Financing Sexual and Reproductive Health and Rights: Why States Must Renew their Health Financing Commitments in the Maputo Protocol

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This year we celebrate 20 years since the Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa was adopted.

Popularly known as the Maputo protocol, this revolutionary human rights instrument was adopted against the backdrop of an urgent need to guide African states towards the collective realisation of gender equality and women’s empowerment in Africa.

It stands as a testament to the commitment of African nations to promote and protect the rights of women and girls , including sexual and reproductive health and rights (SRHR). Two decades later, as we reflect on the progress made since its inception, we must interrogate how health financing and resource allocation as a whole have affected the realisation of reproductive rights in Africa as envisioned in the Protocol.

In many parts of Africa, affordability of health care remains a significant barrier to accessing health care services, including sexual and reproduction health (SRH) services. Resource allocation determines not only the availability and accessibility of these services but also the quality of care people receive. Thus, the Maputo protocol, cognisant of the role resources play in realising sexual and reproductive rights, calls upon member states to ensure that sufficient financial resources are available for the realisation of these rights.

Article 4(2)(i) requires all member states to make adequate budgetary allocations towards health care and provide other resources necessary for implementing and monitoring initiatives to prevent and eradicate violence against women.

Similarly, under Article 14(2)(a) and (b), state parties are mandated to ‘take all appropriate measures to provide adequate, affordable and accessible health services including information, education and communication programmes to women especially those in rural areas’; and are also tasked to establish and strengthen systems connected to pre-natal, delivery and postnatal care, including services that women need while they are breastfeeding.

Under Article 26(2), the Protocol further calls upon State parties to take appropriate measures, particularly providing budgetary allocations and other resources, to effectively implement women’s rights as guaranteed in the Protocol.

Moreover, beyond the Protocol, the African Commission, in General Comment Number 2 on Article 14 of the Protocol, reiterated that states must fulfil their duty by allocating sufficient and available resources to implement the rights guaranteed in the Maputo Protocol.

The Commission urged states to strengthen public health services through adequate financial investments accompanied by specific budgetary allocations under the health budget at national and local levels. The General Comment  further  calls for the comprehensive tracking of health-related expenditure, the development of appropriate monitoring, and evaluation framework that will facilitate control and accountability.

The 2006 Maputo Plan of Action for the Operationalisation of the SRHR Continental Policy Framework; and the African Ministers of Health Continental Policy Framework on SRHR also captured the importance of financing health systems.

Globally, the Maputo protocol is lauded for being the most progressive human rights instrument on women and girls' SRHR. Since its adoption, notable achievements have been made vis-a-vis SRHR in various African countries. However, as we celebrate these milestones, we must acknowledge how failure to fulfil obligations related to financial investment in health has negatively affected the realisation of SRHR in many African countries. 

For instance, in sub-Saharan Africa, maternal mortality ratios remain very high, with an estimated 545 maternal deaths per 100,000 live births per year. Deaths due to unsafe abortions also  continue to remain high. Reports indicate that as of 2019, women from sub-Saharan Africa account for the highest incidence of deaths at 185 per 100,000 abortions, for a total of 15,000 preventable deaths every year.

Furthermore, over the years, we have witnessed  increased reports of various forms of obstetric violence cases during facility-based childbirth. These have been reported across the continent, and  range from forced or coerced sterilisations, postpartum detention in medical facilities, forced abortions, physical and verbal abuse, and neglect. Aside from being interpersonal, this form of abuse is structural and is caused by limited resource allocation, both human and capital.

Thus, while the protocol was a significant leap, its implementation has faced various challenges over the past two decades. One of the primary obstacles being the failure to allocate adequate resources needed to realise sexual and reproductive health and rights fully.

“…we need stronger financing efforts directed towards increasing access to SRH services and commodities…”

Moving Beyond Rhetoric: The Path Forward

Political commitment and legal enforcement are crucial in translating rhetoric into tangible action. While many African countries have ratified the Maputo Protocol, the gap between legal frameworks and their implementation remains significant. Therefore, as we mark 20 years since the adoption of the Maputo Protocol, it is a moment for reflection and an opportunity to renew our commitment to advancing sexual and reproductive rights. 

African Governments must prioritise allocating resources to support reproductive health programs as mandated by the Protocol and other relevant human rights instruments safeguarding sexual and reproductive health and rights. In fact, it is time that they meet and increase their financial obligation as stated in the Abuja Declaration, which requires member states to allocate at least 15% of their annual budget to improve the health sector and urge donor countries to scale up support.

Furthermore, they must honour their 2019 commitment of investing USD 200M in health through stronger domestic and continental funding mechanisms. The importance of health financing has been underscored in the Addis Ababa Declaration on Community Health in the African region, the Ouagadougou Declaration on Primary Health Care and Health Systems in Africa: Achieving Better Health for Africa in the New Millennium, and the Tunis Declaration on Value for Money, Sustainability and Accountability in the Health Sector.

Therefore, going forwards, we need stronger financing efforts directed towards increasing access to SRH services and commodities, strengthening the health systems, and building the capacity of health workers. This should be supported by an effective monitoring mechanism that ensures compliance with the protocol's provisions. Strengthening accountability and fostering collaboration between governments, civil society organisations, and international partners are essential in realising SRHR.