Family Planning in the Context of Latin America's Universal Health Coverage Agenda
Family Planning in the Context of Latin America's Universal Health Coverage Agenda
复制标题
DOI：
10.9745/ghsp-d-17-00057
复制
发表时间：
2017-09-27
影响因子：
4
通讯作者：
Klein, Kate
中科院分区：
文献类型：
--
作者：
Fagan, Thomas;Dutta, Arin;Klein, Kate
背景：过去50年来，拉丁美洲和加勒比国家大大改善了计划生育服务。许多国家最近还通过了关于普遍健康权和全民医保的明确宣言，并开始实施面向全民医保的卫生筹资计划。这些计划将有重要影响的可持续性和进一步增长的计划生育programmes through-region.Methods：我们研究了避孕方法在主要的健康服务和融资计划在9个拉丁美洲和加勒比国家的地位。我们使用了一组关于计划生育覆盖率、计划生育筹资、卫生筹资和计划生育纳入UHC导向计划的37个指标，对二级来源进行了案头审查，包括人口调查、卫生筹资评估、保险登记报告和单位成本估算，并采访了国内专家。虽然大多数拉丁美洲和加勒比国家的现代避孕普及率继续提高，但边缘化群体在获得避孕药具方面仍然存在巨大差距。平均而言，土著妇女的mCPR比一般人口低20%，未投保妇女的mCPR比投保妇女低5%，最贫穷妇女的mCPR比最富有妇女低7%。在最贫穷的五分之一妇女中，投保妇女的mCPR比未投保妇女高出16.5个百分点，这表明保险覆盖面的扩大与计划生育的获得和使用增加有关。在我们审查的高收入和中上收入国家，所有现代避孕方法通常都可通过覆盖大多数人口的社会健康保险计划获得。然而，在低收入和中低收入国家，尽管公共卫生设施免费提供大多数计划生育服务，但缺货和隐性配给构成了重大障碍，使服务对象无法获得他们喜欢的方法或被迫自掏腰包。利用以全民健康保险为导向的计划来维持和进一步提高计划生育的进展，需要各国政府采取深思熟虑的步骤，以贫困和非正规部门人口为目标，（2）将计划生育纳入一揽子福利计划，（3）确保为计划生育提供充足的资金，（4）减少获得服务的非财政障碍。通过这些步骤，各国可以增加对计划生育的财政保护，更好地确保贫困和边缘化人口的健康权。
Background: Countries in Latin America and the Caribbean (LAC) have substantially improved access to family planning over the past 50 years. Many have also recently adopted explicit declarations of universal rights to health and universal health coverage (UHC) and have begun implementing UHC-oriented health financing schemes. These schemes will have important implications for the sustainability and further growth of family planning programs throughout the region.Methods: We examined the status of contraceptive methods in major health delivery and financing schemes in 9 LAC countries. Using a set of 37 indicators on family planning coverage, family planning financing, health financing, and family planning inclusion in UHC-oriented schemes, we conducted a desk review of secondary sources, including population surveys, health financing assessments, insurance enrollment reports, and unit cost estimates, and interviewed in-country experts.Findings: Although the modern contraceptive prevalence rate (mCPR) has continued to increase in the majority of LAC countries, substantial disparities in access for marginalized groups remain. On average, mCPR is 20% lower among indigenous women than the general population, 5% lower among uninsured women than insured, and 7% lower among the poorest women than the wealthiest. Among the poorest quintile of women, insured women had an mCPR 16.5 percentage points higher than that of uninsured women, suggesting that expansion of insurance coverage is associated with increased family planning access and use. In the high-and upper-middle-income countries we reviewed, all modern contraceptive methods are typically available through the social health insurance schemes that cover a majority of the population. However, in low-and lower-middle-income countries, despite free provision of most family planning services in public health facilities, stock-outs and implicit rationing present substantial barriers that prevent clients from accessing their preferred method or force them to pay out of pocket.Conclusion: Leveraging UHC-oriented schemes to sustain and further increase family planning progress will require that governments take deliberate steps to (1) target poor and informal sector populations, (2) include family planning in benefits packages, (3) ensure sufficient financing for family planning, and (4) reduce nonfinancial barriers to access. Through these steps, countries can increase financial protection for family planning and better ensure the right to health of poor and marginalized populations.