Paying for Public Health Out of Our Own Pockets
Kaja Jurczynska, Guest Contributor
Last week, UN Member States, civil society, regional commissions, observers and specialized agencies gathered in New York City for the 46th Session of the Commission on Population and Development (CPD).*
This year’s theme was migration, and the negotiations produced a resolution urging governments to “incorporate a gender perspective into all policies and programmes on international migration” as well as to “provide services that are particularly sensitive to the needs of individual women and adolescents…” Notably, the resolution also calls on governments to mobilize the resources required to realize “migration, development and human-rights related objectives” and ensure that resources are used “in full alignment with the needs and priorities of developing countries.”
Officially, that all sounds good. But, in reality, how have countries fared in meeting their financial commitments to population assistance so far?
Of the $67.8 billion needed for population activities in 2011, the gap between the donor share and actual funding reached $10.8 billion. Developing countries mobilized an unprecedented $54.7 billion worldwide. On the surface, this appears to satisfy their $44.7 billion share. However, more than 63 percent of domestic spending on population activities constituted out-of-pocket spending by consumers! Southern governments mobilized just 36 percent of domestic resources that same year. Out-of-pocket spending on health services including reproductive health and family planning push millions of people into poverty each year, and limits access for those who cannot pay.
Another important finding: officially recorded remittances reached approximately $406 billion in 2012, far exceeding Official Development Assistance (see Figure 1). Governments at the CPD recognized the positive development impacts of remittances, and also called for measures to improve their effectiveness.
What is the link between high remittances and low public sector investment and high out of pocket spending on population activities? Evidence from Mexico suggests that health services are the single largest ticket item that households spend remittances on. Households that lack private health insurance or are covered by low quality public services are more likely to use remittance money on health services than those covered by better-quality private insurance. But households spending scarce remittances on their reproductive health needs come at the high cost of a sister or brother’s education, or an investment in a family business. We cannot harness the full potential of remittances without high quality public health services and robust social protection.
Remittances should complement, not substitute, government investment in vital reproductive health services like family planning and maternal health. The global burden of paying for health services continues to fall disproportionately on the consumer. As we approach the 20th anniversary of the ICPD, donors and governments need to step up and increase their budgets for population activities, particularly reproductive health.
* What is the CPD, anyway? Good question. The Commission monitors and reviews progress towards the seminal Programme of Action (POA) of the International Conference on Population and Development (ICPD), adopted by 179 countries in Cairo. Among its goals, the agenda calls on governments to realize universal access to reproductive health. This year’s resolution on migration recognized the centrality of respecting and protecting the rights of women and girls, who now constitute nearly 50 percent of international migrant population.
Kaja Jurczynska is a Research Associate at Population Action International. She is investigating the interrelationships between population dynamics and environmental, socioeconomic, and political processes.
Originally published by Population Action International.