Memorandum submitted by the UK Network
on Sexual and Reproductive Health and Rights
"KEEPING SEXUAL AND REPRODUCTIVE HEALTH
ON THE AGENDA"
EXECUTIVE SUMMARY
The full paper outlines a number of concerns
that the UK Network on Sexual and Reproductive Health and Rights
(the Network) have about changes taking place in the sexual and
reproductive health funding and policy environment:
1. The Millennium Development Goals (MDGs)
cannot be achieved without full attention being paid to sexual
and reproductive health.
2. Most of the MDGs have important links
to sexual and reproductive health: in particular Goals 1, 2, 3,
4 and 6. However, indicators relating to sexual and reproductive
health are not explicit.
3. The current focus on MDGs has meant that
the commitments arising from ICPD are less visible, and seen as
less important.
4. There is an adverse policy environment,
particularly in the USA.
5. There is also an actual reduction in
funding for sexual and reproductive health as a result of shifts
of funds to HIV/AIDS.
6. Key sexual and reproductive health and
rights issues are not being addressed if HIV/AIDS is taken as
a substitute for sexual and reproductive health:
(i) Gender-based violence;
(ii) Female genital mutilation;
(iii) Young people's access to sexual health
information and services;
7. Effective sexual and reproductive health
and rights programmes provide an essential foundation, and a supportive
environment, for HIV/AIDS prevention, treatment and care programmes.
8. Investment in sexual and reproductive
health could lead to improvements in health, which would translate
into improvements in standards of living for the poor, higher
economic growth and reduced population growth.
9. DFID's current policies and mechanisms
make access to funding for sexual and reproductive health more
difficult to access.
(a) DFID's support for multi-lateral programmes
has increased, resulting in a decreasing amount being available
for NGOs and civil society groups.
(b) DFID's funding focus is detrimental to
sexual and reproductive health. No new money is available. This
leads to unnecessary and potential damaging competition between
those working in HIV/AIDS and those focusing on sexual and reproductive
health.
(c) Sexual and reproductive health NGOs have
been particularly affected by this policy/funding shift.
(i) The Civil Society Challenge Fund has been
extremely prescriptive, and the requirement for matched funding
(which has fortunately ceased) has produced a hostile funding
environment for NGOs in this field;
(ii) No sexual and reproductive health NGOs
were invited to negotiate for a Programme Partnership Agreement
(PPA);
(iii) It is not clear, with new funding arrangements
coming into force, whether the situation for sexual and reproductive
health NGOs will improve;
(iv) DFID's resistance to NGOs providing "service
delivery" means that some sexual and reproductive health
NGOs are getting no DFID funds at all.
10. NGOs are most effective when carrying
out small flexible projects which can be scaled up.
(a) In particular sexual and reproductive
health NGOs are good at dealing with sensitive issues such as
youth sexuality, sex workers or abortion. This role is particularly
important in countries in which such work is politically sensitive.
(b) Southern sexual and reproductive health
rights NGOs are also being marginalized in this policy/funding
environment, so their expertise is also being eroded.
11. There is a close link between poverty,
health and sexual and reproductive health: more than twice the
proportion of the world's children live in poverty (one in three)
than do adults (one in seven), in part because of lack of access
to family planning services and accurate information about contraception.
KEY RECOMMENDATIONS
FOR DFID
1. DFID should demonstrate an effective international
leadership role on sexual and reproductive health and rights
(a) With the policies of the current US administration
so opposed to sexual and reproductive health and rights, DFID
should take a clear lead.
(b) Their lead in reviving and implementing
the commitments of ICPD should be similarly clear. The MDGs should
not be allowed to invalidate the Cairo Programme of Action (the
UN has stated that they should not).
(c) DFID should make sure that the MDGs incorporate
sexual and reproductive health indicators in the course of their
MDG monitoring.
