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The Price Tag

Price refers to the financial, physical, and human resources that are needed to implement policies, plans, and programs. Policies that are well written but that do not have adequate resources for implementation are all too common. In the United States, such policies are often called “unfunded mandates.” Many national reproductive health policies could be given the same label. For example, Ukraine’s National Reproductive Health Program 2001–2005 “received little funding from the national level, and local reproductive health budgets were insufficient to implement the NRHP in its entirety” (Judice, 2004: 1). It is crucial when developing or analyzing a policy to consider the level of resources necessary for proper implementation and whether those resources are already available (and allocated) or need to be added for more effective policy implementation.

Often, assuring adequate funding for programs becomes a problem to be addressed through policy. Turkey faced a crisis of funding for family planning commodities when the main donor organization announced a phaseout of support to the country starting in 1994. Advocacy, policy dialogue, and analysis of the shortfall in funding and implications for the family planning program resulted in a funded line item for contraceptives in the Ministry of Health’s budget (Sine et al., 2004). In Jordan, the structure of the “General Budget” for 2002 was modified to include a budget line item for reproductive health based on the work of a national five-member Reproductive Health Finance Committee established by the National Population Commission (NPC). The committee was composed of members from the NPC, the Ministry of Finance, the Ministry of Health, and major FP/RH NGOs. The purpose of the committee was to develop a strategy to improve reproductive health financing in Jordan. Following participation in an international conference on reproductive health financing, the committee became an active member of a task force charged with developing the National Reproductive Health Action Plan, which has financial sustainability as one of its six components (POLICY Project results database, 2003).

Resources can become a struggle if annual budgets are determined before the reform occurs or if there are obstacles in the government bureaucracy (Brinkerhoff and Crosby, 2002). For example, in Namibia, “once HIV/AIDS became part of the national policy agenda, programmatic action was initially delayed until budget cycles freed up resources within the health sector to be reallocated. Later, as HIV/AIDS was recognized as a policy problem with broader ramifications than just health, the health ministry resisted relinquishing control because it meant that others would receive a share of the funds it managed for HIV/AIDS policy implementation” (Brinkerhoff and Crosby, 2002: 21).

The Minister of Health and Population in Egypt used cost-benefit information in a speech given to the People’s Assembly and in replying to comments from the Health, Population, and Environment Committee of the Parliament in February 2001. The speech was prepared in response to queries about the impact and cost-benefits of the national population and family planning program. The Minister noted that putting money into family planning was a good investment as every Egyptian pound spent on family planning resulted in a savings of 30 pounds that would have to be spent on fulfilling the needs of a growing population. He concluded by requesting an increase in the budget allocations for the population and family planning program (Policy Project results database, 2003). Similar analyses for advocacy and policy dialogue have been undertaken in various countries using the FamPlan and BenCost models found in the SPECTRUM System of Policy Models.

More recent efforts have gained a better understanding of how many resources will be needed to achieve a desired HIV/AIDS-related goal, and how many resources a particular goal will require to be achieved. In South Africa, the application of the GOALS Model has contributed to an increase in the budget of the national government’s expenditure on national HIV/AIDS programs from 783.2 million Rand in 2002– 03, to 1,144.0 million Rand in 2003–04 to 1,589.4 million Rand for 2004–05. In September 2002, the national Department of Health released a report that outlined revisions to the funding requirements for the “Enhanced Response to HIV/AIDS and Tuberculosis in the Public Health Sector 2003/4–2005/6.” The report highlighted how the application of the GOALS Model contributed to developing the government’s AIDS budget (Medium-term Expenditure Framework). GOALS served as a basis for increasing the budgets with regard to programs focusing on HIV transmission through sex work, condom provision, and projected care costs. GOALS also confirmed budgetary estimates with regard to prevention of mother-to-child transmission (PMTCT) as well as current spending on care and treatment (POLICY Project results database, 2003).

Often, increased resources are not available to address emerging problems. Instead, addressing new problems can require taking resources away from other pressing needs (as is the case with HIV and other reproductive health needs currently). Incorporating the budget process into the framing of a policy can ensure feasibility and implementation of a policy.