1.0 Background
In the past 25 years, noteworthy progress has been made towards the realisation of universal sexual and reproductive health and rights (SRHR) in most parts of the world, including in East and Southern Africa (ESA). The ESA region is home to more than 670 million people, with a third of its population between 10 to 24 years of age.
Despite progress, the promise of universal access to SRHR remains to be fulfilled for millions of people in the ESA region. Considering the current pace of progress, it could be concluded that the ESA region is unlikely to achieve universal access to comprehensive SRHR (Box-1) by 2030.
The good news is that the momentum around UHC (Box-2) is growing in the ESA countries. Most countries have committed to (a) progressively achieving UHC; (b) stopping the increase and reversing the increasing trend of catastrophic out-of-pocket health expenditure by providing measures to ensure financial risk protection for eliminating impoverishment due to health-related expenses by 2030; and, (c) progressively mobilise more resources for attaining UHC by following a life-course approach.
To accelerate progress towards UHC, most of the ESA countries are: prioritising the provision of a set or multiple sets of health services tailored to their country's needs; and, developing plans to progressively expand the number of services under UHC as the financing for health increases.
The UHC frameworks of most of these countries include not only ‘what services are covered across the life-span of individuals’ (also referred to as UHC benefit package), but also ‘how they are financed’ (i.e., many countries are trying to refine the existing health financing and financial risk protection mechanisms and/or planning to initiate new mechanisms), and ‘how they are delivered’ (i.e., services delivered at primary, secondary and tertiary level through the public or public-private mixed delivery systems).
2.0 Rationale
The current momentum around UHC in the ESA region provides an opportunity to progressively include comprehensive Sexual Reproductive Health and Rights (SRHR) within the country-specific ‘UHC benefit packages’, ‘UHC Financing arrangements’ and ‘Financial risk protection mechanisms’ by following a life-course approach.
With support from ESARO, nine countries (Botswana, DRC, Ethiopia, Kenya, Malawi, Madagascar, Namibia, South Sudan and Zambia) have done rapid assessments to identify bundles of SRHR services that are currently included in the country-specific UHC benefit packages, financing and financial protection mechanisms
1.0 Background
In the past 25 years, noteworthy progress has been made towards the realisation of universal sexual and reproductive health and rights (SRHR) in most parts of the world, including in East and Southern Africa (ESA). The ESA region is home to more than 670 million people, with a third of its population between 10 to 24 years of age.
Despite progress, the promise of universal access to SRHR remains to be fulfilled for millions of people in the ESA region. Considering the current pace of progress, it could be concluded that the ESA region is unlikely to achieve universal access to comprehensive SRHR (Box-1) by 2030.
The good news is that the momentum around UHC (Box-2) is growing in the ESA countries. Most countries have committed to (a) progressively achieving UHC; (b) stopping the increase and reversing the increasing trend of catastrophic out-of-pocket health expenditure by providing measures to ensure financial risk protection for eliminating impoverishment due to health-related expenses by 2030; and, (c) progressively mobilise more resources for attaining UHC by following a life-course approach.
To accelerate progress towards UHC, most of the ESA countries are: prioritising the provision of a set or multiple sets of health services tailored to their country's needs; and, developing plans to progressively expand the number of services under UHC as the financing for health increases.
The UHC frameworks of most of these countries include not only ‘what services are covered across the life-span of individuals’ (also referred to as UHC benefit package), but also ‘how they are financed’ (i.e., many countries are trying to refine the existing health financing and financial risk protection mechanisms and/or planning to initiate new mechanisms), and ‘how they are delivered’ (i.e., services delivered at primary, secondary and tertiary level through the public or public-private mixed delivery systems).
2.0 Rationale
The current momentum around UHC in the ESA region provides an opportunity to progressively include comprehensive Sexual Reproductive Health and Rights (SRHR) within the country-specific ‘UHC benefit packages’, ‘UHC Financing arrangements’ and ‘Financial risk protection mechanisms’ by following a life-course approach.
With support from ESARO, nine countries (Botswana, DRC, Ethiopia, Kenya, Malawi, Madagascar, Namibia, South Sudan and Zambia) have done rapid assessments to identify bundles of SRHR services that are currently included in the country-specific UHC benefit packages, financing and financial protection mechanisms.
Following these assessments, new resources have become available. WHO has refined the UHC Compendium which provides a database of proven health services and inter-sectoral interventions designed to assist countries in making progress towards Universal Health Coverage (UHC). The UHC compendium includes proven services by intervention areas including the SRH services. On the basis of the UHC compendium, CARMMA Plus, SADC and ESA strategies pertaining to SRHR, UNFPA in partnership with HEARD at the University of KwaZulu Natal, South Africa, has developed a draft SRHR across the life-course matrix. This draft matrix outlines proven services/interventions under each of the nine bundles of SRHR services . Therefore, building on the rapid assessments, there is an urgent need to carry out an in-depth review to identify missing elements of SRHR services in country-specific UHC initiatives (i.e., UHC benefit packages, and financing and financial protection mechanisms) by using the WHO’s UHC Compendium and UNFPA ESARO’s draft SRHR across the life-course matrix.
On the basis of this in-depth review, country-specific policy briefs to help enhance policy makers' and influencers' understanding of how to progressively integrate comprehensive SRHR into UHC will also be developed. This brief will include potential actions for embedding missing elements of SRHR in UHC across life-course to accelerate progress towards (a) universal SRHR; (b) sustainable financing of SRHR; and, (c) UNFPA transformative goals of ending unmet need for family planning, ending preventable maternal deaths, and, ending gender-based violence and harmful practices, and UNFPA ESA regional priority to end sexual transmission of HIV. The policy brief will also outline arguments on how embedding comprehensive SRHR within UHC, by following a life-course approach, is likely to improve the integrated delivery of services, and the defragmentation of multiple health planning, financing and delivery systems.
Scope of Work
UNFPA intends to engage a consultant to:
● Undertake an in-depth assessment to identify missing elements of SRHR in UHC initiatives in particular UHC benefit packages, financing and financial risk protection arrangements by using the WHO’s UHC Compendium and UNFPA ESARO’s draft SRHR across the life-course matrix. If needed carry out key informant virtual interviews;
● Prepare a report on the status of comprehensive SRHR within UHC; and,
● Prepare a policy brief and PowerPoint presentation, in consultation with UNFPA, with evidence-informed actions to progressively situate comprehensive SRHR into UHC.