2. DFID should work more closely with UK
sexual and reproductive health and rights NGOs on policy formulation
(a) Once the current reorganisation of DFID
is complete, it is to be hoped that lines of communication with
appropriate sections of DFID will re-open.
(b) It is also to be hoped that DFID will
take advantage of the intellectual capacity, experience and expertise
of UK sexual and reproductive health and rights NGOs.
3. DFID should ensure that UK sexual and
reproductive health and rights NGO expertise is utilised to the
full in supporting southern NGOs
(a) Sexual and reproductive health rights
should be fully included within Sector Wide Approaches (SWAps)
so that southern NGOs are able to access funding.
(b) DFID should engage with sexual and reproductive
health rights NGOs to develop funded partnerships for northern
NGOs to build southern NGO capacity within the SWAPs environment.
(c) Sexual and reproductive health NGOs should
be short-listed for contracts in the current round of PPAs.
(d) DFID should encourage sexual and reproductive
health and rights NGO involvement to access funding from the Global
Health Fund.
CONCLUSION
It is important to create a much more constructive
relationship between DFID and UK sexual and reproductive health
and rights NGOs, in order to maximise effectiveness across the
relevant work areas, and to re-examine the funding and policy
environment in order to achieve the commitments of the ICPD Programme
of Action, the outcomes of ICPD+5 and the MDGs.
REPORT
1. INTRODUCTION
1.1 The UK Network on Sexual and Reproductive
Health and Rights (affiliated to BOND) welcomes the opportunity
to brief the UK Parliamentary International Development Committee
on 19 November 2002. The UK Network is made up of more than 90
members working in the field of population and sexual and reproductive
health and rights globally. The member NGOs work in the fields
of advocacy, service delivery, training, education and a wide
range of development agendas related to poverty. These NGOs have
a long history of co-operating with DFID, particularly since 1993
leading up to the 10th International Conference on Population
and Development (ICPD) in Cairo, the 4th World Conference on Women
in Beijing and the Cairo+5 review and Hague Forum.
1.2 Summary
This paper outlines a number of concerns that
the UK Network on Sexual and Reproductive Health and Rights have
about several changes taking place in the sexual and reproductive
health funding and policy environment. First, we make the case
that the achievement of sexual and reproductive health and rights
activities are critical to the achievement of the Millennium Development
Goals (MDGs) and sustainable development. We make links between
sexual and reproductive health and rights, education, women's
empowerment and poverty eradication. Next, we analyze a perceived
reduction of funding for sexual and reproductive health services
and outline some of the reasons why. What DFID is saying about
sexual and reproductive health and rights and its commitment to
these issues is briefly touched upon, including recent quotes
from DFID leadership. We next show that what DFID is actually
doing in terms of both its mechanisms and priorities are making
it much harder to access funding for sexual and reproductive health
and rights in the UK and in the South. Finally, the UK Network
on Sexual and Reproductive Health and Rights makes a list of key
recommendations for DFID.
2. ACHIEVEMENT
OF SEXUAL
AND REPRODUCTIVE
HEALTH AND
RIGHTS IS
CRITICAL TO
THE ACHIEVEMENT
OF THE
MILLENNIUM DEVELOPMENT
GOALS
2.1 The Millennium Development Goals (MDGs),
which call for a dramatic reduction in poverty and marked improvements
in the health of the poor, were adopted by the United Nations
General Assembly in September 2000. By the year 2015, all 189
UN Member States have pledged to meet them. The MDGs are increasingly
forming the framework within which donors are planning, allocating
resources, and evaluating their development assistance. This is
happening at a time when the visibility of the 1994 Cairo ICPD
Programme of Action (PoA), and its five year review which agreed
to accelerate the implementation of the Cairo agenda, is declining
within the development debate and sexual and reproductive health
services have slipped down the priority list of donors who have
traditionally supported these issues, including DFID. Sexual and
reproductive health and rights work is nevertheless key to the
achievements of the MDGs. The Report of the Commission on Macroeconomics
and Health presented in December 2001 points out that by reducing
avoidable deaths due, inter alia, to HIV/AIDS and maternal and
peri-natal conditions in conjunction with enhanced programmes
of family planning, impoverished families could enjoy lives that
are longer, healthier and more productive. Therefore, secure in
the knowledge that their children would survive, they could invest
more in the education and health of each child. Thus improvements
in health and especially reproductive health would translate into
higher incomes, higher economic growth and reduced population
growth.
