Report of the Flow of Financial Resources for Assisting in the Implementation of the ICPD PoA

ISSUE 88 - 30 April 2009

Below is a summary of the UN Secretary General's report on funding trends for population activities for the 42nd session of the Commission on Population and Development (April 2009, New York), entitled "Flow of financial resources for assisting in the implementation of the Programme of Action of the International Conference on Population and Development (ICPD)."

The report examines the flow of population assistance funds from donor to developing countries and provides estimates of government and non-governmental investments in population work in developing nations for 2007. It also includes donor and developing country estimates for 2008 and projections for 2009.

This year, in response to the call in paragraph 13.15 of the ICPD Programme of Action that, "estimates should be reviewed and updated" and to harmonize the ICPD financial targets with Millennium Development Goals (MDGs) costing, UNFPA reviewed estimates for the four components of the ICPD costed population package and produced revised estimates to meet current needs.

The data-collection activities for both donor and domestic resource flows were undertaken by the Netherlands Interdisciplinary Demographic Institute (NIDI) under an agreement with UNFPA. Evaluation and analysis of data were carried out jointly by NIDI and UNFPA.

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I. INTRODUCTION
Fifteen years have passed since the ICPD financial targets were adopted. Stocktaking of progress of the Conference 15 years after it was held shows that while resources mobilized have increased, the overall funding is significantly less than necessary to meet current needs and costs, which have grown tremendously since the targets were agreed upon in 1994. The goals and objectives of the Programme of Action of the Conference have not been fully implemented and although important progress has been made, fulfilling the commitments towards the MDGs is not on track. A lack of adequate resources to meet current needs is a major impediment to the achievement of the goals of the Conference and the MDGs.

Donor assistance has been increasing steadily over the past few years, reaching $7.4 billion in 2006. It is expected to surpass $8 billion in 2007 and may further increase to $11 billion over the next two years. These optimistic estimates presuppose that donors will continue to increase funding levels. A rough estimate of resources mobilized by developing countries, as a group, yielded a figure of $18.5 billion for 2007. This number is expected to increase to $19.6 billion in 2008 and $20.5 billion in 2009. These figures also presuppose that developing countries will continue to increase resources for population activities. However, given the current global financial crisis, it is not certain whether countries will continue to increase funding levels for population.

II. DONOR ASSISTANCE TO POPULATION ACTIVITIES
Donor assistance to population activities continues to increase. By 2006, it stood at $7.4 billion. The provisional figure for 2007 is $8.1 billion (see table 1). The 2008 and 2009 figures are projected to be about $11 billion (see figure 1). However, given the current global financial crisis, it is not certain whether donors will live up to their expected future commitments and continue to increase funding levels as they have done in the past few years. It is possible that the final figures for 2008 and 2009 will show decreases in levels of funding for population assistance.

Table 1
International population assistance, by major donor category, 2006-2009
(Millions of United States dollars)

It is important to note that although the total financial target of the ICPD has been surpassed, a closer examination of how the funding is allocated over the four components of the Conference costed population package as compared with the specific targets for the individual categories shows that the increase in funding for HIV/AIDS obscures the fact that funding for the other components is below the agreed targets. Figure 2 compares actual population assistance with the ICPD targets for family planning, reproductive health, STD/HIV/AIDS and basic research, data and population and development policy analysis.

A. BILATERAL ASSISTANCE TO POPULATION ACTIVITIES
Donor countries traditionally provide the largest share of population assistance. Bilateral assistance is estimated at $7.0 billion in 2007, up from $6.6 billion in 2006. According to preliminary estimates, donor countries provided $9.8 billion for population activities in 2008. Projections for 2009 place this number at $9.9 billion. After several years of encouraging increases, official development assistance (ODA) decreased to $103.5 billion in 2007 from $103.9 billion in 2006. The percentage of total ODA that donor countries, as a group, contributed to population assistance increased to 6.46 per cent in 2007 from 6.07 per cent in 2006. There are significant variations between countries in percentage of ODA spent on population activities, from 0.11 per cent to 13.15 per cent.

B. MULTILATERAL ASSISTANCE TO POPULATION ACTIVITIES
Grants
Provisional figures for multilateral assistance show a substantial decrease, from $105 million in 2006 to $50 million in 2007. This is due in part to the fact that a number of United Nations agencies did not provide information by the publication deadline.

Loans
Most loans for population assistance come from the World Bank, which supports reproductive health and family planning service delivery, population policy development, HIV/AIDS prevention, and fertility and health survey and census work. In 2007, the World Bank made available $577 million in loans for population activities.

