House of Commons - International Development

Select Committee on International Development Written Evidence

Supplementary memorandum submitted by the UK Network on Sexual and Reproductive Health and Rights

SUMMARY

The UK Network on Sexual and Reproductive Health and Rights (SRHR) welcomes the publication of this report which is well presented, extremely comprehensive, clear and informative. We note that DFID is committed to contributing to achieving the Millennium Development Goals (MDGs), and we were pleased to see that the report highlights the imperative of addressing the health of poor people as a major priority in addressing the causes of poverty and achieving the MDGs.

In particular we support:

— The reporting of overall increases in funding for International Development.

— That the report highlights HIV/AIDS as one of the key obstacles to achieving the Millennium Development Goals and that progress on Reproductive Health is essential if the MDGs on HIV/AIDS and Maternal and Child Health are to be achieved.

However we do have some significant questions and concerns:

— The concentration on the MDGs to the exclusion of other valid SRH development goals.

— Whether supporting health systems development will result in DFID's desired SRH outcomes.

— Core support for UNFPA appears to be reducing.

— The degree of importance which SRH will attract in the reorganised DFID Policy Division needs to be clarified.

— What plans does DFID have for the SRH organisations and programmes formerly funded through the Health and Population Division?

— The trend in UK NGO funding (not just for SRH NGOs) is for reduced UK government support.

INTRODUCTION

1. The UK Network on Sexual and Reproductive Health and Rights (SRHR) (see Annex 1 for information on the Network) welcomes the publication of this report which is well presented, extremely comprehensive, clear and informative.

MILLENNIUM DEVELOPMENT GOALS AND SRHR GOALS

2. We note that DFID is committed to contributing to achieving the Millennium Development Goals (MDGs), and we were pleased to see that the report highlights that the undue burden of poverty and ill-health falls on women and the imperative of addressing the health of poor people as a major priority in addressing the causes of poverty and achieving the MDGs.

3. However, we believe that DFID should ensure that while concentrating on the MDGs it does not lose sight of the issues highlighted and commitments made at the 1994 International Conference on Population and Development (ICPD) and the UN Women's Conference in Beijing (1995) which highlighted broader SRHR issues such as the problems of gender-based violence, female genital cutting, young people's access to sexual and reproductive health information and services, and unsafe abortion. The International Development Target of "Access through the primary health care system to reproductive health services for all individuals of appropriate age as soon as possible and no later than 2015" is a key omission from the MDGs and we believe that DFID should strive to get this included as an element of the MDG objectives and indicators through involvement with the relevant MDG Task Force.

DFID SUPPORT FOR SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS

4. DFID is right to highlight that HIV/AIDS is one of the key obstacles to achieving the MDGs and we applaud the support that DFID is providing for prevention and care and impact mitigation, as well as financial support for initiatives such as the Medical Research Council's Microbicides Development Programme, the International Partnership for Microbicides, the Global Fund to Fight HIV/AIDS, TB and Malaria, the Global Alliance for Vaccines and Immunisations, and the International Aids Vaccine Initiative.

5. We were pleased to see that Reproductive Health merited a specific section in the Report which confirms that DFID affords a high priority to reproductive health and rights; that the section highlights progress on reproductive health is essential if the MDGs on HIV/AIDS and maternal and child health are to be achieved. However, this section was very brief and did not mention much of the excellent work that DFID is supporting such as: strengthening WHO to draw on country level experience in order to set standards and disseminate best practice; activities to improve the quality, safety and accessibility of abortion services; the provision of condoms and other contraceptives to family planning programmes; social marketing; work with the Population Council and Southampton University in relation to improving young people's sexual and reproductive health; and the major research being carried out by the London School of Hygiene and Tropical Medicine to strengthen SRH policies and programmes. More detail on this work would have been welcome to highlight the importance of these issues.

FUNDING MECHANISMS

6. We note that one of DFID's strategies in contributing towards achieving the MDGs is to strengthen partner government health systems, rather than fund stand alone projects. The logic underlying this is commendable and we would be most interested to know what evidence there is that this strategy is successful, particularly in contributing to reaching the HIV/AIDS and maternal and child health MDGs.

7. The Network is mindful that Health Sector reform has affected the provision of sexual and reproductive health services in developing countries and the way they are funded, particularly where decentralisation may be included in the reform, as this 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.

8. We would like to know more about the efforts that DFID is making 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. What evidence is there that working within a sector wide approach or providing general budget support will achieve DFID's aims for SRH?

9. It is not possible within the 2003 Annual Report, due to the way expenditure is allocated through county programmes etc, to ascertain how much spending there has been on sexual and reproductive health and Rights and/or HIV/AIDs specifically. It would be most useful if future reports could analyse spending thematically for other sectors as well as SRH.

10. We note the contributions that DFID has made to multilateral agencies covering SRH, notably UNFPA, WHO, the World Bank and the EC. However, we note with some alarm that the core grant for UNFPA appears to have declined from £40 million in 2000-01 to £24 million in 2001-02, has an estimated £9 million outturn in 2002-03, and is projected as £18 million per annum for the next three financial years to 2005-06. We would like to know why these contributions are being decreased rather than increased, particularly taking into account that USAID has defunded UNFPA?

