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Resource Requirement to Meet India FP 2020 Commitments Policy Brief-for-online-revised-2 |
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RESOURCE
REQUIREMENT TO MEET
INDIA’S FP 2020 COMMITMENTS
The policy brief is based on the findings of a study conducted by Prof. Barun Kanjilal of Indian Institute Of Health Management Research, Jaipur
on behalf of Population Foundation of India.
A landmark event in the global
discourse on Family Planning
(FP) is the London Summit on
Family Planning in 2012, where
over 60 countries pledged to
increase access for an addi-
tional 120 million women to
family planning services by
2020. Commonly known as the
FP2020 commitments, India
too, committed an outlay of
over USD 2 billion to provide
family planning services to an
additional 48 million women
in the country in addition to
sustaining the current coverage
of about 100 million users by
2020.
At an all India level, the current
(2012) modern Contraceptive
Prevalence Rate (mCPR) is 52.5
per cent. At its existing rate of
increase, the mCPR it is like-
ly to touch 60.1 per cent by the
year 2020, implying that India
will have about 32.8 million
additional users by 2020. This
falls short of the committed
goal of 48 million by about 15
million (Figure 1).
Figure 1: Current trend in FP usage and required coverage
70
60
50
52.5
60.1
65.9
40
30
20
10
0
Current mCPR - 2012 (%)
mCPR in 2020 at current rate of increase (%)
Required mCPR in 2020 to achieve
48 million additional users
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Attaining India’s commitment for the FP2020 goals crucially
hinges on its ability to scale up the coverage of spacing meth-
ods of contraceptives. Given the large young population and
increasing urbanisation, alongside additional educational and
Figure 2: Modern Contraceptive
methods (Current share 2012)
Female
Sterilization
employment opportunities, there is a likely shift in the need for
contraceptives with increasing preference for spacing methods
(Figure 2 and 3).
Figure 3: Modern Contraceptive
methods (Projected share 2020)
Condom
Male
IUD
Sterilization
Pill
Others
This poses a challenge for India’s family planning programme,
which is largely focused on terminal methods. Based on the
secular trend of NFHS-3 and DLHS-4/AHS, the private sector
is expected to cater to 42.5 per cent of all modern contraceptive
users (between 2013 and 2020). But, considering only the spac-
ing methods (pills, condoms and IUDs), 76.5 per cent of the us-
ers are expected to be catered to by the private sector. Therefore,
FP2020 is critically dependent on private sector participation.
At the current trend, the number of ‘additional’ users served by
the private sector, is expected to be close to 10 million while the
required number is almost 22 million to meet the FP2020 goal.
This implies a gap of 12 million that is unlikely to be covered
by the private market on its own. Meeting the FP2020 com-
mitments for India requires active and sustained participation
of the public and private sector delivery systems. The intensity
of drive towards the FP2020 goal needs to be much stronger in
the 10 high priority states (8 EAG states, Assam and Himach-
al Pradesh), most especially in Bihar, Odisha, UP, and Assam
(Table 1).
Table 1: Gaps between current trend and FP2020 goal
States
Additional Users
(2013-20) (millions)
Current FP2020 Gap
Trend Goal
Bihar
Odisha
Uttaranchal
Assam
Uttar Pradesh
(UP)
Jharkhand
Himachal
Pradesh
Madhya
Pradesh(MP)
Chattishgarh
Rajasthan
3.28
0.97
0.25
0.8
6.72
1.47
0.21
2.04
0.84
2.18
7.2
1.83
0.46
1.43
11.09
2.1
0.29
2.78
0.99
2.06
3.92
0.86
0.22
0.63
4.37
0.63
0.08
0.73
0.15
-0.12
Gap % Rank
119.4% 1
88.8% 2
88.5% 3
78.5% 4
65.1% 5
42.7% 6
40.1% 7
36.0% 8
17.9% 9
-5.5% 10
As seen above, states such as Rajasthan, Madhya Pradesh, Chhattisgarh and Himachal Pradesh appear to be ‘on-track’ with respect
to the FP2020 target. On the other hand,
Assam
Bihar
Uttar Pradesh
Require significant scaling up of mCPR to reach their respective FP2020 targets
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CURRENT BUDGET
TRENDS IN FAMILY PLANNING
The central government funds the family planning programme
through two funding channels: a. the treasury route under
the Family Welfare (FW) budget head; b. the off-budget (Soci-
ety) route for Family Planning (FP) under the National Health
Mission (NHM). The treasury (FW) funds for family planning
support: contraceptive procurement and free distribution, infra-
structure maintenance (cost of sub-centres and ANMs), social
marketing projects and FP linked health insurance (for compen-
sations related to sterilization failures).
