After 2020: What’s Next for Global Access to Family Planning
From Felice Apter, Amanda Glassman, Janeen Madan Keller and Rachel Silverman
This note highlights three issues for the global FP movement post-2020, building on CGD’s engagement in this space, including our working group on alignment in family planning. We review the underlying critical assumptions in FP2020’s initial design along with their strengths and weaknesses, and place future approaches squarely within the context of today’s evolving landscape—one that looks very different than the year 2012, when FP2020 was launched.
Flashback to 2012: The Past as Prologue
Family Planning 2020 (FP2020) was launched at the London Summit in July 2012 with much fanfare. It was an ambitious plan with an aspirational goal—120 million additional users of voluntary, high-quality FP services by 2020. And indeed, the FP2020 collective of country governments and donor partners has been part of the global effort to expand FP access in 69 of the world’s poorest countries; compared to 2012, 46 million additional women and girls are using modern contraception. Further, FP2020 and its partners have expanded data collection and analysis. Shared learning and collective action have also been realized through regional engagements like the Ouagadougou Partnership. The Partnership exceeded its initial goal of supporting one million additional users, an increase of over 30 percent, through a coordinated plan to address national laws and regulations, mapping of needs to the local level, programming through high-impact practices (HIPS), and increased funding.
Nearly a decade later, it is a good time to reflect on past lessons and constructively plan for what comes next. At a time when many FP2020 countries are experiencing large increases in the number of people entering reproductive age, expanding access to quality FP services is more important than ever for women, families, communities, and nations as they strive to attain both health and development goals.
In comparison to 2012, when funding was growing, today’s world is one of stagnant donor funding even while multiple global health entities seek replenishments. Adding to this complexity is the changing donor policy environment and evolving donor strategies focused on transition away from aid, including USAID’s journey to self-reliance approach. In tandem, global momentum toward universal health coverage (UHC) has elevated holistic approaches to health financing—potentially replacing the vertical organization by condition- or intervention-specific programs, including those for family planning. Within many countries, there is also a strong movement to decentralize decision making to subnational entities. Finally, the introduction and evolution of a new multilateral funding institution—the Global Financing Facility (GFF)—adds yet another dimension of complexity.
The initial strategy and design of the FP2020 Partnership was built upon a theory of change that reflected the 2012 environment and is no longer fit for purpose. Specifically, we identify and examine with hindsight three assumptions that underpinned FP2020’s strategy in 2012:
- More donor and domestic money for FP would be forthcoming;
- A coordinated partnership would enhance accountability for progress; and
- Harmonizing and aligning FP efforts would achieve greater efficiencies.
In the next section, we review these three assumptions as experienced since 2012, including the strengths, limitations, learnings, and future opportunities. Our analysis leads us to three big-picture takeaways that can help guide the next phase of international FP action: (1) a new paradigm of resource mobilization is needed; (2) accountability requires a clear mandate; accountability and advocacy may not mix; and (3) time to align behind an integrated health financing approach, while keeping the focus on accountability?