New Journal Article Highlights Innovations in Public Financing for Family Planning at the Subnational Level in Nigeria
Contributors: Yijia Shi & Lisa Mwaikambo
The Challenge Initiative (TCI) recently published a case study in Global Health: Science and Practice examining the co-financing model developed by TCI to support states in Nigeria in their family planning and reproductive health (FP/RH) budget allocations and expenditures. The co-financing model aims to not only increase domestic spending but also strengthen accountability in FP/RH financing.
It works by helping states to meet their FP/RH financing commitments by using the TCI Challenge Fund as a mechanism to incentivize domestic funding for FP/RH programming. This is critical because the resources required to achieve states’ health goals exceed existing government budgets and available donor funding. This shortfall motivates efforts to expand non-donor sources of financing. Using a framework to monitor, track and reward financial and non-financial state commitments, TCI’s co-financing model incentivizes state governments’ continuous fiscal capacity improvements.
The benefits of TCI’s co-financing model are as follows:
- Draws on learnings from previous health co-financing mechanisms, such as those championed by Gavi, The Global Fund and World Bank, and promotes self-reliance of state governments and sustainability of proven FP/RH interventions
- Partners with state governments to leverage all available financial and non-financial resources to drive and sustain system-wide changes to improve access to family planning services
- Is built on the practical realities of government funding, which differs from state to state, rather than a one-size-fits-all approach
- Ensures financial sustainability, leveraging and coordinating all available funds while transitioning away from funding available via the TCI Challenge Fund towards greater self-reliance
- Minimizes duplication of effort, facilitates an equitable distribution of scarce resources and allows for more focused domestic financing for health
- Builds stronger relationships between donors, implementers and government and improves accountability in financing of FP/RH and other health sector programs
At the beginning of a state’s engagement with TCI, during the program design phase, the government specifies how much it will spend on its FP program, which TCI uses to determine the Challenge Fund contribution. Consequently, each year the state creates an FP workplan that is incorporated into its annual operational plan (AOP). The workplan then serves as the baseline against which the actual release of government-planned counterpart funds is measured. Connected to high-impact practices and other FP interventions, the co-financing approach seeks to bolster system capacity and institutionalize funding for FP into everyday processes, institutions and funding flows.
The TCI co-financing strategy has assisted TCI partner states in designating FP budget lines and maintaining FP/RH budget commitments and expenditures during the past three years. Thirteen states leveraged a total of N2.03 billion (US$5.6 million) in performance-based co-investment from the TCI Challenge Fund by contributing a total of N1.19 billion (US$3.3 million) in government funds over a period of four years (2017–2021). Collectively, TCI partner states boosted their co-financing commitment as a proportion of total funding from an average of 32% during the initiation phase to 42% during the pre-graduation period.
Taraba State received TCI support to develop an advocacy core group (ACG) and budget-tracking team, which is a subcommittee of the ACG, according to the case study. The budget-tracking team monitors budget commitments and releases and created scorecards that demonstrate government performance, which have been utilized as an advocacy tool. The overall increase in funding committed and released in Taraba was the result of the ACG’s persistent advocacy engagement with the government through budget negotiations with key policy decision-makers, budget memo development, strategic meetings, data utilization to support the government’s decision-making regarding fund allocation and release, and increased community demand for contraceptives, particularly during the COVID lockdown. In Taraba, the number of clients visiting public health facilities has more than doubled during the past three years. The ACG presented these data to the state government as proof of the necessity for continuous and sustained funding for FP, which prompted the state government to work towards maintaining the rising trend by securing more funds.
The TCI co-financing conditions specify that government expenditures on health must meet or exceed minimum co-financing goals with incremental increases from year to year, as outlined in the model, and that state governments must gradually lead the technical implementation of proven FP interventions and deliver results. Built upon current government finance processes and institutions, the TCI co-financing approach emphasizes that only governments can drive program execution for results which will ensure greater likelihood of sustained impact. The model has proven to be an effective strategy for increasing the commitment, release and expenditure of FP funds, building relationships between state actors (donors, implementers and government) and enhancing accountability through transparent agreements and documentation of commitments and the actions required to fulfill them. The authors of this program case study argue that the model is relevant not only for FP programming but also for delivering upon the mandate for Universal Health Coverage and broader health sector priorities.