Review of the inclusion of SRHR interventions in essential packages of health services in low- and lower-middle income countries

Figures & data

Table 1. The Report of the Guttmacher-Lancet Commission's essential package of sexual and reproductive health interventions

GLR 1	Comprehensive sexuality education
GLR 2	Counselling and services for a range of modern contraceptives, with a defined minimum number and types of methods
GLR 3	Antenatal, childbirth, and postnatal care, including emergency obstetric and newborn care
GLR 4	Safe abortion services and treatment of complications of unsafe abortions
GLR 5	Prevention and treatment of HIV and other sexually transmitted infections
GLR 6	Prevention, detection, immediate services, and referrals for cases of sexual and gender-based violence
GLR 7	Prevention, detection, and management of reproductive cancers, especially cervical cancer
GLR 8	Information, counselling, and services for subfertility and infertility
GLR 9	Information, counselling, and services for sexual health and wellbeing

Source: Starrs et al.¹⁴

Figure 1. Case classification scheme on which essential packages of health services (EPHS) were categorised

Table 2. Case Classification results disaggregated by country income status

	Benin		Afghanistan
	Burkina Faso		D.R.C.
	Guinea-Bissau		Ethiopia
	Mozambique		Haiti
	Nepal		Liberia
	Somalia	Burundi	Malawi
	Tanzania	Chad	North Korea
	Togo	Eritrea	Rwanda
	Uganda	Guinea	Sierra Leone
	Angola	Madagascar	South Sudan
	Cameroon	Mali	Bangladesh
	Côte d’Ivoire	Niger	Ghana
C.A.R.	Egypt	Tajikistan	India
Syria	Philippines	The Gambia	Indonesia
Yemen	Ukraine	Myanmar	Kenya
Morocco	Vietnam	Sudan	Nigeria
Pakistan	Zambia	Uzbekistan	Republic of the Congo
Case 1 (5)	Case 2 (17)	Case 3 (12)	Case 4 (17)

Key: Light grey = LIC, Dark grey = LMIC; C.A.R. = Central African Republic; D.R.C. = Democratic Republic of the Congo

Table 3. Inclusion of the Guttmacher-Lancet Report’s nine essential SRHR interventions within Case 4 essential packages of health services (EPHS) disaggregated by country income status and arranged from most to least interventions included

LIC	GLR 1	GLR 2	GLR 3	GLR 4	GLR 5	GLR 6	GLR 7	GLR 8	GLR 9	# GLR interventions within country’s EPHS
Liberia	–	✓	✓	✓	✓	✓	✓	✓	✓	8
Afghanistan	✓	✓	✓	✓	✓	✓	–	✓	–	7
Haiti	–	✓	✓	✓	✓	✓	✓	✓	–	7
Sierra Leon	–	✓	✓	✓	✓	✓	✓	✓	–	7
Malawi	–	✓	✓	✓	✓	✓	✓	–	–	6
Rwanda	–	✓	✓	✓	✓	✓	–	✓	–	6
South Sudan	✓	✓	✓	✓	✓	✓	–	–	–	6
D.R.C.	–	✓	✓	–	✓	✓	–	–	✓	5
Ethiopia	–	✓	✓	✓	✓	–	–	–	✓	5
North Korea	–	✓	✓	✓	✓	–	✓	–	–	5
Total *	2	10	10	9	10	8	5	5	7
LMIC	GLR 1	GLR 2	GLR 3	GLR 4	GLR 5	GLR 6	GLR 7	GLR 8	GLR 9	# GLR interventions within country’s EPHS
Bangladesh	✓	✓	✓	✓	✓	✓	✓	✓	✓	9
India	–	✓	✓	✓	✓	✓	✓	✓	✓	8
Ghana	✓	✓	✓	✓	✓	–	✓	–	✓	7
Indonesia	–	✓	✓	✓	✓	✓	–	✓	✓	7
Nigeria	✓	✓	✓	✓	✓	✓	✓	–	–	7
Kenya	✓	✓	✓	–	✓	✓	✓	–	–	6
Republic of the Congo	–	✓	✓	–	✓	–	✓	–	✓	5
Total *	4	7	7	5	7	5	6	3	5

Key: Within country's EPHS, (✓) = inclusion of intervention, (–) = absence of intervention; * # of EPHS which include the intervention; GLR = Guttmacher-Lancet Report; D.R.C = Democratic Republic of the Congo.

GLR nine essential SRHR interventions:

GLR 1: Comprehensive sexuality education

GLR 2: Counselling and services for a range of modern contraceptives, with a defined minimum number and types of methods

GLR 3: Antenatal, childbirth, and postnatal care, including emergency obstetric and newborn care

GLR 4: Safe abortion services and treatment of complications of unsafe abortion

GLR 5: Prevention and treatment of HIV and other sexually transmitted infections

GLR 6: Prevention, detection, immediate services, and referrals for cases of sexual and gender-based violence

GLR 7: Prevention, detection, and management of reproductive cancers, especially cervical cancer

GLR 8: Information, counselling, and services for subfertility and infertility

GLR 9: Information, counselling, and services for sexual health and wellbeing

Table 4. Results of the Sensitivity Analysis compared to the results of the High-Level Matching for safe abortion (GLR 4)

Country	Liberal inclusion criteria*	Strict inclusion criteria**
Liberia	✓	✓
Afghanistan	✓	–
Haiti	✓	✓
Sierra Leone	✓	–
Malawi	✓	–
Rwanda	✓	✓
South Sudan	✓	✓
D.R.C.	–	–
Ethiopia	✓	✓
North Korea	✓	✓
Bangladesh	✓	✓
India	✓	✓
Ghana	✓	–
Indonesia	✓	–
Nigeria	✓	–
Kenya	–	–
Republic of the Congo	–	–
Total: 17	14	8

Key: (✓) = included, (–) = not included; Light grey = LIC, Dark grey = LMIC; D.R.C. = Democratic Republic of the Congo; Liberal inclusion criteria* = results of the High-Level Matching; Strict inclusion criteria** = results of the Sensitivity Analysis.

Starrs AM, Ezeh AC, Barker G, et al. Accelerate progress – sexual and reproductive health and rights for all: report of the Guttmacher– Lancet Commission. Lancet. 2018;391(10140):2642–2692. doi:https://doi.org/10.1016/S0140-6736(18)30293-9.

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