Paying for Reproductive Health Care: What is Needed, and What is Available?
Malcolm Potts, Julia Walsh, Jana McAninch, Nobuko Mizoguchi, Timothy J. Wade
International family planning perspectives
S10 health education and communication, STD diagnosis and treatment, and infertility prevention and treatment). The Programme of Action also includes estimates of the resources needed for a research, data and policy analysis component, focused on developing demographic and policy-relevant data. 2 According to ICPD projections, reproductive health costs in developing countries will likely total $17 billion in the year 2000 and $21.7 billion in 2015 (Table 1) . Developing countries are expected
... meet approximately two-thirds of the aggregate costs, and international donors one-third, although considerable variation is anticipated, depending on the needs of particular countries. 3 The purpose of this article is not to answer the question of how to pay for reproductive health care in developing countries, but to set out the need for analyzing budgets and costs, critique the data available and identify work that needs to be done. Context: The 1994 International Conference on Population and Development (ICPD) established goals for the expansion of reproductive health services and estimated the funding that would be required from the international community and national governments to meet those objectives. Methods: Available data are examined to determine the extent to which funding has met the ICPD estimates of resources needed. Results: Annual global spending on family planning as of the mid-1990s was less than half the $17 billion that the ICPD estimated will be required in the year 2000. International lending has grown, but support from international donors has not increased to fill the gap; when adjusted for inflation, domestic spending in many countries has fallen. Funding for the prevention of sexually transmitted diseases also falls far short of the projected need. Some 4-17% of government health expenditures in developing countries are committed to maternal health. However, since many women lack even the most basic reproductive health services, the ICPD projections likely underestimate the resource requirements. Conclusions: Funding for reproductive health services falls substantially below ICPD goals. Consumer spending may be able to fill part of the shortfall, but other strategies for meeting the goals will be needed that do not adversely affect demand or social justice. Priorities will have to be carefully set if available resources are to be used as cost-effectively and equitably as possible. International Family Planning Perspectives, 1999, 25(Supplement):S10-S16