11. Could DFID clarify the future of funding support to organisations and programmes, including the knowledge programmes, which were formerly funded through the Health and Population Department?

12. We note that the total level of funding available to UK NGOs/CSOs under the Programme Partnership Agreements (PPA) and JFS/CSCF has been slowly increasing since 2000 and is estimated to have increased more significantly in the 2002-03 outturn (2000-01 total outturn £63 million, 2001-02—£66.38 million, 2002-03—£72.01 million estimated), but will reduce in coming years (plans for 2003-04—£67.8 million, 2004-05—£67.3 million, 2005-06—£67 million). In addition, funding for NGOs involved in Development Awareness activities in the UK is following a similar pattern (2001-02—£5.58 million, 2000-02—£5.41 million, 2002-03—£6.35 million, 2003-04, 2004-05 and 2005-06 each have £5 million planned expenditure), though Strategic Grants are planned to increase from £0.3 million in 2002-03 to £1.5 million, £3 million and £4.3 million over the next three years.

13. Overall, this signals decreased UK government support for UK NGOs, particularly for those smaller and medium sized NGOs funded from the JFS/CSCF "pot", although the PPA "pot" has increased. We understand that those NGOs invited to negotiate for a PPA following the last round of requests for Expressions of Interest are larger NGOs and no SRH NGO has been invited (although all the specialist UK SRH NGOs expressed interest), while a specialist HIV/AIDS organisation has. Could DFID please clarify its priorities for negotiating/awarding PPAs in future rounds—eg will larger organisations with a higher potential impact be favoured; will certain sectors be prioritised or will generalist development NGOs have a higher priority?

14. We note that there will be a Civil Society Performance Fund from 2004-05 and would like more information on what the aims of this fund will be, who will be eligible to apply, and what types of project will be funded?

DFID'S ENGAGEMENT WITH SRH POLICY DEVELOPMENT—UK AND INTERNATIONALLY

15. As this report covers the year 2002-03 there is no reference to the new structure within DFID Policy Division. However as we know that in practice there is no team specifically responsible for sexual and reproductive health, no reproductive health expertise, and no designated "champion" for sexual and reproductive health and rights in Policy Division. We would appreciate information on:

— To what extent is SRH reflected in DFID's key outcomes?

— Who within DFID will lead on SRH policy?

— How DFID will ensure that Policy Division prioritises the full range of SRH issues (as has been the case in past years) and not just HIV/AIDs and Maternal and Child Health.

— Whether it is the intention to "mainstream" SRH and if so, what mechanisms are in place or being developed to ensure effective mainstreaming?

— Who within Policy Division should the SRH NGO Community relate to?

16. We applaud the work that DFID has carried out with a wide range of national governments, donors and NGOs over the past year to defend and promote advances in sexual and reproductive health and rights secured at the 1994 International Conference on Population and Development (ICPD) and we share the concern regarding the conservative stance of groups seeking to undermine reproductive rights. We would like to know what plans DFID has to continue this work in the future, particularly in the run up to the 10th anniversary of ICPD. The Network offers its support for DFID in regard to this work, and would welcome active involvement where collaboration between DFID and the NGO community would be appropriate.

17. Looking forward to 2004 which will see the 10th anniversary of ICPD and taking into account the determined activities of the US administration and other conservative forces to undermine the agreements of ICPD, the Beijing Conference etc. can DFID outline its approach to ensuring that progress to date on SRHandR will continue and who within the Policy Division will be responsible for ensuring that DFID is appropriately represented in the various international meetings and conferences and will ensure that DFID continues to be regarded as a leader in this field?

OTHER

18. We read with interest the information presented about knowledge sharing and lesson learning within DFID and its partners. What plans does DFID have to ensure the outcomes of this become more accessible for the NGO and academic communities in the UK and the South?

CONCLUSION

Overall the 2003 DFID Annual Report is an excellent document and the Network is pleased to see that more attention is being paid to reproductive health in the annual report than recently.

We believe that overall DFID retains its commitment to sexual and reproductive health but it would be helpful if this is made more public.

We hope that the reorganisation in Policy Division will not result in a decreased priority for the full range of sexual and reproductive health issues.

Finally, we hope that SRH and UK NGOs will get continued and improved support from the new Secretary of State for International Development and the Minister for International Development.

10 June 2003

Annex 1

The UK network on Sexual and Reproductive Health and Rights is an independent network which has been established for four years.

The purpose of the network is to promote and support better sexual and reproductive health and rights for all people internationally, especially the poorest and those in marginalised and disadvantaged groups, within the framework of ICPD and ICPD+5, by:

— Collaborating on joint statements and policy and joint activities both in the UK and in countries in which members are working.

— Advocacy at national and international levels.

— Liaising with DFID, other Government departments and other donors, as appropriate.

— Collaborating with interested UK parliamentarians, particularly members of the All-Party Parliamentary Group on Population, Development and Reproductive Health.

— Liaising with UK and other European NGOs working on these issues in the UK and Europe.

In addition to a number of individuals active in this field of work, the following organisations are represented in the network:

ActionAid

African Partnership for SRH and R of Women and Girls

All Party Parliamentary Group

BOND

Commat

Echo Health

Family Health International

Family Planning Association

Healthlink

IAVI