MLI Issue Brief: Getting the details right in financing reproductive health

High-level support and smart program design are crucial to launching health financing strategies, but success hinges on developing effective implementation and monitoring, according to a MLI issue brief on reducing financial barriers to reproductive health released this month. 

“While design of any financing strategy is important, it is often problems in implementation that derail effectiveness,” writes author Allison Gamble Kelley, a health economist and MLI Country Lead for Mali.  Kelley outlines the need for continuous monitoring and adaptation of new programs to ensure that they meet their potential.

The 13-page issue brief, “Reducing Financial Barriers to Reproductive Health Care: Experiences with Free Care and Health Insurance,” explores tensions between financing arrangements that bring rapid gains in targeted areas such as maternity care, and those aimed at sustainable progress for entire health systems. Kelley focuses her analysis on the five countries in which MLI is working to enhance health ministry leadership: Mali, Senegal, Sierra Leone, Ethiopia and Nepal. The report also reviews experiences from Ghana and Rwanda.

Despite political commitment to improve access to services using both free care and expanded insurance options, administrative fragmentation in some countries is hindering operations, according to the paper. The two initiatives often are managed by different parts of the same ministry, or by different ministries completely, with “little articulation of how these two financing strategies relate and interact,” Kelley writes.

Combining short and longer-term strategies can work, Kelley concludes, “If they are coordinated within an overarching financing strategy, and of course, not overly burdensome from an administrative and financial perspective.”

But she adds, “These strategies are complex undertakings, and they require support, supervision, and an eye to evolution and adjustment over time.”

Among lessons learned in reviewing program implementation is the need for effective communication among stakeholders. One particularly poignant example is Kelley’s example of transportation as a barrier to accessing care when Mali launched a free C-section program in 2002. The program ran into long-standing barriers due to confusion over who would pay ambulance maintenance and fuel fees.  Ensuring adequate and sustainable funding also can be an issue. In Sierra Leone, large funding commitments were made by the Government and development partners to launch a free care policy for women and children, but a significant funding gap remains and future funding is uncertain. Communication and predictable resource allocation are essential to ensuring program support from facilities and communities, Kelley says.

With global attention on progress towards MDG 5 and reducing mortality, this issue brief examines the critical role of improving national health financing strategies.  “In keeping with MLI’s focus on country ownership and leadership, “Reducing Financial Barriers to Reproductive Health” calls attention to the importance of effective government leadership to design, implement, and evaluate these programs,’’ said Rosann Wisman, MLI’s Director.