2.2 While the MDGs provide an excellent
development framework oriented towards the elimination of poverty,
and they are wholeheartedly supported by UK NGOs, we have concerns
stemming mainly from the lack of visibility of sexual and reproductive
health and rights within the targets that the UN has chosen and
will use to measure the progress towards achievement of the MDGs.
Although there is consensus that sexual and reproductive health
and rights are necessary for the achievement of the MDGs, their
lack of visibility within the MDG framework as a whole impose
special responsibilities for major global development actors,
such as DFID, whose commitment to sexual and reproductive health
is longstanding. Continued and increasing global investment in
these critical areas is a prerequisite for the successful achievement
of the MDGs, but, because of political opposition from the US
government, the Vatican and some right-wing Islamic countries,
they have not been identified as MDG priorities per se. Hence,
there is a real risk that funding may be switched away from these
programmes towards work more obviously related to the targets
within each MDG (and possibly towards programmes promoting abstinence)
thereby jeopardising the likelihood of the overall achievement
of the goals.
2.3 Which MDGs have a clear relationship
to sexual and reproductive health and rights?
| Goal 1 | Eradicate extreme poverty and hunger
|
| Goal 2 | Achieve universal primary education
|
| Goal 3 | Promoting gender equality and empowering women
|
| Goal 4 | Reducing child mortality
|
| Goal 5 | Improving maternal health
|
| Goal 6 | Combating HIV/AIDS, malaria and other diseases
|
| |
2.4 Each of these goals has targets and indicators that sexual
and reproductive health and rights programmes help to achieve,
particularly those related to Goals 5 and 6. The following indicators
not mentioned in the MGD framework make core contributions:
— meeting the increasing demand for the reduction
of unmet need in reproductive health and family planning methods
and condoms;
— the expansion of access to sexual and reproductive
health care services, including those related to safe motherhood,
safe abortion and the prevention of unsafe abortion, the prevention
and treatment of HIV/AIDS and other sexually transmitted infections;
— advocacy and programme work in connection with
young people's sexual and reproductive health and rights;
— emphasis on improving quality of care;
— attention to promotion of gender equity and equality,
including through education for girls; and
— increasing attention to the prevention of unsafe
abortion.
2.5 In some cases, the connection is obvious; in others,
the sexual and reproductive health and rights dimension may be
a factor of underlying importance. A good example of this is the
goal to "Promote gender equality and empower women",
which has four indicators, one of which is the share of women
in waged employment in the non-agricultural sector. The ability
to manage fertility is critical for the ability of women to work,
and could therefore be identified as an underlying prerequisite
for making significant progress on this issue, but is not visible
in the targets/indicators chosen to measure progress towards the
achievement of this goal.
2.6 There are several key sexual and reproductive health
and rights issues that are not addressed if HIV/AIDS is taken
as a proxy for sexual and reproductive health, which is increasingly
the case. No-one denies that efforts should be redoubled to tackle
the prevention, care and treatment challenges posed by HIV/AIDS.
However, there are several core sexual and reproductive health
priorities, including gender-based violence, female genital mutilation,
young people's access to sexual and reproductive health information
and services, and unsafe abortion, that slip out of view if sexual
and reproductive health is equated as simply addressing HIV/AIDS.
Moreover, such work, along with general efforts to support young
people, men and women to develop the understanding and skills
needed to achieve good sexual health, provides a crucial foundation
for effective HIV programmes. Without such a foundation, HIV programmes
will continue to encounter the challenges posed by the inability
of individuals and communities to talk honestly about sex, by
gender inequality and environments in which the sexual health
rights of individuals and communities are not respected.
