Domestic Government Expenditures on Family Planning
Mobilizing domestic resources for family planning is an important aspect of long-term sustainability of family planning services, and many governments have made commitments to increase domestic expenditures on family planning.
Several efforts are underway to track family planning expenditures, but the task is complicated by the nature of government expenditures. Some health expenditures are clearly identified in budgets as family planning—such as contraceptive commodities, family planning training, and communications programs—and these items are relatively easy to compile from expenditure reports. These items, however, represent only part of family planning expenditures by domestic governments, as the larger costs around personnel and facilities are usually shared across all health activities rather than identified with a particular service such as family planning. Another complication for tracking government family planning expenditures is that health expenditures may be made both by the national government and by subnational administrations such as states, provinces, or districts.
The World Health Organization collects data on health expenditures reported by national governments and makes this information available through its Health Expenditure Database. The goal of this program is to report health expenditures for all countries annually and by topic. Shared expenses are allocated to different diseases/purposes based on a standard approach, such as the proportion of health visits. Eventually we hope that this database will provide annual tracking of health expenditures with family planning-specific reports. To date, however, reports on family planning expenditures are available for only a small number of countries. By 2017 or 2018 this system should cover most FP2020 countries and will give a better picture of what governments are spending on family planning.
In the interim, a collective effort has been developed to try and fill this data gap by using data collected by UNFPA and NIDI on family planning expenditures from most FP2020 countries. Data are collected by national consultants through reviews of published reports and project documents and interviews with key organizations. Data include all expenditures that can be identified as family planning but do not include allocation of shared expenditures. For 2014 this project reported about US$1.1 billion in domestic government expenditures categorized as being spent on family planning in 51 FP2020 focus countries. In most countries, however, these estimates have not yet been validated by country governments, and large variations exist in whether countries account for just commodity expenditures or for larger health system expenditures related to family planning. Next year we hope to take advantage of country consensus meetings to have countries review and validate their expenditure estimates, with the aim of reporting country data next year. As the methodology for collecting domestic expenditures improves and becomes standardized across countries, we also hope to be able to report on trends over time in government expenditures on family planning.