Credit: Carla Matta, Health and Education Policy Plus
Development programs cannot succeed without adequate and consistent sources of funding, and family planning programs are no exception.
However, what we're seeing in Guatemala is different than other countries in the region and beyond. Between 2011 and 2018, Guatemala’s Ministry of Health has spent US $15.2 million on contraceptives, contributing to a hugely successful program.
How did Guatemala do it?
The story we tell from Guatemala is complex and spans years. It involves shrewd policy actors — heroes and villains — intimate knowledge of the national political system, and a focus on big-picture issues that consequently influenced not only family planning, but other health programs in the country. Ultimately, it required strong alliances that worked with patience, persistence, and the knowledge to know when and how to act.
Alcohol Tax Revenue for Family Planning
In 2004, after years of advocacy, Guatemala modified its Distribution of Distilled Spirits, Beer, and Other Fermented Beverages Law (referred to as the "alcohol law") to allocate 15% of generated revenues to programs focused on reproductive health, family planning, and alcoholism.
The following year, the country adopted a Law on Universal and Equitable Access to Family Planning, which created a budget line item for the alcohol tax revenue and established a commission for contraceptive security, whose mandate included monitoring the family planning law.
Five years later, Guatemala adopted a Safe Motherhood Law requiring that the Ministry of Health spend at least 30% of the alcohol tax revenue on contraceptives.
Implementing the Laws
Behind these legal maneuverings were champions from civil society and government who pressured the congress, the courts — even the president! — to pass the laws and ensure that they were implemented. Over time, a network of civil society organisations formed and recruited allies in positions of power. In 2008 the National Reproductive Health Observatory was established, serving as a watchdog organisation composed of representatives from academia and civil society.
In 2009, the National Contraceptive Security Commission was established with the goal of ensuring all citizens have access to family planning and that funding is available to ensure the required supply of commodities. This commission is composed of representatives from government and civil society.
These groups paved the way for a steady source of funding for contraceptives — though ensuring that these funds are properly allocated and disbursed remains a challenge.
Allocating and Using the Funds
Between 2011 — the year following the passage of the mandatory funding for contraceptives through the Safe Motherhood Law — and 2018, the Ministry of Health has spent about US $15.2 million on contraceptives out of the US $53.6 million it has received from the tax: approximately 28% of the revenue received. Overall flow of funds has remained on track, but the annual flow of funds has been erratic due to fluctuations in how the national budget is executed.
Additional legal changes, advocated by civil society groups, together with the National Contraceptive Security Commission, have allowed the available funds to be used more efficiently. For example, in 2015, the congress amended the contracting law to allow contraceptives and essential drugs to be purchased from the lowest cost provider — either domestic or international. This overturned a prohibition on the use of government funds for purchasing health commodities from international agencies.
Permanently amending this law allowed Guatemala to use its available funds more efficiently for purchasing contraceptives, vaccines, antiretroviral drugs, and micronutrient supplements.
More to be Done
While Guatemala has been successful in mobilising public resources for family planning commodities, funding is still not sufficient to cover the full cost of implementing all aspects of the national family planning program. Nevertheless, its story reinforces the importance of a strong legal and policy framework for financing health services and supplies, an officially established entity that provides monitoring and oversight, as well as the importance of continuing to fight for those laws and funding sources that are vulnerable to challenges from a range of political and institutional forces.
Guatemala highlights the effective interplay between civil society and government champions, strong policies and regulations with the needed support to implement them, and ongoing monitoring to ensure that the situation doesn’t backslide. The success we've witnessed has been based on committed champions who worked short-term tactics and mid-term strategies to achieve a long-term goal — and a political know-how and persistence to hold the government accountable to the commitments it has made to its citizens.
This article originally appeared in Medium and was adapted with permission.