2.7 The links between sexual and reproductive health
and rights and poverty, education, and civil society awareness
2.7.1 Link between poverty, development and sexual
and reproductive health and rights
In developing countries, reproductive ill health is a major
threat to the well-being of adults, many of whom are in the early
years of their working lives. Women and children, especially those
in poverty, bear the burden of poor sexual and reproductive health.
HIV/AIDS is destroying families and erasing decades of gains in
development. Maternal illness often keeps women and children locked
in a vicious cycle of poverty. More than twice the proportion
of the world's children live in poverty (1 in 3) than do adults
(1 in 7), in part because families often lack access to family
planning services and accurate information about contraception.
Early pregnancies undermine girls' schooling, health and status.
Successful sexual and reproductive health programmes promote social
and economic development.
2.7.2 Link between education and sexual and reproductive
health and rights.
The World Bank recognizes these linkages:
"There is evidence that better education is associated
with higher contraceptive use and lower fertility. This evidence
may reflect a variety of mechanisms. More education expands economic
opportunities for women and so can raise the opportunity cost
of having more children. Infant mortality is lower in families
in which women are better educated, and so fewer births are required
to achieve their desired number of children. It has been shown
that better education can improve the effectiveness of contraceptive
use. Investments in improving poor people's access to education
and health can therefore have a double impact. These investments
have been shown to improve social progress, economic growth and
reduce poverty directly. To the extent that they are associated
with lower fertility and population growth, they can also contribute
to a virtuous circle of improved maternal health and better investment
in children's health and education, which reinforce these gains[1]."
2.7.3 Link between civil society awareness and sexual
and reproductive health and rights
Work in pursuit of the Cairo agenda has focussed on sexual
and reproductive health in tandem; the rights-based approach has
included the twin elements of enhancing civil society awareness
of commitments that governments have entered into by signing treaties,
such as the International Covenant on Economic, Social and Cultural
Rights and the Convention on the Elimination of All Forms of Discrimination
Against Women (CEDAW), that has the status of international law,
and the various mechanisms by which commitments are monitored,
and the extent to which the rights of individual women and men
are respected, protected and fulfilled through sexual and reproductive
health services provided by governmental and non-governmental
agencies. The concept of entitlement has much to offer as we tackle
core elements of the Cairo agenda and the MDGs that are currently
unfulfilled—the core "added value" is the element
of accountability, and of civil society/public/private partnerships
working together to identify accountability mechanisms, and making
them work more effectively.
3. REDUCTION
IN FUNDING
FOR SEXUAL
AND REPRODUCTIVE
HEALTH AND
RIGHTS
This section looks at some of the ways that both the priorities
to fund sexual and reproductive health and rights and the mechanisms
to fund it are changing.
3.1 Health sector reform
3.1.1 Health sector reform has affected the provision
of sexual and reproductive health services in developing countries
and the way they are funded. Decentralisation may be included
in the reform, which may lead to insufficient supplies of sexual
and reproductive health commodities in some areas; it may also
include the introduction of cost recovery and user fees which
have been shown to deter women from going for services that they
need. Furthermore, sexual and reproductive health services may
be excluded from local portfolios, especially where funding is
limited, to fund the prevention and treatment of major diseases
such as HIV/AIDS, malaria and tuberculosis.
3.1.2 Health sector reform may include the introduction
of sector wide approaches (SWAps) for providing funding by the
donor community. In theory SWAps mean that instead of individual
donors funding their own specific projects and activities all
the funding is put in a "basket" and is then used to
fund a programme proposed by the Government. In practice, countries
are coping with a complex mix of basket funding and possibly parallel
funding and even some earmarked funding, because not all donors
support SWAps.
