This paper examines the impact of different financing regimes on the delivery of reproductive health services in low and middle-income countries. Financing is an important entry point for examining the impact of health sector reforms on reproductive health. It is likely that different financing regimes have different implications for access to reproductive health services. Health systems are increasingly funded from a multiplicity of sources and through a wide range of fiscal mechanisms. The effects of these changes in modes of financing on reproductive health services are not well understood.
The paper explores three issues. First, it looks at the broad trends in health financing in low and middle-income countries and how they relate to the provision of reproductive health services. At international level, these include transfer mechanisms, such as project and programme aid, social funds and the growing influence of verticality in multilateral funding strategies. At national level, these include cost recovery measures such as fees, pre-payments and insurances, as well as safety nets.
Second, it asks whether and how the balance has shifted between collective and individual responsibility for reproductive health and what are the implications for outcomes. There has been an increasing trend towards use of the private sector, even by poor people, as public sector health provision has come under strain. Rising costs of medical care also mean decreasing access to services, particularly for the very poor. To what extent have changing financing modes shifted the cost burden of reproductive health related conditions towards the end user?
Third, it considers what kinds of monitoring, oversight and advocacy can be undertaken nationally to improve the financing and implementation of effective reproductive health care. Several methodologies have been developed which could potentially be adapted to monitor reproductive health spending, such as National Health Accounts and Women’s Budgets. It notes their advantages and limitations.