The WHO has released two new tools offering evidence-based strategies to support the effective and efficient integration of sexual reproductive health (SRH) services within national primary health care (PHC) strategies to advance progress towards universal health coverage (UHC).
Health systems that achieve UHC and the health-related Sustainable Development Goals rely heavily on a solid foundation of PHC. The majority of SRH services, such as antenatal and post-natal care, contraception and abortion care, can be provided through PHC. However almost everyone of reproductive age—about 4.3 billion people—will not have access to at least one essential reproductive health intervention over the course of their lives. More examples and clear ways to implement service delivery are needed.
Because integrating SRH within PHC for UHC requires both political commitment, as well as defined and coherent strategies, these practical tools aim to help decision-makers, programme managers, implementers, civil society, researchers, and wider health systems communities.
Handbook
The first tool is a handbook Critical considerations for achieving universal access to sexual and reproductive health in the context of universal health coverage through a primary health care approach. The contents cover guidance for the inclusion of comprehensive SRH services in health benefit packages, planning and implementation of integrated packages of SRH services, as well as accountability processes and measures for ensuring universal access to all essential SRH services.
For effective and integrated SRH, the handbook calls for identifying the rights and responsibilities of the target groups; monitoring implementation of national action plans; ensuring sufficient resources; informing and supporting health care providers; and making health systems more adaptive.
This piece of work also highlights examples of innovative ways SRH services have been integrated in national PHC strategies across many countries. Not only do these examples demonstrate a variety of approaches across countries that take into account economic, social and cultural contexts which influence SRH services, but also lessons and tactics that can be applied in nearly every context.
For example, we learn of key actions for strengthening service availability and readiness for safe abortion services in Ireland, the role of evidence in catalyzing policy action in addressing the mistreatment of women during facility-based deliveries in Guinea and the application of health technology assessment for the inclusion of the HPV vaccine in the health benefit package in Thailand.
“Sexual and reproductive health is critical to health and wellbeing across the life course, and therefore has to be embedded and integrated with primary health care, with universal access to all,” said Professor Pascale Allotey, Director of Sexual Reproductive Health and Research at WHO, and the United Nations Special Research Programme in Human Reproduction Programme (HRP). “There is simply no universal health coverage without sexual and reproductive health.”
Learning by Sharing Portal
The Learning by Sharing Portal (LSP) is a second tool to support the integration of SRH in wider UHC related reforms. The portal, launched on 19 July 2022, is an online repository of qualitative case studies documenting the experiences of stakeholders in implementing an integrated SRH-UHC. The goal is to pool together normative tools and guidance for member states and other stakeholders, including donors and countries, which will bring programmes closer to full alignment.
“The SRH-UHC portal is a powerful tool, allowing countries to learn best practices from each other through peer-to-peer learning,” said Teresa Soop, Senior Research Advisor for SIDA and Chair of the Governing Board of HRP.
The portal features national-level implementation stories from across the world on “how” governments can address the sexual and reproductive health needs of women, adolescents and hard-to-reach populations. The LSP launch reflects a years-long, collaborative process in which WHO partnered with United Nations Population Fund (UNFPA) in developing content through an open call for stories and peer-reviewed literature that demonstrated a clear link between SRH and UHC.
Stories are about changing policies and legislation in Kazakhstan, aligning donor priorities in Malawi, community health workers increasing service coverage in India, training religious leaders in Somalia and partnerships for progress between governments, non-governmental organizations (NGOs) and the private sector in countries such as Mexico, Nepal and Pakistan.
Both the Handbook and LSP emphasize that progress towards universal access to SRH services depends on the meaningful participation of the people affected by these policies in every aspect of planning, implementation, monitoring and accountability.
Listening and responding to the voices of those most left behind is essential and mechanisms to enable participation and voice must be integral to all national efforts. Acting together, everyone concerned with achieving universal access to SRH services through strengthened PHC systems can benefit from the evidence and lessons documented in these tools.
