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Forum on Financing Reproductive Health Services in the Context of Health Sector Reform

The Partners for Health Reformplus (PHRplus) project, in collaboration with the CATALYST consortium, conducted a half-day forum on Financing Sexual and Reproductive Health Services in the Context of Health Sector Reform, held July 16, 2003, at the National Press Club in Washington, DC. The purpose of the forum was to share lessons learned and experiences from developing countries which have used different mechanisms to finance and sustain sexual and reproductive health services in light of evolving health sector policies.

Chairing the forum, PHRplus Project Director, Nancy Pielemeier, began the panel discussion by summarizing the key components of health sector reform and referred participants to the framework set forth in the recently-released brief by Population Reference Bureau (PRB) and PHRplus entitled, Health Sector Reform: How it Affects Reproductive Health. The three panelists provided engaging and thought-provoking presentations from three different perspectives: the private commercial sector; the public sector; and NGO.

Carlos Carrazana, Director of the Summa Health Foundation, discussed Nicaragua’s experiences with financing and expanding reproductive health (RH) services through the private for-profit sector. The presentation, Financing and Expanding RH Services through the Commercial Sector, outlined some of the successes and challenges of the transformation of the Nicaraguan Social Security Institute (INSS) into a purchaser, rather than provider, of health services. Since 1993, the INSS has been contracting NGO, private commercial, and MOH facilities for the provision of services to social security contributors. Under the new financing and delivery model, contracted facilities (known as EMPs) have been providing a sustainable level of reproductive health services in low-resource settings. The presentation also highlighted capacity constraints within the commercial sector and issues surrounding accreditation and other mechanisms to promote quality of care.

Thomas Merrick from the World Bank Institute shared his insights on the impact of health sector reform initiatives on reproductive health in his presentation titled, Financing Reproductive Health Services in the Context of Health Sector Reform: Reflections on Recent Experience in Bangladesh and the Philippines. He stressed the political realities that sometimes slow down the bold steps that health reform often requires and the importance of seizing windows of opportunities for action. He cited examples of the mixed effect of decentralization of health resources and decision making on reproductive health services and the importance of educating consumers /clients about their rights and responsibilities in evolving health systems.

María Isabel Plata from PROFAMILIA/Colombia gave an in-depth picture of the challenges faced by her NGO in providing family planning and reproductive health services in the 1990s as the government implemented health policy reforms and donor resources became scarce. In her presentation entitled, PROFAMILIA/Colombia and the Health Sector Reform, Plata frankly discussed the necessary institutional changes and innovations necessary to continue to provide quality services in a changing political environment, such as providing new services and broadening the client base; strengthening accounts receivable, cost accounting and management information systems; and advocating for reforms that promote sexual and reproductive health services.

At the close of the presentations, Dr. Pielemeier summarized the key themes emerging from all presentations including the importance of building capacity throughout the health sector, the need to educate the public about their rights as clients and consumers of family planning goods and services, the need for working capital until providers are sustainable in their operations, and the need to set appropriate incentives to promote the use of family planning services. In addition, panelists agreed on the need to: develop and ensure effective means of accreditation and quality assurance and phase in integration of commodity procurement systems until health reform efforts are well underway.

For more information on the forum, contact Tania Dmytraczenko at

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