By Adam Lewis & Cate Nyambura, FP2030
The promise of universal health coverage (UHC) is as inspirational as it is aspirational: according to the WHO, it means that “all people have access to the full range of quality health services they need, when and where they need them, without financial hardship”. In other words, “leave no one behind”. The global community has set out to achieve this promise by 2030, and nearly all countries have signed on to fulfill it. But according to latest estimates, 30% of the world still cannot access essential health services, meaning more than two billion people are currently being left behind.
Among those left behind are hundreds of millions of sexually active girls and women in low- and middle-income countries (LMICs) who are seeking to avoid pregnancy but lack access to modern contraception. Despite being considered a key element of primary healthcare and linked to a range of positive health outcomes – from lower maternal and child mortality to improved nutrition and longer life expectancy – family planning remains out of reach for too many people in too many places, stifling the promise of UHC and jeopardizing healthy futures for countless families and communities.
This year marks the midpoint moment for the realization of SDG 3 and the whole 2030 Agenda for sustainable development (SDGs), so it is an opportune time to take stock of progress, double down on best practices, and try out new solutions to fill the gaps that remain. With 218 million girls and women in LMICs who want to avoid pregnancy but are not using a modern method of contraception, the reality is that we will not meet our family planning goals without new, innovative approaches to delivering or facilitating care. One approach – hardly new, yet often overlooked – is proactive, intentional engagement with the private sector: an under-tapped resource in the family planning movement.
When people seek to prevent pregnancy by using contraception, they turn to a wide range of methods and service delivery points. In most countries, these service delivery points are typically government clinics and pharmacies, but 34% of women and girls in LMICs access their contraception from the private sector – particularly young, unmarried clients seeking short-acting methods like condoms and pills, and those living in higher-income, urban communities. Even in countries dominated by public sector service provision, family planning commodities might be produced, supplied, distributed, and/or promoted by private sector entities, with many local private brands and information providers enjoying high levels of trust across a wide range of communities. And increasingly, private insurers and employers are offering health coverage packages that include contraception, which may only be available to clients of higher income and employment levels, but provide emerging avenues of access and cost-sharing through engagement with the private sector.
While often referred to in aggregate (“the private sector”), this collection of companies and service providers is diverse, dynamic, and deeply entrenched in both family planning and health systems more broadly – representing an important asset in countries’ efforts to overcome unmet need for contraception and achieve UHC. In fact, many national governments have started to acknowledge this potential and outline specific roles for the private sector in family planning: Nearly all FP2030 commitment-makers have called on the private sector to carry out key functions in their family planning ecosystem, including financing and insurance, workforce development, supply chain and logistics, data, marketing, awareness, quality improvement, ICT, and several others areas crucial to the realization of national family planning goals. Such prioritization and specificity of private sector engagement by LMIC governments signals a new era of openness to a “total market approach,” where health system stakeholders can maximize the efficiency, equity, and sustainability of family planning efforts through cross-sector coordination, placing the country farther along its pathway toward UHC.
Given the size and scope of the private sector in family planning and the expectations set for it by national governments, there is an opportunity to bring these vital actors to the table in a more meaningful, mutually beneficial way – one that harnesses their innovation, expertise, reach, resources, and influence to make sure nobody is left behind. Of course, such engagement is not without risk: there are many examples of private sector entities providing poor quality products and services, charging unreasonably high prices, operating outside of regulations, exacerbating inequities, and conducting business in an otherwise unethical manner. With meaningful engagement, the family planning community and the private sector can navigate these risks jointly and successfully to realize the promise of family planning for all who want it and position family planning as an essential element of UHC.