3.1.3 The least developed countries are also required
to complete a Poverty Reduction Strategy Paper (PRSP) if they
wish to access concessional loans from the World Bank or to benefit
from debt relief under the Highly-Indebted Poor Countries (HIPC)
initiative. While the PRSPs may include health components they
rarely include sexual and reproductive health and rights.
3.1.4 As a result, it is imperative for donors to ensure
that sexual and reproductive health and rights continue to be
included in country programmes at local and district as well as
national levels.
3.2 Ultra-conservative and religious opposition.
The actions of the Bush administration in introducing the
"Global Gag Rule"[2],
the cutting of funding to UNFPA and attempts at the recent (October
2002) ESCAP meeting in Bangkok to renege on Cairo agreements clearly
demonstrate the extent of the impact that religious opposition
and ultra-conservative governments can have on the provision of
funding for sexual and reproductive health and rights. While the
most extreme opposition to the provision of funding can be seen
in the USA, it also has the potential to affect the development
policies of some of the European countries and could indeed have
an impact on the funding development policies of the European
Commission.
3.3 Reproductive health is interpreted to mean abortion
and thus not funded.
3.3.1 Both the ultra-conservative and religious opposition
narrowly and falsely interpret sexual and reproductive health
and rights to mean abortion and this is then used to isolate and
discredit the need for safe abortion and also as a reason not
to fund any sexual and reproductive health services at all. This
was clearly the case in the Bush administration's decision not
to fund UNFPA, despite the evidence from the fact-finding missions
sent to China which stated categorically that UNFPA was not funding
any activities connected with abortion or the China "one-child"
policy.
3.4 Sweeping changes in setting priorities for funding.
The increasing prevalence of HIV/AIDS and the adoption of
the MDGs have led to a change in funding priorities for many governments.
Funding of the MDGs means that funding will be available for HIV/AIDS
and to prevent maternal and infant mortality, but other areas
of sexual and reproductive health and rights as identified at
ICPD, Beijing and ICPD+5 are likely to be lost especially other
family planning methods, sexual and reproductive health IEC, gender-based
violence, including female genital mutilation (FGM), unsafe abortion,
through to new priorities such as emergency contraception. It
is imperative that DFID take the lead, particularly within the
European Union to ensure that all areas of sexual and reproductive
health and rights receive adequate funding and not just those
that are easily identified within the MDGs and targets.
4. WHAT
IS DFID SAYING
ABOUT THE
IMPORTANCE OF
SEXUAL AND
REPRODUCTIVE HEALTH
AND RIGHTS?
4.1 The UK Secretary of State for International Development,
Clare Short, has repeatedly underlined DFID's commitment to sexual
and reproductive health and rights. On 25 February, 2002, Hansard
records the following statement:
Reproductive health is a priority for my Department. The
target of achieving access to reproductive health for all by 2015
is at the core of our reproductive health policy. We are working
with partners to ensure that the international community and developing
countries continue to give the issue the priority it demands.
On 18 April, 2002:
Despite the decision of the US to withhold funds from
certain organisations, the US remains a major source of support
for services aimed at improving reproductive health.
Sexual and reproductive health care in developing countries
continues to be a key priority for my Department. Achieving universal
access to reproductive health for all by 2015 underpins our approach.
Good reproductive health is of course also vital to achieving
the Millennium Development Goals (MDGs) related to lowering maternal
mortality and combating HIV/AIDS. We are working in partnership
with national Governments and key organisations to strengthen
the capacity of health systems to deliver good reproductive health
care and services.
My Department's total bilateral expenditure on sexual
and reproductive health activities, including HIV/AIDS, has risen
from £38.4 million in the financial year 1997-98 to £206.6
million in 2001-02. We also provide significant levels of funding
to UNFPA, UNAIDS and WHO to support their work to improve the
quantity and availability of reproductive health services.
