Thematic Working Groups

UHC & SRHR: Capacity Building and Strategizing

Eight different thematic workshops took place at the 17^th International Dialog aiming at informing participants about a broad range of topics regarding Universal Health Coverage (UHC) and Sexual and Reproductive Health and Rights (SRHR) in this context.

People: Covering the most vulnerable population groups in UHC

SM Shaikat from SERAC, Bangladesh

Providers: UHC reforms and community-based service providers

John Lotspeich from Marie Stopes International, UK

Packages: Comprehensive SRH packages in UHC reforms

Helga Fogstad from PMNCH, Switzerland

Politics: Promotion of SRHR in the framework of UHC reforms

Fabian Cataldo from IPPF, UK and Amos Mwale from Centre for Reproductive Health and Education, Zambia

Payment: Financing of SRH services

Dr Lale Say from WHO, Switzerland

Private Sector and Prices: Affordable quality services and products

Brian McKenna from the Reproductive Health Supplies Coalition, Belgium

Brian McKenna - Private Sector and Prices

Prevention and Health Promotion:

Sajja Singh from Yuwa, Nepal and Jairo Rodrigues from the Guyana Responsible Parenthood Association – both part of the Right Here Right Now Network established by Rutgers

Power of the Law:

Christina Zampas Centre for Reproductive Rights, Switzerland

The following summaries shall give an exemplarily impression of the workshops People and Private Sector and Prices and highlight the discussions.

Example 1: People

SM Shaikat, the Executive Director of SERAC in Bangladesh, led a workshop on how to provide UHC for the most vulnerable population groups such as refugees, migrants, youth, sex workers, men who have sex with men, LGBTI+, young women, people who use drugs and people with disabilities. The workshop looked at how UHC reforms can help to ensure equity and access to SRH services for all people and what must be taken into account to make this happen.

During the workshop, participants discussed main challenges in providing UHC for the most vulnerable population groups, such as:

Social stigmas: Social stigmas around sex and sexuality are a significant barrier to people seeking SRH services and receiving fair and professional treatment.
Lack of trained health professionals: A lack of specifically trained medical professionals exists as well as a lack of a monitoring system to inspect how professionals handle people who are seeking help.
Limited coverage by social security schemes: Most vulnerable groups are often not effectively covered by existing social security schemes. The exclusion of undocumented migrant poses a specific challenge in this regard.
Lack of governmental buy-in: UHC can only be realized with governmental support and targeted funding.
Lack of target setting: Progress is unlikely if no clear and short term local and national targets for comprehensive SRH services are set.

Participants also looked at possible solutions, as for example:

Breaking down barriers: In order to encourage and enable people to come forward and ask for help and advice, the medical profession must prioritize tackling social stigmas around sex and sexuality. This awareness can be achieved by providing healthcare professionals with training on how to handle vulnerable groups.
Investment in technology: The support of technology is vital in ensuring feedback on services and improving quality.
Budget implementation: Budgets must be efficiently planned and fully used. Governments must listen to people so that funding is linked to the actual needs of the population in order to ensure that all services are fully utilized.
Targets and roadmap: A roadmap and short-term targets are vital for progress. These must be compared to internationally set targets (by the UN) to ensure long-term success.

Interview with SM Shaikat, Executive Director of SERAC-Bangladesh

Qu. Mr. Shaikat, what discussion did you hope to generate between the participants during this session?

Answer: We had two different rounds with guiding questions which prompted the audience to think about certain issues. One of the guiding questions was, who are the people who don’t have access to the UHC system? Also, what are the circumstances that change and influence health coverage and the policies and indicators that can help a country make progress? We also talked about best practices that may exist to support Universal Health Coverage for vulnerable communities.

Qu: Are vulnerable people listened to sufficiently to clarify what help and services they need?

Answer: It’s sad but true that vulnerable groups are not heard enough because they can’t access the spaces, like advocacy spaces. We don’t really ask them what they need. There are many suggestions like sustainable planning. But sustainable planning must of course include the target groups who we are designing this scheme for and this is sometimes missing. We rely mainly on quantitative data i.e. this percentage believes X, this percentage thinks Y. But what about beyond the numbers? We need qualitative, people-centered research. We need the stories. Because stories give you a different perception compared to the numbers and bar charts. This is what today’s discussion provoked a lot.

Qu: Is the response from health professionals and others in the healthcare sector enough in response to the sharp increase in refugees, displaced and other vulnerable people around the world?

Answer: Definitely the world is facing its most critical time for centuries. There’s climate change, there’s a lack of jobs, there are epidemics and of course increasing inequality. The GDPs are increasing but of course the inequality is getting larger, and there’s no good intervention to reduce inequality. We’re always looking at the GDP but in its shadow, there’s inequality which we don’t notice enough. And this then has an effect on GDP, because if we don’t invest in health, it’s a risk for every other investment.