C. PRIVATE ASSISTANCE TO POPULATION ACTIVITIES
In 2007, it is estimated that foundations and non-governmental organizations contributed $479 million to population activities, up from $406 million in 2006. It is not certain how the current financial crisis will affect the level of private assistance to population activities in 2008 and 2009.

D. EXPENDITURES FOR POPULATION ACTIVITIES BY GEOGRAPHICAL REGION
Sub-Saharan Africa, which includes the majority of the least developed countries, continues to be the largest recipient of assistance, receiving more than half of all assistance going to the five geographic regions. Over 40 per cent of all population assistance goes to fund global and interregional population activities, including advocacy; research; reproductive health; support to the Global Fund to Fight AIDS, Tuberculosis and Malaria; HIV/AIDS prevention, care and support; and safe motherhood.

E. EXPENDITURES FOR POPULATION ACTIVITIES BY CATEGORY OF ACTIVITY
The largest and increasing proportion of total population assistance goes to fund HIV/AIDS activities. Funding for family planning services decreased significantly from 40 per cent in 1997 to 5 per cent in 2007, while funding for basic reproductive health services decreased from 33 per cent to 17 per cent during the same period. Consistent with the rapid spread of the HIV/AIDS pandemic, funding for HIV/AIDS activities increased sharply since 1997, from 16 per cent of total population assistance to 75 per cent in 2007. Funding for basic research activities decreased with fluctuations, from 15 per cent in 1997 to 3 per cent in 2007 (figure 4).

Funding for family planning services decreased in absolute dollar amounts since 1995 when UNFPA first began monitoring resource flows by the four ICPD costed population categories. Although funding for reproductive health and basic research activities increased, HIV/AIDS activities continue to receive by far the largest proportion of population assistance. In fact, donor countries are expected to continue to spend a large percentage of their population assistance on STD/HIV/AIDS activities in 2008 and 2009.

F. EXPENDITURE FOR POPULATION ACTIVITIES BY CHANNEL OF DISTRIBUTION
In 2007, just under one third of population assistance was channelled by NGOs, compared to 41 per cent that went via the bilateral channel and 27 per cent that came from multilateral sources. This trend is expected to continue in 2008 and 2009 largely as a result of bilateral AIDS programmes.

III. DOMESTIC EXPENDITURES FOR POPULATION ACTIVITIES
It is estimated that developing countries spent $18.5 billion for population activities in 2007. The largest amount was mobilized in Asia ($11.2 billion), followed by sub-Saharan Africa ($3 billion), Latin America and the Caribbean ($2.6 billion), Eastern and Southern Europe ($922 million) and Western Asia and Northern Africa ($839 million).

Domestic expenditures are estimated to have increased to $19.6 billion in 2008 and they are projected to further increase to $20.5 billion in 2009. Asia is expected to continue to mobilize the largest amount of financial resources in both 2008 and 2009. Sub-Saharan Africa is expected to mobilize the second largest amount of funds, followed by Latin America and the Caribbean. Eastern and Southern Europe ranks fourth in 2008 and fifth in 2009 after Western Asia and Northern Africa. Given the current global financial crisis, it is possible that resources will not reach projected levels.

Of all domestic expenditures for population 45 per cent was spent on STD/HIV/AIDS activities in 2007. This percentage varied considerably by region, from over 92 per cent in sub-Saharan Africa to 22 per cent for Asia and the Pacific. Figures for Asia are low because data on out-of-pocket spending are not complete.

Table 2
Projection of global domestic expenditures for population activities, 2007-2009
(Thousands of United States dollars)

* Consumer spending on population activities covers only out-of-pocket expenditures and is based on the average amount per region as measured by the WHO (2004) for health care spending in general. For each region, the ratio of private out-of-pocket versus per capita government expenditures was used to derive consumer expenditures in the case of population activities.

IV. Revised cost estimates to meet current needs
The financial targets of the ICPD were fixed some 15 years ago and do not meet current needs that have grown dramatically since the targets were agreed upon. At that time, the population and health situation in the world was much different from what it is today. The HIV/AIDS crisis is far worse than anticipated, and infant, child and maternal mortality remains unacceptably high in many parts of the world. Health-care costs have increased dramatically and the lack of progress on ICPD targets has been identified as being linked to a number of issues including the lack of investment in the development and support of health systems and programmes.

As many countries around the world prepare for the 2010 round of censuses, costs of data collection and dissemination have risen substantially. In addition, the value of the dollar today is far lower than it was in 1993. As a result, the ICPD targets of $18.5 billion in 2005 and $20.5 billion in 2010 are simply not sufficient to meet the current needs of developing countries in the area of family planning, reproductive health, STD/HIV/AIDS and basic research, data and population and development policy analysis.

