Health systems that achieve UHC and the health-related Sustainable Development Goals rely heavily on a solid foundation of PHC. Most SRH services, such as prenatal and postnatal care, contraception and abortion care, can be provided through PHC. But nearly 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 lifetime. More examples and clear ways to implement services are needed.
Because integrating SRH within PHC for UHC requires both political commitment and defined and coherent strategies, these practical tools are designed to assist decision makers, program managers, implementers, civil society, researchers and wider health system communities.
The first resource is a Handbook Critical Considerations for Achieving Universal Access to Sexual and Reproductive Health in the Context of Universal Health Care through a Primary Health Care Approach. The content includes guidelines for including comprehensive SRH services in health packages, planning and implementation of integrated packages of SRH services, as well as accountability processes and measures to ensure universal access to all essential SRH services.
For effective and integral SRG, the handbook advocates mapping out the rights and responsibilities of the target groups; monitoring the implementation of national action plans; ensure sufficient resources; informing and supporting healthcare providers; and making healthcare systems more adaptable.
This piece also highlights examples of innovative ways in which SRH services have been integrated into national PHC strategies in many countries. These examples demonstrate not only a variety of approaches in different countries that take into account economic, social and cultural contexts that influence SRH services, but also lessons and tactics that can be applied in almost any context.
For example, we learn about key actions to strengthen service availability and preparedness for safe abortion services in Ireland, the role of evidence in catalyzing policy action in addressing the mistreatment of women during childbirth in centers in Guinea, and the application of evaluation of health technology for the inclusion of the HPV vaccine in the health benefit package in Thailand.
“Sexual and reproductive health is critical to health and well-being throughout the lifecycle, and therefore needs to be embedded and integrated into primary health care, with universal access for all,” said Professor Pascale Allotey, Director of Sexual Reproductive Health and Research at WHO, and the United Nations Special Research Program on Human Reproduction (HRP). “There just isn’t universal health coverage without sexual and reproductive health.”
Learning by sharing portal
The Learning by Sharing Portal (LSP) is a second resource to support the integration of SRG into wider UHC-related reforms. Launched on July 19, 2022, the portal is an online repository of qualitative case studies documenting stakeholder experiences in implementing an integrated SRH-UHC. The aim is to bring together normative tools and guidance for Member States and other stakeholders, including donors and countries, bringing programs closer to full alignment.
“The SRH-UHC portal is a powerful tool that allows 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 HRP Board of Directors.
The portal features national-level implementation stories from around the world on “how” governments can address the sexual and reproductive health needs of women, adolescents and hard-to-reach populations. The launch of the LSP reflects a years-long collaborative process in which WHO collaborated with the United Nations Population Fund (UNFPA) in developing content through an open call for stories and peer-reviewed literature demonstrating a clear link between SRH and UHC.
Stories include changing policies and legislation in Kazakhstan, aligning donor priorities in Malawi, community health workers expanding service delivery 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 the 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 to and responding to the voices of those most lagging behind is essential and mechanisms to enable participation and voice must be an integral part of all national efforts. Working together, everyone concerned with achieving universal access to SRH services through enhanced PHC systems can benefit from the evidence and lessons documented in these tools.