Payment-by-results contracts are the best way to ensure aid reaches girls, says Baroness Sugg

Baroness Sugg at a Dfid project in Senegal
Baroness Sugg at a Dfid project in Senegal Credit: Dfid

Payment-by-results contracts help to ensure UK aid is spent on family planning initiatives that prioritise vulnerable women and girls, the international development minister has claimed. 

Last year the Department for International Development (Dfid) launched a £200 million programme in 27 countries across Africa and Asia, which aimed to provide sexual health services for women who often miss out – teenagers and the poorest in society. 

The fund, called Wish (women’s integrated sexual health), includes results-based financing – meaning project partners will only be paid if they can demonstrate they have reached certain groups of marginalised women. 

The project partners, in this case Marie Stopes International and International Planned Parenthood Federation, do not have to deliver certain quantities of contraception services – performance targets are based solely on access. 

Speaking to The Telegraph from Senegal, Baroness Sugg said that “it’s an absolutely priority” to give marginalised women choice over contraception – and payment-by-results contracts help to “ensure we’re getting to those people who most need it”. 

“The Wish programme is all about targeting the hardest to reach girls and women,” said Baroness Sugg. “It is the first time we’ve put this as an indicator… but we’ve got to make sure we’re getting to the most vulnerable [women], which is why these contracts with partners are so important.” 

The approach comes amid growing concerns that poor women and teenagers are being left behind in the drive to increase access to contraception and abortion services. 

In Cairo 25 years ago, the United Nations held a landmark summit on family planning, which brought together world leaders and donors from across the globe. 

The summit – the International Conference on Population and Development (ICPD) – was much-heralded for championing a “rights based approach” to sexual health and targets to increase access to family planning were agreed by 179 governments. 

But as the international community prepares to meet for the second ICPD in Nairobi this November, concerns about stalling and unequal progress have been raised. 

Over a quarter of a century, global access to modern methods of contraception has increased by just six per cent. 

“There is no doubt that progress has been made,” said Arthur Erken, director of communications and strategic partnerships the UNFPA, the UN’s family planning arm. “In 1994, access to contraception was very low, it was basically just the urban elite who had access.”

He said that developing countries have seen the most rapid improvements – access to modern methods of family planning has increased from 15 per cent in 1994 to 37 per cent in 2019.

“But we are far from finished, there is still a lot of work to do,” Mr Erken added. “Changing behaviour and ideas, it takes time, it takes generations. And I do have concerns that there are groups of people who are being left behind. 

“The main rally cry in Nairobi will be that we must not leave these people behind, and that governments must increase investments and follow up on commitments,” he said. 

Baroness Sugg echoed Mr Erken’s message and said the UK was a “world leader” in efforts to “drive the family planning agenda forward.” 

“We really hope the summit is going to be a key moment in the defense, progress and advancement of sexual and reproductive health and rights,” she said. 

Baroness Sugg added that meeting women in Senegal – where just 24 per cent of women aged 15-49 use modern contraception – had “really hit home how transformative” access to family planning is. 

The Wish programme was launched in the West African nation in January, in partnership with Marie Stopes International, and Dfid say that already 20,000 women have been able to access contraception services for the first time. 

Senegal has also benefited from the UK’s market shaping approach, which has reduced the price of the contraceptive implant by 50 per cent and driven a threefold increase in uptake in developing countries. 

Previously, supply of the contraceptive implant was in a so-called “market trap”, as low demand made production expensive. 

In 2013, the UK was part of a partnership that collectively agreed to buy a minimum volume of implants over six years, allowing manufacturers to increase production and reduce prices. 

“Reproductive rights are human rights, and in order to give people their reproductive rights we’ve got to get that choice right, get our approach right,” said Baroness Sugg. “That’s abundantly clear to me. 

“The UK has got to put our money where our mouth is, but we must also ensure the investments we are making are sustainable, are good value for money and get to as many people as possible,” she said. 

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