Evaluating Contraception for Inclusion in Health Benefits Packages: Conceptual Issues and a Proposed Analytical Framework

As low- and middle-income countries advance towards universal health coverage (UHC), the family planning community increasingly recognizes that inclusion within health benefits packages (HBP)—a cornerstone of UHC policy—may be essential for the sustainability of family planning financing. Designing HBPs requires weighing competing priorities within the health sector and ensuring alignment between the cost of the package and the reality of finite resources. However, the family planning and health financing communities have remained largely siloed. Better engagement is needed between advocates for contraceptive access and health policymakers so that decisionmakers can effectively and equitably weigh the costs, savings, and value of contraception to inform benefit package design. This paper offers an approach that can help donors, governments, and family planning advocates evaluate contraception for inclusion in HBPs, or—more broadly—for subsidization with public funds. First, it describes relevant methodological challenges, including the need to address the non-health benefits of contraception, model method choice, and conceptualize comparators for analysis. Second, it synthesizes evidence on the cost-effectiveness of contraceptive services and finds that contraception is often cost-saving. Third, it reviews the current state of knowledge about the status of contraception in HBPs. Finally, it proposes for further discussion an analytical framework for the design of a contraceptive benefits package within different settings. By engaging in health benefits design, the family planning community and civil society can engage in more effective advocacy and better ensure that those with the greatest health needs are given due consideration within a broader context of resource constraints and competing priorities.