The inclusion of sexual and reproductive health services within universal health care through intentional design

Figures & data

Table 1. 5P framework

Purchasing domains	Purchasing elements	SRH considerations
People: For whom to purchase	Defined target clientele Clientele awareness Community and society engagement	Unmet need Equity (e.g. poor women and men, adolescents) Client adherence (e.g. FP, ART medication) Financial barriers/ out-of-pocket expenditure
Package: What to purchase	Defined benefit objectives Defined benefit package	Broad contraceptive options to improve choice, enable switching, and reduce discontinuation SRH integration into RMNCAH continuum/packages Benefits beyond health outcomes (e.g. autonomy, economic participation)
Provider: From whom to purchase	Contracting Accreditation Integration (e.g. of public and private providers; of relevant services)	Physical access/choice of outlet Minimum quality standards Integration of the private sector including digital support Client realisation of rights to services and quality
Payment: How to purchase	Payment rates Payment methods Provider autonomy Claims processing Quality assurance (data and clinical)	Likelihood of being offered an SRH service, or choice of service (e.g. choice of FP method, choice of uterine evacuation) Efficiency and quality Regulatory and public financial management
Polities: Why purchase (rationale and institutional arrangements)	Political commitment Institutional arrangements Purchaser alignment (across mechanisms) Monitoring and accountability Performance management	Societal benefits (SRHR, gender equality, public health impact) Economic benefits (women’s participation in the labour force and demographic dividend) Normative environment and ability to realise SRH rights Stewardship and ownership (e.g. government and donors, central and decentralised) Fragmentation and adequacy of financing (horizontal and vertical coherence) Regulatory and legal environment (e.g. safe abortion)