By MOSES CHIMFWEMBE
AS Zambians await the presentation of the 2022 National Budget, stakeholders in the health sector will be eager to know how much will be allocated to the Ministry of Health, particularly, the provision of Sexual and Reproductive Health and Rights (SRHR).
The presentation of the 2022 National Budget is coming at a time when the flagship United Nations (UN) family planning programme that promotes the rights of every woman, man and child to enjoy a life of health and equal opportunity in Zambia is slashing its funding by 85 per cent.
The UK government announced in April this year that it will cut aid to the United Nations Population Fund (UNFPA) from its original 2021 commitment of $211 million to $32 million.
Further, the UK’s aid agency Foreign, Commonwealth and Development Office (FCDO) is also cutting contributions to UNFPA’s “core funds” by $17 million (or 60 per cent).
These massive cuts will undoubtedly have a negative effect on the provision of SRHR services in 150 countries around the globe where
UNFPA procures various reproductive health commodities and medicines to prevent maternal deaths.
In 26 nations, including Zambia, the UN agency is the major procurer of contraception, while in another 22 countries, it is the only buyer.
In Zambia, UNFPA provides at least 60 per cent of contraception for the public sector while Government’s contribution has been low and fluctuates over time owing to the country’s fiscal policy position that was weakened by maturing debt and inadequate fiscal space.
At the end of 2020, the UNFPA reached over 84,000 additional users of modern contraceptives, bringing the total number of women using a modern method of contraception in Zambia to over 1.5 million.
“Through the procurement of 60 per cent family planning commodity needs for the public health sector in 2020 in Zambia, 605,000 unintended pregnancies and 133,000 unsafe abortions were averted, UNFPA further averted 1000 maternal deaths,” UNFPA Country Representative Gift Malunga said in a twit.
While stakeholders around the world have repeatedly been calling on governments to source for health financing domestically to lessen reliance on donor funding.
Zambia’s National Health Insurance Scheme, which was established to ensure local health financing, is yet to make a mark.
However, with the proposed cuts to UNFPA, activists in the country are bracing for the looming shortages of SRH commodities. Centre for Reproduction Health and Education (CRHE) Executive Director Amos Mwale said the funding cuts to UNFPA will result in shortages of birth control commodities, and has the potential to derail Zambia’s progress made in SRH.
“It would have been ideal for the UK government to spread the cuts over several years to allow countries to transition to domestic funding,” he said.
Mr Mwale has, therefore, called on the ‘New Dawn Government to ensure that SRH commodities are part of the Ministry of Health procurement.
“The new administration should commit resources to the procurement of contraception. Let’s apportion resources to family planning and ensure that the actual procurement is done. We have seen situations where money is allocated but commodities are not procured,” he said.
Hivos regional SRHR fund policy, advocacy and campaigns programme officer Nana Zulu said a defunded UNPFA will result in inadequate family planning commodities in the country.
She said, “We already have a high unmet need for contraceptives in Zambia, so what we are going to see is a surge in unintended pregnancy and that will ultimately result in an increase of unsafe abortions.”
Ms Zulu said when girls fall pregnant, they drop out of schools and the impact will be huge and disproportionately affect women and girls because access to SRH commodities will be reduced.
She said domestic resource mobilisation for SRHR programmes will be key to cushion the impact of donors withdrawing their funding.
“In Zambia, we are largely donor dependent. It is now time to start recognising that we need to have our own resource base for health services. Other than National Health Insurance Management Authority (NHIMA), we should ensure that from our national budget and other resources, we allocate reasonable amounts to the procurement of our own SRH commodities,” she said.
Zambia has committed to the Sustainable Development Goals (SDGs) and a number of the 17 SDGs are linked to SRH improvements, including access to family planning, which is connected to national development, improved health, gender equality, education, and sustainability.
Further, the country has developed an Integrated Family Planning Costed Implementation Plan and Business Case (2021-2026) which has outlined the key interventions and investments in family planning to support the country’s Vision 2030 as well as achieving the SDGs.
The total financing commitment made for Zambia Integrated Family Planning Costed Implementation Plan and Business Case (2021 to 2026) stands at $4,278,205 for 2021, $263,601 for 2022 and $333,267 for 2023 with more commitments expected including for periods where no commitments were made.
The family planning financing gap is estimated to be $12.7 million in 2021, $43.5 million in 2022, $51.3 million in 2023, $52.3 million in 2024, $52.7 million in 2025 and $24.5 million in 2026.
The implementation of the business case (2021-2026) that will provide national guidance for increased knowledge and access to family planning interventions will definitely require adequate resources.
It remains to be seen whether the new government will allocate more resources to sexual and reproductive health services in the forthcoming national Budget, with the anticipated funding cuts to UNFPA by the UK government.