On 24 July, 2002:
My Department supports a number of international sexual
and reproductive health organisations which share our aim of eliminating
poverty including United Nations agencies and non-governmental
organisations. We believe that the goal of the international conference
on population and development of universal access to reproductive
health is central to attainment of the health Millennium Development
Goals, specifically those related to maternal mortality, HIV/AIDS
and child mortality. Without access to high quality reproductive
health services and care, it is most unlikely that progress will
be achieved in meeting the health MDGs. We will continue to support
international organisations which make an effective contribution
to these goals, and of course the efforts of governments seeking
to improve people's access to reproductive health services.
4.2 DFID is committed to the MDGs, International Development
Targets (IDTs), the ICPD Programme of Action and the Beijing and
Rio/Johannesburg Action Plans among other UN documents that support
and promote sexual and reproductive health and rights. DFID is
finalising the Statistics on International Development that includes
data relevant to both health and population as well as income,
poverty, education, environment, economic linkages and economic
indicators. This indicates their focus on and prioritisation of
sexual and reproductive health and rights. DFID has endorsed the
IDTs in its two White Papers of 1997 and 2000 and has a target
strategy paper on health that is largely focused on sexual and
reproductive health and rights.
5. CHANGES
IN DFID FUNDING
POLICY FOR
SEXUAL AND
REPRODUCTIVE HEALTH
AND RIGHTS
AND THE
EFFECTS ON
UK-BASED SEXUAL
AND REPRODUCTIVE
HEALTH AND
RIGHTS NGOS
5.1 Increased bi-lateral support for multi-lateral
programmes and SWAps.
The UK government has a history of providing strong support
for bi-lateral programmes and it is obliged to provide significant
support to the EC. With the move towards supporting SWAps and
general budget support, along with the adoption of the MDGs, DFID's
support for multi-lateral programmes has increased, leaving a
decreasing pot of funds available for a broader range of NGOs
and civil society organisations (CSOs).
5.2 Increased emphasis on HIV/AIDS as a separate priority
distinct from sexual and reproductive health—using already
identified financial resources.
DFID has increasingly tried to address all of the Cairo objectives,
including HIV/AIDS. However, the intentions of Cairo were to ensure
that all sexual and reproductive health issues were implemented
in an integrated manner. Unfortunately, it seems that DFID as
well as many other donors are increasingly funding work in vertical
programmes again (eg support for the Global Fund for AIDS, TB
and Malaria). Now, the funding for HIV/AIDS is growing dramatically
(for multi-lateral and large vertical programmes) at the expense
of reproductive health, since there is no "new" money.
This has meant increasing, unnecessary and potentially damaging
competition between those working in HIV/AIDS and those wanting
to work in sexual and reproductive health and rights in an integrated
manner.
5.3 Increasing shift away from project/programme funding
to "contracted" funding—for DFID priority areas
of work.
5.3.1 Since adopting the IDTs and now the MDGs, DFID
is under increasing pressure to "deliver" on the targets
it has signed up to. As DFID is, rightly, moving to achieve high
impact through large-scale coherent sectoral programmes rather
than relatively small scattered projects, the way in which this
aim is achieved is by developing large-scale programmes for which
tenders are invited from any suitably constituted organisation
in the world that is equipped to deliver the results (as aid is
now "untied").
5.3.2 It is difficult for UK NGOs to compete within this
framework as we have not been supported by DFID over the years
(or by anyone else) to build up a critical mass of capacity in
this way. Other country NGOs, especially in the USA, have had
considerable overhead support from their governments in the past
and now have organisations with infrastructure and high level
technical representation worldwide, making them better placed
to compete for UK tendered work. Thus a lot of relevant UK experience
and expertise is being wasted, and stands a chance of being lost
forever (if UK NGOs are forced to close down for lack of funding)
as other organisations, both for profit and non-profit, compete
for DFID work. It is indeed ironic that US-based NGOs are increasingly
benefiting from this process as their own government has more
or less stopped funding comprehensive sexual and reproductive
health work by re-introducing a policy that operates exclusively
against non US-based NGOs.
