Universal Health Coverage: Not Without Family Planning

The concept of UHC has been brought to the forefront of discussions due to the COVID-19 pandemic, which has frayed health care systems and inequitable distribution of testing and vaccines. The pandemic has highlighted the importance of UHC, regardless of geographical location or health care needs. Currently, 270 million women worldwide do not have access to modern contraception, a significant barrier to achieving UHC. Family planning is often overlooked in discussions of UHC, with some viewing it as a long-term issue rather than an immediate priority. However, family planning is essential to UHC, as it provides individuals with the "choice" and "empowerment" to make decisions about their health and well-being. The UHC/family planning nexus provides numerous benefits, including improved health, choice, and empowerment for women. Family planning also expands opportunities for education, sustains population growth, and accelerates national development. Conversely, UHC restores equality, promotes social cohesion, and contributes to meeting a country's development goals. The greatest obstacle to achieving UHC is weak health systems, which manifest as obstacles to advancing the family planning agenda. Human resource gaps, financial protection, data systems, health care infrastructure, and leadership and governance are all critical areas that need to be addressed to achieve UHC. Human resource gaps, particularly in the provision of long-acting family planning methods, remain a significant barrier to universal access to family planning. Financial protection for UHC and family planning is not showing a positive trend, with household contributions dominating and donor funding often relied upon. Data systems in many countries are functioning at sub-optimal levels, making it difficult to understand equity gaps among population sub-groups. Health care infrastructure, including the availability of contraceptives and essential commodities, also hampers progress toward UHC. Leadership and governance are critical to reaching UHC and meeting the unmet need for family planning among populations worldwide. Gender-based barriers to service delivery, including a lack of privacy and confidentiality for women and girls, unbalanced gender composition of the health workforce, and a widespread gender pay gap among health workers, also impede UHC and family planning. To address these challenges, innovation, collaboration, and acceleration are essential in family planning programs. Innovations can take the form of new technologies, creative thinking, and execution, and can be implemented within existing national systems. Examples of innovative solutions include surgical task-shifting in countries such as Nepal and Kenya, and co-financing initiatives like Nigeria's The Challenge Initiative (TCI), which aims to bridge the gap in funding family planning programs. In conclusion, achieving UHC requires addressing the challenges of weak health systems, human resource gaps, financial protection, data systems, health care infrastructure, and leadership and governance. Family planning is a critical component of UHC, providing individuals with the "choice" and "empowerment" to make decisions about their health and well-being. Innovation, collaboration, and acceleration are essential in family planning programs to address the challenges ahead and achieve UHC.