Integrating Family Planning into Universal Health Coverage Efforts

Cover of the brief: Picture of Nepalese mother, father and baby with name of the brief on the top - Integrating Family Planning into Universal Health Coverage Efforts.
You can download the full brief using the link.

The following are excerpts from a SHOPS Plus brief, Integrating Family Planning into Universal Health Coverage Efforts. Download the full brief here

The universal health coverage movement presents potential pathways for attaining family planning goals. Family planning advocates are evaluating opportunities to integrate, scale up, and sustain coverage of family planning via financing mechanisms and to coordinate with broader efforts to expand coverage of preventive and primary health services. 

The following are common approaches used to finance health within the context of UHC and the significance of these approaches for family planning. 

Financing family planning in the context of UHC

Of current interest within the family planning community is whether and how the full range of family planning services can be made accessible, particularly to underserved populations such as youth or the poor.

Family planning has historically been delivered via standalone, or vertical programs, funded by donors. These programs capture and retain dedicated technical expertise and funding. However, a vertical family planning program that offers free or highly subsidized services financed by an external funder can have the unintended effect of creating a disincentive for a publicly financed program to cover family planning services. 

Covering family planning in insurance schemes

Family planning services are often excluded from health insurance benefit packages. Exceptions to this are found in many Latin American countries, where progress toward UHC is generally more advanced. 

Research by Avenir Health found that just six of the 14 government-sponsored health insurance schemes in USAID family planning priority countries include family planning in their benefit package. 

Insurance programs tend to cover costly health events, such as hospitalizations. Family planning is preventive and lower in cost than most other services.

The role of private providers

Research from the USAID-supported SHOPS project showed that over a 20-year period, the private sector was the source of family planning for just under half of contraceptive users in Latin America and the Caribbean as well as Asia. In sub-Saharan Africa, the private sector share was just under a third. SHOPS research also shows that private providers are an important source of care for the poor (see figure below).

Small- and medium-sized private providers remain largely untapped by health financing programs. 

Use of private providers for modern family planning methods by two lowest-wealth quintiles. 17% Sub-Saharan Africa; 25% Latin America and 33% Asia.

Financial terms for clients and providers matter

Theoretically, all other things held equal, clients—especially those who are poor—are likely to choose methods (and providers) that are less expensive for them.

Financial terms matter for providers, too. Specifically, payment mechanisms and rates influence providers’ willingness to participate in health financing programs and whether they have a financial incentive to provide one method over another. 

The rise of strategic purchasing

Strategic purchasing refers to a shift from a traditional, reactive bill-paying or line-item budget approach to proactive ones whose design and implementation are evidence-based and support achieving health system objectives. 

A dominant provider payment mechanism in use is fee-for-service, and an emerging one is capitation. Below is a comparison of the two payment mechanisms.

Comparison of provider payment mechanisms


Implications for Family Planning

Family planning advocates can champion the case for effectively covering family planning in the following ways.

  1. Build the case. Greater evidence on what works and does not work is the foundation of a persuasive case for including family planning in health financing programs. 
  2. Engage private providers. Making progress toward UHC is enabled through a total market approach that considers the potential contributions of public and private providers, including small- and medium-sized private providers. 
  3. Strengthen voice. Family planning advocates must argue for effective coverage of family planning in insurance or other health financing programs. They must become more fluent in speaking the language of stakeholders who are accountable for broader health system goals and functions.
  4. Commit to a long-term process. Most low- and middle-income countries are at a nascent stage of UHC. Progress takes time, and learning comes through experimentation and iteration. 
  5. Be pragmatic. There will always be gaps in population coverage, service coverage, and financial protection. Insurance should be viewed as part of the solution, but not a total solution. 

Download the full brief.

Health Area



Sustaining Health Outcomes through the Private Sector (SHOPS) Plus is a five-year cooperative agreement (AID-OAA-A-15-00067) funded by the United States Agency for International Development (USAID). This website is made possible by the generous support of the American people through USAID. The information provided on this website is not official U.S. government information and does not represent the views or positions of USAID or the U.S. government.

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