The inclusion of sexual and reproductive health services within universal health care through intentional design

Abstract

In this paper, we argue that how sexual and reproductive health (SRH) services are included in UHC and health financing matters, and that this has implications for universality and equity. This is a matter of rights, given the differential health risks that women face, including unwanted pregnancy. How traditional vertical SRH services are compensated under UHC also matters and should balance incentives for efficiency with incentives for appropriate provision using the rights-based approach to user-centred care so that risks of sub-optimal outcomes are mitigated. This suggests that as UHC benefits packages are designed, there is need for the SRH community to advocate for more than simple "SRH inclusion". This paper describes a practical approach to integrate quality of SRH care within the UHC agenda using a framework called the "5Ps". The framework emphasises a "systems" and "design" lens as important steps to quality. The framework can be applied at different scales, from the health system to the individual user level. It also pays attention to how financing and resource policies intended to promote UHC may support or undermine the respect, protection and fulfilment of SRH and rights. The framework was originally developed with a specific emphasis on quality provision of family planning. In this paper, we have extended it to cover other SRH services.

Level of satisfaction and sexual and reproductive health needs of deaf persons in Ghana: a sequential explanatory mixed method study

“…In view of this, the realization of SRH as a human right ensures that women are safe from sexual exploitation, eliminates preventable maternal deaths, and ensures that reproductive health services such as contraceptive services, family planning counseling, and safe abortion services are available to all [6][7][8]. While some countries have taken steps to optimize the prioritization of SRH [9][10][11][12][13], other countries are being urged to move from political rhetoric and take concrete steps regarding enabling services for all [9,13]. However, there are still gaps in service provisions for minority groups such as deaf persons at high risk of exclusion from SRH policies [11,12].…”

Advancing Rights-Based Family Planning from 2020 to 2030

“…Similarly, the push to expand access to family planning within Universal Health Coverage (UHC) is underpinned by human rights. 60 , 61…”

“…Similarly, the push to expand access to family planning within Universal Health Coverage (UHC) is underpinned by human rights. 60,61 Pay More Attention to Accountability A number of respondents said that more work is needed to promote accountability, including policy and budget accountability, 62,63 and social accountability, for citizens and communities as rights-holders to hold duty-bearers, including officials and providers, to account. Several respondents underscored the need for accountability, but each pointed to the responsibilities of others, showing that a more holistic and comprehensive approach is needed.…”

“Imagining the world anew”: a transformative, rights-based agenda for UHC and SRHR in 2021 and beyond

“…Not losing sight: the challenge of upholding quality while expanding access Another key lesson that emerges in the themed issue is that, while the inclusion of comprehensive SRH services in HBPs is necessary, and investing in the health system to strengthen its capacity to ensure services are in place to deliver the package is equally critical, 8,11 these may not be sufficient for ensuring translation of services into accessible and quality services that meet the needs of those at the tail end of society's pecking order. 12 If anything, the challenge for quality of care persists even in contexts in which considerable progress towards UHC has been made. This is especially well highlighted by Juárez-Ramírez et al, who report that access to good quality maternal care (i.e.…”

“… 13 Appleford et al propose a “5-P” approach (people, package, provider, payment, polity) to ensuring quality of SRH care within the UHC agenda, arguing for both “systems” and “design” lenses as important steps to quality. 12 This approach needs to be tested across different settings, particularly in contexts of marked social and income inequalities.…”