiopia is facing multiple crises at one time.

Key findings

  1. Coordination and collaboration across actors as part of the overall health response often remains a significant challenge. Effective coordination is critical to ensure a comprehensive family planning response. Failure to adequately include family planning in pre-crisis preparedness planning limits humanitarian responders’ ability to deliver services during an emergency. Often development actors are not involved in the planning process, creating issues in provision of sustainable comprehensive family planning services during the post-crisis phase.
  2. Governing laws, policies and regulations affect the availability of commodities and ability to access health care, including family planning. Humanitarian contexts are often unpredictable and unstable — this can have an impact on family planning commodities and supplies. Factors affecting the ability of the supply chain to ensure continuity of care for clients include delays due to a country’s import regulations and costs, higher requirements for last-mile delivery and lack of capacity of local suppliers.
  3. Predicting and supplying commodities through a tailored response that meets the needs and preferences of the displaced population across different crisis phases is challenging. One of the major difficulties for family planning humanitarian response actors is associated with their ability to navigate the transition from the use of reproductive health kits, designed for immediate short-term response, to sustainable supply chains when the crisis stabilizes or becomes protracted. This lack of transition preparedness is compounded by funding fluctuations and gaps leading to inappropriate financing decisions over methods offered that are associated, at least in part, with changes in the humanitarian actors managing the reproductive health response over time.
  4. Subsidized health services in long-term refugee contexts contribute to increases in family planning knowledge and use. However, out-of-pocket payments are a critical issue that restrict access to reproductive health in humanitarian crisis contexts. Setting up financial protection programs that include family planning would address immediate issues linked to the financial cost of accessing services while mitigating the longer-term financial burden that women and adolescent girls might experience in unplanned birth. Currently, there is little evidence on existing financial protection measures and how these might reduce out-of-pocket payments across different contexts of crisis response, but generating that evidence could help guide future efforts to reduce financial barriers to women and adolescent girls during humanitarian crises.
  5. Funding streams specific to the family planning humanitarian crisis response are difficult to track due to their limited visibility in financial data reporting systems. With funding information aggregated to reflect the overall health response, family planning humanitarian program actors are unable to clearly estimate current funding gaps, predict unanticipated financing challenges or promote financial accountability. The absence of a central repository for reproductive health data collected during a humanitarian emergency limits the ability to share information and data for informed decision making and improved coordination across partners and to draw comparisons across crisis settings.

Recommendations

Better and earlier planned integration of family planning services in host country health systems provides opportunities to create more synergies between central and local host governments, philanthropic agencies and institutions, implementers and partners. A united and concerted effort by these actors toward the family planning humanitarian response will help to: agree on and implement standards for family planning service quality and affordability; develop mitigation plans for foreseen financing gaps to achieve the desired scale and quality of services; and explore gender-sensitive interventions and programs focused on economic and financial inclusion of displaced populations as potential transition opportunities for more sustainable family planning.

The family planning-humanitarian crisis response framework introduced in this report, and the discussion of cases and issues, can be applied to predict and address problems that affect access, quality and financial protection for family planning services in future crises. Use of such frameworks, together with ongoing changes to humanitarian crisis response financing (as laid out in the Grand Bargain and other approaches), may lead to improvements in a number of areas, including planning and coordination, pre-positioning and conditioning of the supply chain for family planning commodities, shared data to inform decision making and more sustainable service delivery.

Looking to the future, the protracted nature of some crises does not clearly fit the mission of purely humanitarian crisis response actors. As a result, addressing the long-term reproductive health and family planning needs of refugees and other displaced people in these situations requires sustainable solutions. Humanitarian crisis response plans can evolve to cater to long-term settled situations for displaced people. However, planning for family planning services over these longer-term arrangements is a developing area of work that requires further attention.

Read the full report here.