Family planning services financing in the West African Economic and Monetary Union countries: Trend analysis from 2013 to 2021.

Background: Access to high-quality family planning (FP) services is crucial for addressing unintended pregnancies and maternal mortality. There is uncertainty about health expenditures, especially FP services, by financing sources. Aim: The study aims to conduct key analyses on health and reproductive health expenditures in the West African Economic and Monetary Union (WAEMU). Setting: This analysis was performed across the eight WAEMU countries (Benin, Burkina Faso, Côte d'Ivoire, Guinea-Bissau, Mali, Niger, Senegal and Togo) from 2013 to 2021. Methods: We conducted a secondary data analysis using the Global Health Expenditures Database. The variables were the current health expenditures, reproductive health expenditures, and FP expenditures by funding source (National General Government, External Funding Sources, and National Private Sector). We performed a trend and funding-source analysis in purchasing power parity in United States dollars. Results: Current expenditures allocated to health, reproductive, and FP services increased in recent years, growing by 4.6%, 5.9%, and 2.7% per year, respectively, in the region. The evidence is strong that countries have commitments to improving health and strengthening access to reproductive health services, especially modern contraceptives. However, FP funding is still dependent on external resources. In most countries, including Benin, Burkina Faso, Guinea- Bissau, Mali, and Senegal, more than half of FP expenditures are funded by external resources, whereas Côte d'Ivoire and Niger rely heavily on government resources. In Togo, the main FP funding sources are the domestic private resources. Conclusion: The significant dependence of Public Finance management systems on external funding, with the government's low contribution, may undermine the sustainability of FP programmes in these countries. Contribution: The evidence suggests increasing domestic resource mobilisation for FP through integrated co-financing mechanisms and advocacy for FP reprioritisation within governments' health budgets, and ensuring efficient and equitable allocation of existing resources through resource reprogramming based on the country background, national priorities, and high-impact interventions.