Potential for Family Planning Program Sustainability Across 33 Countries in Two Regions of sub-Saharan Africa.

Abstract

Background: Sustainability, with countries taking ownership for funding and ensuring access to services and contraceptive commodities, has long been an aim for FP. Recent shocks to donor funding have added urgency to country sustainability. Findings from the 2023 National Composite Index of Family Planning (NCIFP) and its special questions on Sustainability provide a broad view from 33 counties across two sub-regions of sub-Saharan Africa of expert respondents' perceptions in that year on the potential for program sustainability.

Methods: The cross-national NCIFP survey has been conducted since 2014. Its 2023 special questions were designed to take the pulse of stakeholders steeped in their countries' FP program about the state of sustainability, actions being taken, and main challenges their countries faced. Items related to donor dependency, coordination, FP in country plans for Universal Health Coverage (UHC), planning for future demand, and key barriers to sustainability.

Results: Both regions scored highest on the extent to which FP is included in UHC plans and lowest on the items related to donor reliance, indicating high dependency for contraceptive commodities and programmatic support. Donor dependence and lack of domestic financing were most often cited barriers, with human resources; commodities and logistics; and sociocultural, gender and religious barriers all receiving over 10% of the responses on key challenges. The extent to which governments had developed plans to make their national FP programs more sustainable to meet demand varied.

Conclusion: These data provide an important snapshot of family planning programs across SSA prior to the abrupt cancellation of USAID funding in January 2025. Country context, including national wealth and government effectiveness, is important. From the 2023 NCIFP, understanding program experts' perspectives, and identifying similar and unique challenges countries face, is critical to help shape support to strengthen the capacity of countries to move towards FP program sustainability.