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 roundseg 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
DEVELOPMENTUK 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
International Family Health
IPPF
JSI
London School of Economics
London School of Hygiene and Tropical Medicine
Margaret Pyke/Stakeholder Forum
Marie Stopes International
National AIDS Trust
NAZ Foundation
Population Concern
PSI Europe
Reproductive Health Matters
Save the Children
Terrence Higgins Trust
University of Southampton
Y Care International
Youth Coalition
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