Date/Time: Thursday, November 14, 2013 Session:

Author(s):

2.4.14 Contraceptive Financing

Nelson Keyonzo, JHPIEGO Faith Abilla, JHPIEGO Peter Kagwe, Jhpiego Alan Johnston, Independent Feddis Mumba, Tupange / Jhpiego Lucy Kimondo, National Council for Population Development George Kichamu, National Council for Population Development Family Planning Financial Resource Studies at the City Level in Kenya Research Abstract Family planning practice

Title of Abstract: Abstract Type: Topic:

Significance/background
Monitoring financial commitments to family planning programs is a challenging issue, especially at the sub-national level. Most studies to date have been undertaken at the national level. Many of these are limited to looking at government commitments. Government budgets and expenditure reports usually do not disaggregate family planning from the broader reproductive health budgets and expenditures. It is even more difficult to track family planning commitments from development partners and national NGOs. Many of these organizations do not have data disaggregated into specific program areas. Data may not be available for specific sub-national areas. And many of the programs are integrated programs where it would be very difficult even to estimate the proportion devoted to family planning. Finally, many family planning costing studies have been limited to looking at the costs of FP commodities, and have not included facility, staffing and administrative costs. Although Kenya has conducted several studies of National Health Accounts, these have also encountered the same issues: they have been limited to the national level, have not disaggregated the reproductive health expenditures to look specifically at family planning, and have focused mainly on government expenditures and those development partner expenditures which were included in the national budget

Main question/hypothesis
The Kenya Urban Reproductive Health Initiative Tupange a 5 year program funded by the Bill and Melinda Gates Foundation focuses on improving access to FP for the urban poor. During its first three years the project has focused its program initiatives in the three major cities of Nairobi, Mombasa and Kisumu. One of the major objectives of Tupanges advocacy strategy is to increase the amount of funding available to support family planning. To monitor the success of this strategy, the project, and the City Councils with which it works, need to know how much is already being

spent on family planning. To answer this question the project carried out FP financial resource studies in Mombasa and Kisumu to determine the total available funding for FP from government, development partners, and national NGOs operating in these cities. A similar study will be carried out in Nairobi in 2013.

Methodology
The family planning resource studies were carried out in 2012 in the cities of Mombasa and Kisumu. Two stakeholder meetings were held in each city to agree on the objectives and methodology. The goal of the studies was to develop an estimate of the total financial resources devoted to family planning in each city including funding from government, development partners and national and local NGOs operating family planning services in the city. This did not include out-of-pocket expenditures by family planning users. Data was collected for the 2010/2011 and the 2011/2012 financial years. Two data collection instruments were used. The first collected data from a sample of family planning providers (hospitals, clinics) including estimates of family planning commodity costs, facility costs, and staffing costs (the proportion of time each staff category devoted to family planning services). The second instrument collected information from development partners and NGOs on expenditures on family planning programs including family planning expenditures by broad categories including fp commodities, staffing costs, and administrative cost. The data were then analyzed and reports prepared for presentation to the city councils.

Results/key findings
The analysis showed that in Mombasa (population: 939,370) about Ksh 107.34 million (US$ 1.31 million) were spent on family planning services in 2010/11 and Ksh 133.14 million (US$ 1.62 million) were spent in 2011/12, representing an increase of 24 per cent in expenditure between 2010/11 and 2011/12. In terms of cost categories, administration took the largest share (38%), followed by FP commodities and supplies (29%) and outreach services (12%). The analysis also showed that the bulk (over 80%) of the expenditure came from the development partners. The analysis showed that in Kisumu (population: 450,262) about Ksh 84.18 million (US$ 1.03 million) were spent on family planning services in 2010/11 and Ksh 109.96 million (US$ 1.34 million) were spent in 2011/12, representing an increase of 31 per cent between 2010/11 and 2011/12. In terms of cost categories, FP commodities and supplies took the largest share (34%), followed by administration (29%), and outreach services (15%). The analysis also showed that the bulk (over 85%) of the expenditure came from the development partners. In both cities, despite the heavy reliance on international sources, government provides very critical support to the family planning program in terms of commodities and personnel in service delivery.

Knowledge contribution
The participatory design of these family planning resource studies helped to ensure that the findings would be carefully studied and utilized by the city councils and other family planning champions to lobby for additional resources. The studies show that it is possible to estimate total resource flows for family planning at the city level. The methodology provides a tool for health planners at the city level to continue monitoring family planning resources and for family planning champions to lobby for additional resources.