The FP component under NHM supports direct costs related to
providing sterilization and IUD services in camp mode, family
planning awareness activities and accreditation of private facil-
ities for providing FP services. It does not include costs of the
health staff providing family planning services, training of staff
on family planning or the procurement of contraceptives and
sterilization equipment. These are combined with others (for
maternal, child health facility strengthening under IPHS) as sep-
arate budgets under the NHM. Family Welfare, which includes
budgets for family planning components, constituted only 4 per
cent of the 2014-15 Health and Family Welfare budget (Budget
Estimates – BE). On the other hand, under the National Health
Mission (NHM) FP was around 2 per cent of the total NHM re-
sources in the year 2013-14.
Figure 4: FP budget - Current trend
FP budget required to cover the expected increase in mCPR
Current trend of FP budget
30
25
20
15
10
05
00
2013-14 ‘14-15 ‘15-16 ‘16-17 ‘17-18 ‘18-19 ‘19-20
Notwithstanding the increases in NHM allocations for FP by 47
per cent between 2013-14 to 2015-16, shortfalls to the tune of
Rs.1,500 (US $231 million) (Figure 4) persist. The current trend
in budgetary increases thus makes it difficult to reach even 33
million additional users by 2020 (as per the current trend of
increase in mCPR). The trend in allocation of resources from
the central government is however, discouraging, with current
movements indicating that there would be a significant deficit in
terms of meeting the required support from this source. These
have shown a sharper declining trend in the last few years; for
instance, allocations through it have been reduced by 54 per cent
between 2013-14 and 2015-16. Since the contraceptives and IEC
materials are obtained from this budget, the declining trend from
2011-12 (Figure 5), clearly raises serious concerns about the pos-
sibility of attaining the FP2020 goals, if the trend is sustained.
Current movements indicate that there would be a significant
deficit in terms of meeting the required support from this source.
These have shown a sharper declining trend in the last few years;
for instance, allocations through it have been reduced by 54 per
cent between 2013-14 and 2015-16. Since the contraceptives and
IEC materials are obtained from this budget, the declining trend
from 2011-12 (Figure 5), clearly raises serious concerns about
the possibility of attaining the FP2020 goals, if the trend is sus-
tained.
Figure 5:Trend in actual allocation through Central
Sector budget for FP
2007
-08
2008
-09
2009
-10
Social marketing of contraceptives
Free distribution of contraceptives
Procurement of supplies & materials
2010 2011 2012 2013 2014
-11 -12 -13 -14 -15
30
25
20
15
10
05
00
2015
-16
At the state level, a review of the recent state NHM plans shows
that most EAG states have raised state contributions to the re-
source envelope for FP. This is a clear indication that there is a
need for the Centre to step-up with more resources (the central
resource share matching state resources in 60-40 ratio) to meet
the FP2020 goal. For example, the approved allocation in UP
(under NHM) has risen from Rs. 115 crores (US $17.7 million)
in 2013-14 to Rs. 212 crores (US $32.6 million) in 2015-16. This
is an increase of 84 per cent in just two years. Similarly, the ap-
proved outlay in Odisha has increased from Rs. 27 crores (US
$4.15 million) in 2013-14 to Rs. 51 crores (US $7.85 million), i.e.
an increase of 88 per cent. Bihar, on the other hand, showed a
comparatively sluggish growth – just a 44 per cent increase be-
tween 2013-14 and 2015-16. It is also noteworthy that at least one
of the EAG states (UP) has explicitly mentioned FP2020 in one
of the PIP cost items.
