Joint memorandum submitted by Marie Stopes
International and Interact Worldwide
Introduction
As leading NGOs in the field of international sexual
and reproductive health and rights (SRHR), including HIV/AIDS,
Marie Stopes International and Interact Worldwide (formerly Population
Concern) commend the Department for having made significant progress
against the public service agreement over the last year. In particular
we welcome the continued commitment and leadership in the field
of sexual and SRHR, including HIV/AIDS. We applaud the broad and
integrated approach to these issues in accordance with the Cairo
Programme of Action. DFID's championship of SRHR in the international
donor community is critical in this area characterised by attempts
to erode rights.
With this memorandum we would like to highlight central
issues in the Departmental report pertaining to our work in SRHR
for the Select Committee's consideration.
SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS
We wish to stress that SRHR is relevant not only
to the Millennium Development Goals on maternal and infant mortality
and HIV/AIDS but to all the MDGs and the overall goal of poverty
reduction. MSI and Interact share DFID's concern at the poor progress
towards the goals on maternal and infant mortality as indicated
by DFID's example of the problems encountered in the African context
We are very encouraged that DFID is taking a forthright
stand on the issue of safe abortion- which remains controversial.
We hope that DFID will sustain dialogue on this issue at the highest
level. MSI has direct experience of the issues surrounding abortion
in, for example Nepal where our partner offers safe abortion as
part of its SRHR programme, whilst Interact is seeking to improve
the policy environment in this respect.
MSI and Interact note that the expenditure by the
department on SRHR programmes including HIV/AIDS was £270
million in the reporting period. We believe that a linked response
to SRHR and HIV/AIDS should be promoted. We are however concerned
that funding is increasingly focussed on HIV/AIDS rather than
broad SRHR programming and that this will result in an emphasis
on treatment to the exclusion of prevention which is best addressed
as part of a broader SRHR strategy. MSI and Interact value DFID's
traditional support of preventative approaches, as we are profoundly
aware of this issue through partner programmes working in communities
where girls between the ages of 15 and 24 represent the largest
group currently at risk of infection. In this context both MSI
and Interact favour the promotion of condoms as preventing both
infection and unwanted pregnancy.
With 1.2 billion young people worldwide becoming
sexually active, we feel this group warrants special attention,
which the Departmental report does not reflect. Similarly the
SRHR needs of conflict affected populations (refugees, internally
displaced people, armed forces and combatants as well as peace
keeping forces) are not explicitly referenced.
UNMET NEED FOR CONTRACEPTION
There is growing demand for sustained supply of SRHR
commodities including contraceptives, condoms, HIV testing kits
and equipment for emergency obstetric care. There is a well documented
global shortfall in these supplies which are a part of WHO's essential
drugs list. A number of factors contribute to shortages in the
supply of contraceptives and other SRH commodities such as lack
of donor support and poor coordination among donors; inadequate
budgeting by developing countries; problems in the supply chain
itself and limitations in the manufacturing capacity of high quality
SRH commodities. We would like to impress upon DFID's Access to
Medicines Team the need to address the shortfall as a matter of
urgency.
The Departmental report mentions technical assistance
(TA) to provide access to a range of contraceptive methods, however
is not clear if such TA also covers the much needed capacity building
to improve the logistics of providing SRH supplies, particularly
condoms, as well as the forecasting and estimation of needs in
these supplies. In addition, the report does not specify if TA
includes local production and strengthening of local manufacture
of high quality commodities.
In the context of budget support DFID is encouraged
to ring-fence funding for SRH supplies and ensure that national
governments include a specific line in their annual budgets for
SRH supplies and capacity strengthening in the areas mentioned
above.
BUDGET SUPPORT, SWAPS AND IMPLICATIONS FOR SOUTHERN
NGOS
MSI and Interact note that DFID is committed "when
circumstances are appropriate" to move away from project
support in favour of budget support. This instrument has irrefutable
advantages in creating government ownership of poverty reduction
strategies, however, there remain serious issues around governance
and government capacity. We recognise DFID's efforts to build
the capacity of government to address these, but solutions will
be found only in the long term.
We welcome DFID's intention to classify budget support
and that the 2004 edition of Statistics on International Development
will give more detail on levels and destinations of budget support.
We anticipate that this will facilitate more detailed information
on support for the various components of SRHR, including HIV/AIDS,
for example SRH supplies including those channelled through
social marketing.
With respect to SWAPs, not given prominence in this
report, failure to include all stakeholders in the planning and
implementation of service provision has been shown in earlier
DFID studies to result in serious lack of quality services, particularly
for vulnerable groups. We urge, therefore, that the evidence base
for budget support and for SWAPs be studied carefully in each
recipient country.
