Tracking Family Planning Spending Using the System of Health Accounts Framework

in collaboration with several international partners, aimed to track family planning spending using the System of Health Accounts (SHA) Framework. The project's primary objective was to help countries understand how money was used for family planning programs and where the money came from. The SHA 2011 is an internationally recognized framework for systematically tracking health spending in a country. It captures the magnitude and flow of all health spending, breaks down spending by source, financing arrangements, type of provider, and interventions. The framework contributes to the measurement of a country's health system performance, provides comparisons over time and across countries, and captures the priority placed on family planning (FP) versus other health conditions or diseases. The SHA 2011 data can inform FP programming in several ways. It can be used to align spending with priorities, negotiate for increased FP resources, conduct financial sustainability analysis, assess spending decisions to achieve FP targets, realign spending to increase the efficiency of FP spending, and track the composition of financing to more domestic sources, particularly household spending. Country data using the SHA 2011 framework shows that FP spending varies significantly across countries. In Namibia, FP spending accounted for 6.3% of current health expenditure in 2013, while in Cote d'Ivoire, it accounted for 5.6% in 2013. In some countries, such as Comoros, FP spending was as low as 0.2% of current health expenditure in 2011. The data also highlights potential efficiency considerations. In Sierra Leone, for example, FP spending per capita was lower than the percentage of FP needs met, suggesting that spending may not be effectively targeting FP interventions. In contrast, in Cambodia, FP spending per capita was higher than the percentage of FP needs met, indicating that spending may be more effective in achieving FP targets. The SHA 2011 framework also provides insights into the changing composition of financing for FP programs. In Niger, for example, the share of household spending in FP financing increased from 10% in 2011 to 30% in 2013, while the share of government spending decreased from 60% to 40% over the same period. However, challenges in applying the SHA 2011 framework include boundary clarifications, accounting for shared costs, and lack of detailed data to disaggregate spending. Documenting country examples of policy changes resulting from Health Accounts data can help address these challenges and improve the effectiveness of FP programming.