5.4 Changes to DFID funding of UK NGOs.
5.4.1 DFID's primary mechanism for funding UK NGOs and
their southern partners is now through the Civil Society Challenge
Fund (CSCF) which replaced the Joint Funding Scheme (JFS) four
years ago. The CSCF is extremely prescriptive in terms of what
types of projects will be supported and, as over the last three
years it was increasingly necessary for UK NGOs to make matching
contributions to project budgets, UK NGOs either did not get projects
funded because of the type of project they wished to present (eg
IFH, MSI) or had to give up presenting proposals because the level
of matching funds was too high to fundraise for (eg Population
Concern).
5.4.2 It is also significant that in the last round of
negotiations for Programme Partnership Agreements (PPAs) (whereby
NGOs with aims and strategies closely allied to those of DFID
would be assured of core funding for several years) not one sexual
and reproductive health and rights NGO was invited to negotiate
for a PPA—thus indicating a low level of interest in sexual
and reproductive health and rights NGO programming within DFID's
Civil Society Department.
5.4.3 The current round of CSCF funding has now reverted
to 100% project support which is very positively welcomed by the
sexual and reproductive health and rights NGOs. However, the overall
DFID CSCF budget has not increased in 2003-04 (and is set to reduce
in future years) so, coupled with the fact that more NGOs and
CSOs apply for funding each year and that all NGOs and CSOs will
be awarded 100% funding (under both JFS and CSCF non-sexual and
reproductive health and rights only got 50% funding), it is uncertain
whether this return to 100% funding will translate into more sexual
and reproductive health and rights NGO projects being funded for
2003-04.
5.4.4 It is also significant that the areas of NGO activity
that are of interest to DFID have changed. DFID will no longer
support NGOs to provide "service delivery" which means
that a number of UK sexual and reproductive health NGOs simply
aren't getting CSCF money at all (eg MSI). Those who have been
funded by the CSCF must work within narrow parameters to be eligible
for DFID funding. DFID now believes that the main raison d'être
for international NGOs is to provide capacity building for their
southern partners, particularly supporting them to effectively
lobby their governments to provide services. DFID currently believes
that the role of northern NGOs is to support southern NGOs to
press their governments to provide all of the services their people
need rather than work with southern NGOs to provide services to
groups that urgently need them. If realisable at all, this is
a long-term strategy for advocating universal service delivery—in
the meantime many southern NGOs will find it increasingly difficult
to fill the gap left by inadequate government-supported service
provision.
5.5 No flexible funding for NGOs.
NGOs are best at carrying out small, flexible projects that
can often demonstrate what can be done on a larger scale. In addition,
NGOs can tackle work on the extremely sensitive issues such as
youth sexuality or abortion which are important elements of sexual
and reproductive health and rights but which government programmes
find it hard to address. NGOs in the current DFID climate have
little access to funding for innovative, small scale, demonstration
projects and/or projects which can reach particularly vulnerable,
marginalised groups such as young people and sex workers. In addition,
our southern partners increasingly have to work within SWAps and/or
PRSPs but they find it hard to do so. They are not confident enough
or sufficiently skilled in advocacy to make their voices heard
when PRSPs/SWAps are being developed; and they are not set up
to bid for service delivery etc when required to under SWAps.
Thus there is a danger that the expertise of southern NGOs working
in sexual and reproductive health and rights (as well as service
delivery capacity) is also being eroded. There is much that northern
NGOs can do, that others can't to provide capacity building for
southern NGOs to enable them to work effectively in this new,
more challenging environment.
6. RECOMMENDATIONS
FOR DFID
We believe there are three significant areas for action:
1. DFID should once again take an international leadership
role on sexual and reproductive health and rights.
2. DFID should work more closely with UK sexual and reproductive
health and rights NGOs on policy formulation.
3. DFID should ensure that UK sexual and reproductive
health and rights NGO expertise is utilised to the full in supporting
southern NGOs.
