Investments in Family Planning are not only important to empower women to achieve their desired family size and at their desired interval between the children, it also is a smart investment option for human development. It is estimated that every $1 invested in Family Planning saves $4 in other health and development areas, including maternal health, immunization, malaria, education, water and sanitation (USAID, 2011). But Family Planning in India has received low priority as far as public funding is concerned. The Family Welfare budget of the Government of India, which includes budgets for family planning components, constituted only 4% of the 2014-15 Health and Family Welfare budget (Budget Estimates – BE). On the other hand, under the National Health Mission (NHM), the expenditure under the Family Planning (FP) budget head was around 2% of the total NHM expenditure in the year 2013-14.
Even this meagre budget on Family Planning, is not allocated optimally to items that are critical for the Family Planning program across the country. A disproportionately large proportion goes for cash incentives rather than on actual service delivery. An analysis of the Family Planning expenditure under NHM (excluding the HR component) showed that 82% of flexi funds for Family Planning are being used for compensation (to the users of sterilization and IUCD) and incentives (to staff and ASHA) [Source: NHM allocations for 2015-16 for Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand]. Also, within the method mix, terminal methods take precedence over spacing methods. The similar analysis of NHM funds show 77% of the fund (excluding the HR component) is targeted to limiting methods, most of which is to be spent on paying compensation.
The NHM route of financing Family Planning in India has shown signs of increasing budgetary allocations, which has increased by 47% from 2013-14 to 2015-16. However, the trend of allocation of Central Sector resources is discouraging, which has shown a decline by 54% between 2013-14 and 2015-16. Since the contraceptives and promotional materials (for Information Education Communication – IEC) are obtained from this budget, the declining trend since 2011-12, clearly raises serious concerns about the sustainability of FP services to meet rising future needs.
Despite a visible and significant upward trend in the NHM resources, the progress in the forthcoming years is marked by a serious concern about the changing pattern of the centre-state allocation formula. According to this, the states, with their tight fiscal space, are expected to share 40% of programme funds from their own resources. The changing pattern of centre-state share in financing of NHM, the poorer states (like Bihar and Uttar Pradesh) will find it difficult to attract larger central funds.
Hence, it would be necessary to track the budget and expenditure for family planning at all levels, especially on key items like spacing methods and contraceptives, IEC, Quality Assurance, HR and training. This may help advocate better with central and governments regarding increased funding of specific areas under family planning.
Objective of the Technical standing committee:
- To advocate for increase in budget in Family planning at all levels to ensure quantity and quality.
- To identify areas for increased funding under the Family Planning budget at all levels and advocate for the same.
- To suggest tracking and continuous monitoring of Family Planning budgets, expenditure and outcome at all levels.
- To engage various stakeholders to present the evidence of family planning budgets and expenditure, and advocate with them for increased funding of family planning.
- To develop a timeline and priority tasks for the ARC national Technical standing committee for a period of two years.
- Generate evidences to do advocacy to increase budget in family planning.
- Undertake tracking mechanism for monitoring budgets on family planning expenditure.
- Meetings with stakeholders to present evidences for the requirement for increasing family planning budgets.
Technical Standing committee: