The Pretense of Inclusion: Contextualizing Sexual and Reproductive Health Policies in Lived Realities of Indigenous Youth
Financing for family planning and reproductive health care, commodities and services is central to guaranteeing women’s and girls’ sexual and reproductive health and rights.
Currently, though, many governments still depend heavily on donor investments to fund family planning (FP) commodities and programs. At the same time, many low-income countries risk losing eligibility for donor funds as they transition to middle-income status and make other development gains. In an increasingly volatile donor environment, domestic resource mobilization for FP remains an issue needing urgent prioritization.
Through key informant interviews and analysis of existing data in 2018, PAI found that ultimately the government reconciled the loss of USAID FP/RH funding solely through funds from the treasury. It did so by creating a new budget allocation for the Ministerio de Salud Publico (Ministry of Public Health, MSP) for FP. Importantly, though, there is no evidence of the government having generated additional revenue to account for the new budget line—which could implicate trade-offs with other programming if government funds were redirected. Additional funds could have (but did not) come from taxes or even social security funds, including the public health insurance scheme.
While MSP secured a budget allocation for FP/RH programs, to date, most of those funds are directed toward contraceptive procurement, leaving little for programming. Likewise, from the government perspective, the speed of transitioning FP financing roles and responsibilities from donor to domestic ownership proved to be a challenge. Thus, the way the Dominican government has financed FP and mobilized domestic sources of funding to replace donor funds raises concerns about the sustainability of that funding as well as the ability of the government to sufficiently meet women’s and girls’ FP needs.
