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Programme Priorities |
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| Reproductive Health Including Family Planing and Sexual Health |
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| Reproductive Health, including Family Planning and Sexual Health
Population and Development
Strategies
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More than half the countries responding to the UNFPA Field Inquiry reported having taken significant measures to improve the quality of reproductive health services since ICPD in 1994. More service providers are being trained; health infrastructure and facilities are being improved; monitoring and evaluation efforts are being strengthened; and referral to reproductive health services is being enhanced. There has also been greater recognition of reproductive rights, with several countries having formulated policies and laws to combat female genital mutilation (FGM) and sexual and gender-related violence. However, the inquiry also showed the need to augment existing reproductive health programmes with new components and to integrate reproductive health services into primary health care systems. Greater effort is also needed to promote the decentralization of health care systems. Major challenges include improving financial resources, strengthening human resources and addressing sociocultural issues that may impede service delivery and/or the achievement of reproductive health. The "Expert Round-table Meeting on Ensuring Reproductive Rights, and Implementing Sexual and Reproductive Health Programmes, Including Women's Empowerment, Male Involvement and Human Rights" provided insights applicable to the Fund's programmes. The round table, organized in Kampala by UNFPA in collaboration with the United Nations Population Division, was attended by some 50 experts and observers from around the world. Attendees included representatives from governments as well as non-governmental organizations (NGOs), from both developing and developed countries. Also participating were experts on reproductive rights and health from academic and research institutions and United Nations agencies. The meeting sought to identify post-ICPD strategies aimed at ensuring reproductive rights and making sexual and reproductive health programmes operational. Additionally, it attempted to identify successes and constraints in the policy, legal, administrative, managerial, strategic and financial aspects of such programmes. Finally, it tried to reach a consensus on actions needed to accelerate progress towards the achievement of ICPD goals. The round table focused on actual case studies. For example, the experiences of Zambia provided insights into the process of developing a sexual and reproductive health policy. Bangladesh was the focus of the discussion on broadening the constellation of services within existing systems. The experiences of PROFAMILIA, a Colombian non-governmental organization, shed light on the participation of NGOs in providing services. And Uganda's Reproductive, Education and Community Health Programme (REACH), which has helped discourage the practice of FGM, illustrated the importance of creating the necessary conditions for implementing sexual and reproductive health and rights. The Kampala round table reinforced many of the Field Inquiry's findings. For example, while various elements of reproductive health care are available in many countries, these elements are not always well connected. Most programmes still have vertical administrative structures and compartmentalized budgets and staff, all of which inhibit coordination among institutions and limit programme effectiveness. There is a need to strengthen collaboration among national ministries and institutions and to decentralize health care systems to ensure that care actually reaches the local level through coordinated networks of services. The Field Inquiry, round table and other follow-up activities all showed that meeting the goals of ICPD in the area of reproductive health requires reducing vertical administrative structures and integrating all aspects of reproductive health into primary health care systems. A related task is integrating different institutional structures, or at least improving collaboration among them. Other challenges include improving logistics systems and training and overcoming social and cultural barriers to service access - for example, by educating men regarding their roles and responsibilities concerning women's health. The round table's recommendations addressed many of these challenges. Several focused on health-sector reform. For example, it was suggested that health systems be reoriented, to ensure that sexual and reproductive health policies, strategic plans and all aspects of implementation are rights-based, cover the clients' entire life cycles, and serve all who require reproductive health services. Change should, round-table participants agreed, be incremental and phased according to resource availability. Moreover, the process should involve all partners, including those from civil society. A related recommendation called for the creation of an enabling environment, at all levels of society, which would promote women's empowerment and involve males in securing sexual and reproductive rights within a human-rights framework. Country-level initiatives. UNFPA is attempting to address these challenges through a series of initiatives in its country programmes. For example, by the end of 1998, the Fund had helped Pakistan's Ministry of Population Welfare carry out an evaluation of all of its family planning outlets. The evaluation identified a number of actions needed to establish an integrated reproductive health system incrementally. Information gleaned from the monitoring visits will guide the Government in 1999 as it works to improve the quality and variety of reproductive health services. Elsewhere, in Kenya for example, the Fund is supporting the development and implementation of comprehensive, integrated reproductive health services. In the last two months of 1998, UNFPA joined other international partners in assisting the Ministry of Health in a study of six selected districts. The study assessed the districts' commitment, capability and preparedness to implement integrated, comprehensive reproductive health programmes. In the United Republic of Tanzania, UNFPA was actively involved, through its country programme, in helping ensure that reproductive health services were not lost or marginalized during the nation's reform of its health sector last year. Also during the year, the country office obtained $4.2 million in multi-bilateral assistance to supplement the Fund's regular programme. This programme provides comprehensive integrated reproductive health services in 38 underserved districts, with an emphasis on reducing maternal mortality and morbidity. In Cambodia, UNFPA helped the Government provide reproductive health services in more than 50 per cent of the country's health centres, including in eight new provinces. The Fund also helped develop a national strategy for information, education and communication (IEC) in support of reproductive health. Nineteen ninety-eight saw the debut in Sri Lanka of a network of "Well Women's Clinics", which take a holistic approach to women's reproductive health needs. UNFPA's country office helped establish the clinics though a consultative process that involved the Government as well as professional colleges, such as the colleges of obstetricians and gynaecologists, pathologists, and surgeons. |