The revised ICPD cost estimates appear below in Table 3.

Table 3
Revised ICPD cost estimates, by sub-region, 2009-2015
(Millions of United States dollars)

As expected, the revised estimates are much higher than the original targets of the ICPD agreed upon in 1994 because they take into account both current needs and current costs. As in accordance with past practice, these costs do not take inflation into account. The costs are considered minimum estimates required to implement the goals of the ICPD in the areas of family planning, reproductive health, STD/HIV/AIDS and basic research, data and population and development policy analysis.
Total costs for sexual/reproductive health, which includes the family planning and maternal health components (including direct costs and programme and systems costs), are estimated to be $23.5 billion in 2009, peak at $33.3 billion in 2014 and decrease slightly to $33 billion in 2015. Total costs for the HIV/AIDS component are estimated to be $24 billion in 2009 and increase each year thereafter, until they reach $36.2 billion in 2015.

Current funding levels are far below the revised cost estimates. It is estimated that about 11 per cent of the revised costs of family planning/reproductive health, 35 per cent of HIV/AIDS, and 14 per cent of data and research will be covered by population assistance in 2009.

It is clear that funding levels will not be sufficient to meet current requirements. Both donor and domestic funding should be increased in all four components of the Conference costed population package to ensure implementation of the ICPD goals and the achievement of the MDGs.

V. CONCLUSION
A. PROGRESS IN RESOURCE MOBILIZATION
There has been an increase in the flow of financial resources for assisting in the implementation of the ICPD Programme of Action, but this has been primarily a result of the increase in funding for HIV/AIDS activities, including both prevention and treatment. But even these increases do not meet current HIV/AIDS needs that are much higher than had been anticipated when the targets were set.

Funding for family planning, which has been steadily decreasing, is significantly below the suggested ICPD targets and is not meeting current needs in this area either. Additionally, there has not been sufficient investment in the health systems of developing countries to enable the achievement of the ICPD targets.

No one had foreseen the escalation of the AIDS pandemic. Health-care costs have skyrocketed since then. In addition, the lack of sufficient investment in the first 15 years since the Conference has left many countries well behind the pace for achieving the targets and requiring significant investment to accelerate progress. As a result, the ICPD targets are not sufficient to meet the current needs of developing countries.

The revised cost estimates presented in this report are more in line with the MDGs costing and are intended to more accurately reflect the necessary financial resources currently needed to facilitate the achievement of the targets of the ICPD and the MDGs. Current funding levels are much below the revised and more realistic targets necessary to realize the ICPD goals and achieve the MDGs. This is true for all four components of the costed population package. The lack of adequate funding remains the chief constraint to the full implementation of the goals of the ICPD and the Millennium Summit.

B. KEY AREA REQUIRING FURTHER ATTENTION
Continued resource mobilization advocacy efforts on the part of both donors and developing countries are essential to fully implement the ICPD agenda and achieve the MDGs. Implementing the ICPD Programme of Action, especially the reproductive health goal, is essential for meeting the MDGs directly related to health, social and economic outcomes, especially those in the areas of children, mothers, HIV/AIDS, gender and poverty.

The challenge before the international community at ICPD at 15 is to reaffirm its commitment to the achievement of the ICPD goals and the MDGs by mobilizing the resources required in all areas of the costed population package of the ICPD: family planning services, reproductive health services, STD/HIV/AIDS activities and basic research, data and population and development policy analysis. Without political will and a firm commitment to population, reproductive health, and gender issues, it is unlikely that the goals and targets of the ICPD and the Millennium Summit will be met.

A copy of the Secretary-General's report on, "The flow of financial resources for assisting in the implementation of the Programme of Action of the International Conference on Population and Development" can be found here.

All previous issues of the UNFPA Global Population Policy Update can now be found on UNFPA's website.

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This newsletter is issued by the United Nations Population Fund (UNFPA) in its capacity as the secretariat for the biennial International Parliamentarians' Conference on the Implementation of the ICPD Programme of Action (IPCI/ICPD). The first IPCI/ICPD was held in November 2002 in Ottawa, Canada; the second in October 2004 in Strasbourg, France; and the third in November 2006 in Bangkok, Thailand. These dispatches are intended to highlight important developments taking place around the world so that parliamentarians can stay informed of and learn from the successes, setbacks and challenges encountered by their fellow counterparts in other countries and regions in their efforts to promote the implementation of the Programme of Action of the International Conference on Population and Development (September 1994, Cairo, Egypt). It should be noted that UNFPA does not necessarily endorse all of the policies described in this newsletter.

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