Assessing public and private sector contributions in reproductive health financing and utilization for six sub-Saharan African countries

Reprod Health Matters. 2011 May;19(37):62-74. doi: 10.1016/S0968-8080(11)37561-1.


The present study provides evidence to support enhanced attention to reproductive health and comprehensive measures to increase access to quality reproductive health services. We compare and contrast the financing and utilization of reproductive health services in six sub-Saharan African countries using data from National Health Accounts and Demographic and Health Surveys. Spending on reproductive health in 2006 ranged from US$4 per woman of reproductive age in Ethiopia to US$17 in Uganda. These are below the necessary level for assuring adequate services given that an internationally recommended spending level for family planning alone was US$16 for 2006. Moreover, reproductive health spending shows signs of decline in tandem with insufficient improvement in service utilization. Public providers played a predominant role in antenatal and delivery care for institutional births, but home deliveries with unqualified attendants dominated. The private sector was a major supplier of condoms, oral pills and IUDs. Private clinics, pharmacies and drug vendors were important sources of STI treatment. The findings highlight the need to commit greatly increased funding for reproductive health services as well as more policy attention to the contribution of public, private and informal providers and the role of collaboration among them to expand access to services for under-served populations.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Africa South of the Sahara
  • Delivery, Obstetric / statistics & numerical data
  • Female
  • Health Services Accessibility / economics
  • Humans
  • Maternal Health Services / economics*
  • Middle Aged
  • Private Sector / economics*
  • Public Sector / economics*
  • Quality of Health Care / statistics & numerical data*
  • Reproductive Health Services / economics*
  • Reproductive Health Services / statistics & numerical data*
  • Sexually Transmitted Diseases / diagnosis
  • Sexually Transmitted Diseases / therapy
  • Women's Health
  • Young Adult