6.1 DFID's Leadership Role.
6.1.1 Given the fact that the present US administration
takes a strong anti-reproductive health and anti-abortion stance
and is now pressing for a full withdrawal from the commitments
agreed at Cairo, it is imperative that the UK government take
a strong and leading role in the promotion, protection and support
of sexual and reproductive health and rights. This is relevant
to the areas of policy, programmes and resources.
6.1.2 Firm commitment and leadership by the UK is more
important than ever in convincing the rest of the world to increase—not
decrease—its support for achieving the ICPD goals. This
is particularly important considering the imminent expansion of
the EU, including 10 new member states that may not share the
same progressive views on sexual and reproductive health and rights.
6.1.3 DFID should ensure that the MDGs are being monitored
to ensure that the appropriate investment is being made commensurate
with their commitment to sexual and reproductive health and rights.
DFID must take the lead, particularly within the EU to ensure
that all areas of sexual and reproductive health and rights receive
adequate funding and not just those that are defined as MDG goals
and targets.
6.1.4 It is important to emphasise that the UN document
that introduces the MDGs states that "The list of Millennium
Development Goals does not undercut in any way agreements on other
goals and targets reached at the global conferences of the 1990s",
which means that the Cairo Programme of Action continues to be
a relevant part of the development agenda.
6.2 Greater communication, consultation and collaboration
between DFID and UK sexual and reproductive health and rights
NGOs.
6.2.1 NGOs had numerous opportunities to interact with
DFID's Health and Population department in the mid-1990s. These
included group and individual meetings as well as being on UK
government delegations to UN conferences on sexual and reproductive
health and rights. Of a particularly interactive nature was the
UK NGO Group's written and verbal response to DFID's target strategy
paper on health. With the on-going re-organisation of DFID, it
has become increasingly difficult to discern with whom sexual
and reproductive health and rights NGOs should communicate in
the Health and Population department. It is hoped that this will
be settled soon.
6.2.2 DFID's draft guide for UK civil society states
that DFID will work with civil society by information sharing
and dialogue, funding support and contractual arrangements. We
hope this will happen.
6.2.3 Formal consultations on particular issues or themes
are undertaken and DFID has a web site and public enquiry point.
Less formal consultation is done through established networks
or membership organisations such as BOND. However, the UK NGO
Group on Sexual and Reproductive Health and Rights is not being
used to maximum capacity by DFID and this has contributed to marginalisation
of these issues.
6.2.4 DFID has not taken advantage of NGOs' intellectual
capacity, experience and expertise in helping to shape and form
DFID policies and strategies on sexual and reproductive health
and rights. Mechanisms and means for DFID and NGOs to share, learn
and thus create improved outputs need to be developed.
6.3 Maximising UK NGO expertise to support southern
NGOs.
6.3.1 DFID should ensure that sexual and reproductive
health and rights is given a high priority within SWAps, and that
southern NGOs are able to access funding through SWAps to support
their service delivery activities.
6.3.2 DFID should actively engage with UK NGOs to develop
appropriately funded partnerships for northern NGOs to build southern
NGO capacity to work within the SWAps environment.
6.3.3 DFID should ensure that UK sexual and reproductive
health and rights NGOs are invited to negotiate for contracts
in the current round of PPAs.
6.3.4 DFID should encourage sexual and reproductive health
NGO involvement in country co-ordinating mechanisms (CCM), to
access funding from the Global Health Fund.
17 December 2002
1
World Development Report 2000-01. Attacking Poverty. Washington
DC: The World Bank, 2001, p 49. Back
2
The Global Gag Rule was implemented by the Bush Administration
in January 2001 and disqualifies foreign non-governmental organisations
(NGOs) from receiving US family planning funds if they provide
legal abortion services or provide counselling and referral for
abortion, or if they lobby to make abortion legal or more widely
available in their own country. Back
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