5 Sexual and Reproductive Health
47. The Department recognises that improving sexual
and reproductive health (SRH) is integral to achieving the MDGs
and reductions in global poverty to which it is committed.[99]
The international policy climate around SRH however, has become
increasingly difficult. This is reflected by the failure to secure
international consensus on the inclusion of an MDG relating to
the target of universal access to reproductive health by 2015,
agreed by the International Conference on Population and Development
(ICPD) in 1994. We echo the concern of DFID regarding the stance
of the present US Administration which often equates SRH with
the promotion of abortion.[100]
Objections to condom programmes, the removal of funding from
the UN Population Fund (UNFPA) by the US Agency for International
Development (USAID) and calls for 'abstinence only' policies to
combat HIV/AIDS risk undermining international progress on reproductive
rights secured at the ICPD.[101]
We encourage DFID's efforts to influence the international policy
environment and to defend the policies agreed at the ICPD as complementary
to progress towards the MDGs.
48. The Departmental Annual Report shows DFID's annual
expenditure by country and region. DFID spent over £220 million,
in cash terms, on SRH in 2001/2. Unfortunately this figure is
not clearly set out in the annual report, nor is it possible to
tell how much of the total was spent on HIV/AIDS. This lack of
sectoral accounting makes it impossible to identify the relative
funding priorities for DFID's sexual health objectives, how they
have changed over time or are projected to shift in the future.
Although it is, in many cases, impossible to separate HIV/AIDS
from SRH, there are several aspects of SRH work that are distinct.
For example, work around maternal health which relates to MDG
5. It would be helpful to be able to distinguish how the total
allocation of funding to SRH and the proportion of this total
dedicated to HIV/AIDS programmes breaks down and has changed over
time. While we welcome the proposal to structure future reports
according to DFID's objectives, it would be useful if they could
also present key financial data with respect to SRH. In addition,
the importance of adequately explaining instances of 'flexible
financial management' within future reports is underlined by the
confusion surrounding the reporting of variations in the UNFPA's
core grant allocation since 2000/2001.
49. We consider the inclusion of a specific section
on Reproductive Health within the Departmental Annual Report as
further evidence that DFID affords priority to this sector. But
the recent restructuring of the Department and the creation of
a new Policy Division have entailed the loss of the SRH team within
the Health and Population Division at DFID. SRH issues will now
be addressed by three separate teams, namely those with responsibility
for HIV/AIDS, MDGs and Reproductive Health and Service Delivery.
As a result it does not appear that there is any one person with
sole responsibility for overseeing SRH within DFID. Despite DFID's
Deputy Director of Policy's assurance that "reproductive
health will be on everybody's radar now" we remain concerned
that Departmental restructuring should not result in SRH being
given a lower priority. [102]
If the intention is to 'mainstream' SRH within DFID, we would
like to hear more in future reports about the mechanisms by which
this will be achieved. We would also like to see information detailing
how, since its restructuring, DFID has continued to prioritise
the full range of SRH issues (including gender-based violence,
unsafe abortion and young people's access to SRH information and
services), not just those which are more easily identified within
the MDGs.
50. With the introduction of the MDGs, DFID has increasingly
shifted away from its historical support for bilateral programmes
and towards supporting Sector-wide approaches (SWAps), providing
general budget support and contributing to multi-lateral programmes.[103]
In this funding environment, an increased responsibility falls
on NGOs to lobby developing country governments on SRH service
delivery. DFID continues to support individual NGOs, predominantly
through the Civil Society Challenge Fund,[104]
but the change in funding methods has to some extent reduced the
funding available from DFID for NGOs and other civil society organisations.
There is a danger that overly prescriptive requirements on grants
from the Civil Society Challenge Fund may reduce the advantages
of flexibility and innovation which characterise the non-governmental
sector. The expertise of "Southern" SRH NGOs is in particular
danger of erosion in this funding environment, particularly where
these organisations face barriers to participation in the formulation
of national level strategies (including PRSs and Global Fund for
HIV, TB and Malaria applications).[105]
In future reports we would like to see evidence of how these funding
strategies have supported DFID's objectives in relation to SRH,
with particular attention paid to the participation of "Southern"
NGOs.
51. Health Sector reform in many developing countries
has negatively affected the provision of SRH services, particularly
where reform has involved decentralisation. This has often led
to insufficient supplies of sexual and reproductive healthcare
commodities, the introduction of cost recovery and user fees and,
in some cases, the exclusion of sexual and reproductive health
services from local portfolios.[106]
With the shift towards Sector Wide Approaches (SWAps) and general
budget support DFID needs to find ways of ensuring that SRH continues
to be included in country programmes at local and regional as
well as at national levels.
52. We welcome recent funding commitments to HIV/AIDS
from the US and DFID. However we remain concerned that the existence
of MDG relating to HIV/AIDS should not be allowed to cause a shift
in Departmental focus and funding away from broader issues of
SRH, as has occurred in the health sector more widely.
99 Department for International Development, Departmental
Report 2003, Cm5914, May 2003. p.52 Back
100
Ibid. Back
101
Ev 34 Back
102
Q35 Back
103
Ev 24 Back
104
Individual NGOs can also be funded through country programmes
as part of their overall strategy or through Partnership Programme
Agreements (PPAs) with DFID (Ev24). Some NGOs expressed concern
however that there are currently no reproductive health NGOs in
PPAs with DFID (Ev 31, Ev 34). Back
105
These include many developing country government 's reluctance
or inexperience in working with NGOs (and vice versa) and the
very sensitive nature of reproductive health related programmes
(particularly those relating to youth sexuality, commercial sex
work or abortion) (Ev 34). Back
106
Ev 17. Paragraph 3.1.1 Back
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