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BUDGETARY ALLOCATION
REQUIRED TO MEET FP2020 COMMITMENTS
To meet the FP2020 goal, the government would need to spend
approximately Rs. 15,800 crores (US $2.4 billion) during 2013-
2020 to provide family planning services by publicly funded pro-
viders. This, however, may still not guarantee the additional 48
million users since private sector clients (users served by private
sector) may not increase adequately to bridge the required gap.
If all the additional 48 million FP users are to be covered by both
the public and private providers, at the current public-private mix
(ratio of 70-30), an additional Rs. 11,150 crores (US $1.7 billion)
is required over the next four years, i.e. an additional Rs. 2,800
crores (US $431 million) per year approximately, from 2016 to
2020 (Figure 6). If all the additional 48 million FP users are to
be covered by the public health system, an additional Rs.18,730
crores (almost US $3 billion) is required over the next four years,
i.e. an additional Rs. 4,700 crores (US 723 million) per year, from
2016 to 2020 (Figure 7). Projections in the 8 EAG states and As-
sam and Himachal Pradesh show that they are expected to fall
short of financial resources by Rs.3,800 crores (around US $585
million) collectively, if all the additional users are catered to by
the public health system.
Figure 6: FP budget for FP2020 target- Additional users served by current public-private mix
2013-14
2014-15
2015-16
2016-17
2017-18
2018-19
35
30
25
20
15
10
05
00
2019-20
FP budget required for
additional 48 million users,
at current public-private
mix
Current trend of FP
budget
Figure 7: FP budget for FP2020 target- Additional users served by public health system
2013-14
2014-15
2015-16
2016-17
2017-18
2018-19
60
50
40
30
20
10
00
2019-20
FP budget required for
additional 48 million users,
all by public health system
Current trend of FP
budget
In terms of the percentage of the current allocation trend, the
government would require at least 32 per cent of additional fi-
nancial resources from the central government, in order to meet
the costs of just the additional public users. The requirement for
the additional fund climbs to 95 per cent if the ‘private gap’ is to
be filled by public providers. A more efficient approach to ad-
dress the gap is to involve private providers through the social
franchising / social marketing (SF/SM) mechanisms, especially
in select EAG states, such as, Bihar, Chhattisgarh and Odisha.
If all the additional 48 million FP users are to be covered by the
SF/SM mechanisms, an additional Rs. 23,000 crores would be re-
quired over the next four years, i.e. an additional Rs. 5,750 crores
per year from 2016 to 2020 (Figure 8).
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Figure 8: FP budget for FP2020 target- Additional users served by social franchising/social marketing
2013-14 2014-15
2015-16
2016-17
80
70
60
50
40
30
20
10
00
2017-18 2018-19 2019-20
FP budget required for
additional 48 million users,
through social marketing/
franchising
Current trend of FP budget
The SF/SM mechanism would better ensure the required progress towards the FP2020 goals, but would also cost more. This would
need an increase of public finance by 131 per cent if the government finances the operation of the SF/SM channels.
POLICY
RECOMMENDATIONS
TO ADDRESS THE CONCERNS
n A revision of the FP component in the Centre-State n More specifically, the resources for FP2020 need to be
resource sharing formula is required to meet the FP2020 tightly ring-fenced with a maximum central share to as-
commitment
sure the fulfillment of commitments
KEY POLICY RECOMMENDATIONS
n Though the overall budget for family welfare in the
country has declined, the recent increase in family
planning budget under the NHM (which is a small
proportion of family welfare budget) should be sus-
tained.
n Reverse the declining trend of central government
budgetary allocation for contraceptives.
n Involve the private sector in contraceptive promo-
tion and distribution through social marketing and
social franchising.
n Introduce additional contraceptive methods that
are safe and cost-effective.
n Invest in research on the cost and financial impli-
cations of new family planning technologies.
n More specifically, the resources for FP2020 need to
be tightly ring-fenced with a maximum central share
to assure the fulfillment of commitments
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