NGOs have a crucial role to play in reaching underserved
groups particularly in the case of the sensitive issues encompassed
by sexual and reproductive health and HIV/AIDS. Service provision,
advocacy, public awareness and policy development in these areas
have been spear-headed by the NGO sector. South Africa is an example
where NGOs and other civil society organisations (CSOs) have been
the catalysts to the government's commitment to address the pandemic.
The evidence based, innovative approaches sought by DFID are most
often provided by NGOs. While admittedly NGOs cannot provide the
same widespread impact as government-led national programmes could
ideally achieve, there are specific culturally sensitive areas
that governments are typically unwilling to address - the issue
of unsafe abortion is a case in point.
Budget support in particular can result in funding
difficulties for Southern NGOs engaged in this work. We seek commitment
that the role of NGOs and other CSOs in the South is recognized
and supported within SWAPs and PRSP frameworks. Flexible solutions
to ensure the support of these SRHR programmes should be found.
DFID AND UK BASED NGOS AND INTERNATIONAL NGOS
The move away from project support in favour of SWAPs
and Budget Support is also having serious impact on Northern and
International NGOs engaged in SRHR. These are experiencing funding
difficulties to the point that certain organisations are ceasing
to operate. This poses a significant threat to progress towards
the MDGs. While the report expresses DFID's intention to support
more NGOs with PPAs, we note that there is no significant increase
in projected budget provision to ensure this support.
We encourage DFID to recognize the importance of
NGOs in delivering the Cairo Programme of Action, particularly
in the sensitive areas of safe abortion and post abortion care
which governments typically find difficult to address. Northern
and International NGOs are playing an important role in raising
awareness of issues like maternal mortality and its causes in
global policy fora, with governments, donors and civil society
in general. NGOs with partners working at the grass roots in the
South channel invaluable experience to contribute to the evidence
and knowledge base on all key SRHR issues. In many cases these
NGOs are facilitating Southern access to SRH rights and supporting
the delivery of a broad range of services in this sensitive area
of human development. There is an urgent need for SRHR NGOs to
be positively considered for negotiating PPAs with DFID.
We appreciate that DFID continues to consult NGOs
and other CSOs on its policy development (RH and Rights Position
Paper as well as the HIV/AIDS strategy and the HIV/AIDS Treatment
and Care Policy consultation papers are recent examples). This
is indicative of the importance DFID places on Northern NGOs as
critical players in the development process. DFID is urged to
continue its support for and dialogue with this sector.
DFID AND MULTILATERAL AGENCIES
MSI and Interact would like to commend DFID on continued
efforts to influence EU development policy to give stronger emphasis
to poverty reduction. In particular we welcome efforts to prevent
the budgetisation of the European Development Fund (EDF). We urge
DFID to galvanise the support of like minded governments to ensure
that the EDF maintains a strong poverty focus.
In view of the new structure and membership of the
EU and the forthcoming restructuring of the European Commission,
we are confident that DFID will ensure that the UK government
supports the nomination of a strong and independent Commissioner
for development to uphold a poverty reduction focus in development
policy.
We further anticipate that DFID's expressed commitment
to the Cairo Programme of Action and, in particular the forthright
position on safe abortion and post abortion care, will be reflected
in the focus of its presidencies of the G8 and the EU in 2005,
and similarly upheld within the World Bank.
REVIEW OF THE MILLENNIUM DEVELOPMENT GOALS AND POVERTY
REDUCTION
The report clearly underscores DFID's commitment
to achieving the MDGs. We would, however like to see SRHR clearly
identified as a crucial element in achieving all of the goals.
It is important that DFID use its influence within the World Band
to ensure that the Global Monitoring Review, identifies SRHR as
an indicator. This is in line with the present emphasis given
by the Millennium Development Project on monitoring progress towards
these goals.
Similarly, DFID should encourage Southern governments
to include specific reference to health / SRH and the role of
private sector and NGOs and other CSOs in delivering SRHR information
and services in formulating national poverty reduction strategies
DFID STRUCTURE
We are aware that the structure of the Policy Division
in the Department has undergone a further readjustment since publication
of the 2004 report and are cautiously optimistic that recent changes
underscore the importance of SRHR in tackling poverty and will
ensure enhanced linkages between SRH and HIV/AIDs programmes.
We would, however, exhort the Select Committee to monitor and
review the effectiveness of the structure at a later stage.
MSI and Interact appreciate this opportunity to comment
on the Departmental Report and look forward to the Hearing on
22 June 2004.
June 2004
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