There are also vulnerable communities who have been around for a long time like the LGBTQ community or unmarried young people. All the religions get together to criminalize unmarried young people if they even try to learn about SRHR. We’re not responding to these issues enough. But there are good examples of where we are reaching out. In Tunisia, they’re trying to provide migrants with HIV services. In Bangladesh, there was the recent response to the 1.3 million Rohinga refugees. It was a huge influx but the country responded very comprehensively. But people don’t only move because of war and conflict. They may move because of climate change or because they want a better income. You can’t stop people based on their passports and visas. It will affect people everywhere and you need to get prepared. System need to be prepared to respond to their needs and those needs are not just food and shelter. Proper health coverage is a must, it’s a human right, and you must consider it like that.

SM Shaikat, Executive Director of SERAC-Bangladesh

Example 6: Private Sector and Prices

Brian McKenna, Deputy Director of the Reproductive Health Supplies Coalition (RHSC), led a discussion on how the availability and affordability of reproductive health supplies can be influenced including the role of the private sector in this regard.

During the workshop, price-increasing factors were discussed, amongst others:

Hard-to reach populations: Smaller, rural, marginalized and/or hard-to reach areas and populations have less purchasing power what can be a disincentive for investors. This is compounded by supply difficulties due to the lack of distribution channels and geographical distances.
Inefficient procurement systems and regulations: Weak and inefficient procurement systems, as well as inadequate regulations and registration fees exist.
Business models: Some products are only available at high cost, for instance, implants that are only available with a few providers who charge extra fees. This is partly because of a business model that targets the upper class, instead of the majority.
What do people need?: Often, there is a gap between what is supplied and what people actually need.

Participants also discussed the role the private sector can play to increase access, as for instance:

Changing the business model: Instead of costly products for some, the business case might be reproductive health supplies at a lower price for many. However, challenges, such as lack of functioning local markets and high registration fees must be addressed in order to make this business model work.
Sharing Know-How: If the sector is willing to share its expertise in the area of management and supply chains, private-public partnerships can help to improve the supply of reproductive health products and contribute to lower prices.

Participants also discussed different solutions for improving the access to contraceptives, including for example:

Integration into UHC schemes. The inclusion into national benefit packages increase the purchasing power of local populations and can therefore contribute to foster functioning markets for reproductive health supplies.
Joint procurement systems (e.g. for different products, also beyond health products) can help to lower costs and thus to reduce prices.
Inclusion of civil society in decision-making processes can build pressure for investing in hard to reach areas and populations. Furthermore, the inclusion and empowerment of users, especially women, can help to guarantee that the supply meets the demand “on the ground”.
Demand creation: a lack of education means many people are not aware of the need for contraception. This in turn leads to a lack of market for companies to tap into. This can be addressed by demand creation and comprehensive sexuality education.

Interview with Brian McKenna, Deputy Director of the Reproductive Health Supplies Coalition (RHSC).

Qu: Brian, what needs to be at the center of guaranteeing affordable contraceptive products and services?

Answer: The woman. It’s multifaceted and there’s a spaghetti bowl of different ways products can get out to her. But she can make the solution a lot more targeted and succinct. If we put the woman at the center of what we’re thinking about, that person doesn’t just have needs in that specific area. She’s a mother with children, with all kinds of different issues in her life. If we’re thinking about just her family planning or reproductive health needs, we’re missing the larger picture and we’re not going to be serving her and her needs.

Qu: Is this discussion dominated by the fact that men are in positions of responsibility and decision making roles?

Answer: That is the case in a number of circumstances. Is it hindering access? It may be, although that’s hard to say on a global level. Could there be better gender equity in this field as opposed to others? Absolutely. If we had more women making decisions in some of these areas, it may very well be that we would have different solutions.

Qu: Why are products like cold beer and Coca Cola always available in remote villages and yet it remains so difficult to get vital products such as contraception to people?

Answer: It’s a business, they have done a tremendous job of brand recognition, of creating demand, people want it and seek it out. It’s certainly an issue for sexual and reproductive health products. They’re also masters of supply chain management. Getting a Coke out to a village in the middle of nowhere is extraordinary and it’s something that we as a community need to learn from. Coca Cola has some pretty great collaborations with organizations working in the health sector that help get some of these products and services out to the same places where you can find a Coca Cola. And that’s the joke, isn’t it? You can always find a Coke, but you can’t always find the products we’re talking about. If there’s any determination of an unhealthy supply chain, it’s a stock-out - which is when a woman asks for a particular contraceptive product and it isn’t available. That’s one of the problems we’re trying to solve and that’s a problem Coca Cola has done such a good job of solving, the product’s almost always there.

Brian McKenna, Deputy Director of the Reproductive Health Supplies Coalition (RHSC)