Memorandum submitted by Marie Stopes International
In view of the forthcoming inquiry by the International
Development Committee on the effectiveness of EC Development Assistance,
please find following the contribution by Marie Stopes International
(MSI) on the role of the EC in supporting reproductive health
care and HIV/AIDS prevention policies and programmes.
MSI has worked with the principal EU institutions,
namely the Council of Ministers, the European Commission and the
European Parliament, for over ten years.
Since 1991, MSI has provided secretariat services
to the Working Group on Population, Sustainable Development and
Reproductive Health in the European Parliament. The Group provides
members of the European Parliament with a forum for dialogue and
action on the related issues of population growth, reproductive
health, sustainable development and gender equality. In accordance
with the ICPD Programme of Action, it advocates the support of
sexual and reproductive health and rights and women's empowerment
as the basis for social and human development. Since its creation,
the Group has played a key role in influencing EU policy on reproductive
As well as working closely with the European
Parliament, MSI has worked in partnership with the European Commission
for many years, and has gained considerable expertise in European
community policy and funding for reproductive health programmes.
Reproductive health and HIV/AIDS prevention for
While welcoming poverty reduction as the over-arching
objective of the Commission's development policy statement, and
the importance given to social and human development and, in particular,
to health and education, it is vital that the commitment to increasing
and improving access to reproductive health care services and
information be upheld as a priority area. This is especially
important given the increasing feminisation of poverty and the
dramatic increase of HIV infection among women.
The Commission's central tenet that the integration
of developing countries into the world economy is key to achieving
poverty reduction must take into account the growing spread of
disease and ill-health in the developing world and their economic
and social impact. HIV/AIDS in particular has reversed development
gains in some of the world's poorest countries.
In order to contribute to the attainment of
international development targets, and to fulfil its commitments
made at the major UN conferences, the Community's new development
policy should provide a stronger rights-based framework for sustainable
development. Special attention should be given to gender equality
in striving to achieve women's empowerment. Human rights and
gender equality should be integrated into the EC's political dialogue
with its partners.
HEALTH, HIV/AIDS AND
The EC has become an increasingly important
player in health, HIV/AIDS and population (HAP) activities, with
assistance to these sectors having grown significantly from barely
1 per cent of total EC aid in 1986 to over 8 per cent of total
aid today (compared to an OECD average of approximately 5.5 per
cent in 1998).
Total EC commitments to health, AIDS and population
amounted to almost 700 million euro in 1999, making it the largest
donor after the World Bank, supporting health-related programmes
in over 70 countries.
In welcoming the priority given by the EC to
health-related interventions and in particular to the fight against
HIV/AIDS, it is important to note the role of special budget line
B7-6212, Aid for Population and Reproductive Health, including
HIV/AIDS, in Developing Countries. This small but significant
budget line is of great importance as it is intended to fund innovative
pilot interventions to test new ideas and approaches which can
then be incorporated into the EC's larger-scale strategies. As
such, it is intended to complement the EC's main financial and
technical cooperation instruments by supporting policy and strategy
development, in order to improve the effectiveness of the EC's
action in these areas.
Despite the EC's renewed commitment to the ICPD
+5 process during 1999, in its Preliminary Draft Budget for 2000,
the Commission proposed to delete budget line B7-631 (aid for
population and reproductive health policies and programmes) and
proposed over a 60 per cent cut to budget line B7-6211 (the fight
against HIV/AIDS in developing countries). The inconsistency between
the Commission's stated commitments and its proposed cuts to budgetary
allocations was due to a lack of sufficient human resources and
resulting difficulties in managing small budget lines. Following
concerted action by European Parliament members of the Development
Committee, and, in particular, members of the Working Group on
Population, Sustainable Development and Reproductive Health, the
two lines were merged into a single line (B7-6212) and funding
allocations, amounting to 20 million euro, were restored. This
example highlights the need to ensure that allocations to small,
but strategically important funding instruments, is not threatened
in the future and that the Commission's staffing problems are
properly addressed in the current reform process.
The further rationalisation of the different
financial instruments for development cooperation, as outlined
in the Commission's policy statement, is welcome. However, regrouping
thematic budget lines under common denominators such as "social
development" should take into account the EC's added value
and experience in health-related interventions and the priority
given to reproductive health. Access by civil society organisations
to these budget lines should also be maintained and improved through
improved management of EC aid. Furthermore, rationalisation of
budget lines should be accompanied by an increase in funding allocations
and the visibility of specific interventions in areas such as
reproductive health, HIV/AIDS and gender should be maintained.
OF EC EXTERNAL
Human resources and management
The growth in volume of EC aid in recent years
has not been matched by a corresponding increase in human resources
to manage funds. This, coupled with complex administrative procedures,
has meant considerable discrepancies between aid commitments and
disbursements, leading to the under-spend which has characterised
EC aid in the 1990s. An increased number of officials with expertise
in social and human development, in particular reproductive
health, HIV/AIDS and gender issues should be employed by DG Development.
This is essential in order to ensure effective and efficient management
EC aid in these sectors, and to ensure that they are real priority
areas for poverty eradication.
Capacity building in-country
Following an audit of the Commission's delegations
carried out by Marie Stopes International in 1999, although the
majority stated that the EC funded at least one reproductive health
programme in their country, most of the delegations said they
lacked any related expertise and had never undergone training
in population and reproductive health issues. Knowledge and
expertise within the Commission's delegations in-country need
to be strengthened, in order for EC delegations to effectively
manage projects and programmes in-country. This is especially
important in view of the foreseen increased devolution of project
management to the Commission's overseas delegations, as outlined
in the Commission's development policy paper.
Appropriate monitoring and evaluation mechanisms
are necessary in order to assess the effectiveness of EC aid and
to ensure transparency and accountability. This is particularly
important for improved communication and exchange of information
between the European Parliament and the Commission.
Reproductive health indicators and health impact
assessments should be used systematically in order to gauge the
effectiveness and qualitative impact of EC aid and to ensure systematic
feedback into policy dialogue and programme formulation.
The new ACP-EU Partnership Agreement represents
an innovative framework for development cooperation, with poverty
eradication at its heart. The new agreement gives unprecedented
importance to social and human development and makes specific
reference to the need to integrate "population issues
into development strategies in order to improve reproductive health,
primary health care, family planning; and prevention of female
genital mutilation" (Article 25).
It also explicitly states that cooperation will
include the fight against HIV/AIDS. The new policy framework provides
great scope for reducing poverty through an integrated approach
based on economic, social and human development and regional integration.
This approach should be taken as a positive example in finalising
the new EC development policy. The new EC policy statement and
the reform process must facilitate the implementation of social
sector programmes within the new cooperation agreement.
Marie Stopes International
1 European Community Development Cooperation Fact Sheet
on Health, AIDS and Population (HAP), May 2000. Back