Family planning via strategic purchasing

Punjab is home to a staggering 52 per cent of the country’s total population. With an estimated 127 million residents, it ranks as the 11th most populous region globally, surpassing entire national populations like Germany (85m), Japan (112m), and Malaysia (34m). The province’s population is growing rapidly at 2.53pc annually, projected to reach 150m by 2030. This significant demographic expansion presents both opportunities and substantial challenges for family planning and healthcare services in Punjab.

While both public and private sectors are actively involved in providing contraceptives and promoting family planning, the province’s population growth continues at a rapid pace, suggesting that current initiatives may be reaching a plateau. The province’s limited fiscal space also necessitates a comprehensive strategy for resource mobilisation to finance the necessary services. To address the persistent unmet need for contraceptives, strategic purchasing could be explored as a promising approach.

Strategic purchasing in family planning emphasises a more targeted, value-driven approach to procuring services, ensuring that resources are allocated efficiently to enhance population health outcomes. In Punjab, adopting strategic purchasing practices could drive transformative improvements in service delivery, patient engagement, and care quality. This approach not only strengthens access to family planning services but also optimises resource use for greater impact.

A key example is the transition from traditional, volume-based payment models to performance-based payment models, where payments are tied to specific outcomes, such as increased contraceptive uptake or expanded service delivery networks in rural areas. By incentivising both quantity and quality of care, the government can motivate providers while holding them accountable for delivering accessible, high-quality family planning services.

Rwanda’s community-based pay-for-performance programme provides an illustrative case. This initiative, aimed at improving maternal and child health — including family planning — tied payments to health facilities based on performance indicators. These included metrics like the number of family planning consultations and quality measures such as patient satisfaction and follow-up care.

Engaging in public-private partnerships could help contain the population crises

The programme’s implementation led to a notable increase in family planning visits, enhanced quality of counselling, and more effective management of contraceptive supply stocks, demonstrating the potential of strategic purchasing to improve healthcare outcomes.

The Government of Punjab has been actively exploring various strategic health purchasing approaches to expand access to family planning services. A recent collaboration with the World Bank exemplifies this commitment, focusing on interventions that leverage a pay-for-performance model to enhance both the accessibility and quality of family planning services.

A promising area for further development under strategic purchasing is the strengthening of public-private partnerships (PPPs) in family planning service delivery. Currently, the public sector shoulders much of the responsibility for providing these services in Punjab, resulting in fragmented access — particularly for long-term contraceptive methods.

This fragmentation leads to limited access, with the bulk of services concentrated in urban and peri-urban areas, while rural populations remain underserved.

An integrated approach, leveraging PPPs, could help bridge this gap by improving service availability in rural areas, expanding options for contraceptive methods, and creating a more cohesive network of family planning providers across the province.

One notable project was piloted in Rahim Yar Khan and Dera Ghazi Khan, where the government of Punjab, in partnership with the private sector, introduced travel vouchers for beneficiaries of the Benazir Income Support Programme. These vouchers aimed to overcome transportation barriers, allowing beneficiaries to access family planning services more easily at private and public healthcare facilities.

By engaging private sector providers, the initiative ensured beneficiaries could reach quality care without incurring travel expenses, thus improving service accessibility for low-income families. This intervention also included a pay-for-performance element for private sector service providers, who were compensated based on the services they delivered to beneficiaries.

As a result of the programme, the reported contraceptive prevalence rate (CPR) increased by 10pc in Rahim Yar Khan alone after pilot testing, underlying the notion that if concerted efforts are made strategically, positive outcomes can spur. However, consistent efforts and policy are required to expand the outreach.

Currently, progress remains slow, with coverage lagging and key indicators stagnating. To make a meaningful impact, Punjab must align family planning policy objectives with purchasing strategies that specify what to buy, how to buy it, and who would benefit. Evidence-based approaches are essential to define the service mix, volume, and provider selection in a way that maximises policy goals and aligns with societal needs.

The writer is currently working on health financing in Pakistan’s development sector.

Published in Dawn, The Business and Finance Weekly, November 25th, 2024