Report of the Flow of Financial Resources for the Implementation of the ICPD PoA- A 10-year review

ISSUE 25 - 19 May 2004

This issue of the UNFPA Global Population Policy Update focuses on funding trends for population activities during the past ten years since the Cairo 1994 International Conference on Population and Development (ICPD). Below is a summary of the UN Secretary General's report prepared by UNFPA for the 37 th session of the Commission on Population and Development entitled "Flow of financial resources for assisting in the implementation of the Programme of Action of the International Conference on Population and Development: a 10-year review."

Please note that all previous issues of the UNFPA Global Population Policy Update can now be found on our website at: http://www.unfpa.org/parlamentarians/news/newsletters.htm

SUMMARY

Ten years after the Cairo Conference, the levels of resource mobilization are still inadequate to fully implement the Cairo agenda. Though the resources for population have increased steadily over the last 10 years, the report indicates the Conference target of $17 billion by the year 2000 was not met. In order to achieve the $18.5 billion target for 2005, the international community must allocate a larger share of official development assistance (ODA) to population activities and increase the overall levels of aid, while developing countries must mobilize additional domestic resources.

It should be noted that provisional figures for 2002 and estimates for 2003 are encouraging. Donor assistance increased to $3 billion in 2002 and is expected to increase slightly in 2003. A rough estimate of resources mobilized by developing countries, as a group, adjusted for decentralized government expenditures in one large country, yielded a figure of $11.7 billion for 2003. Still, the challenge is to reach the target for 2005, concludes the report.

ICPD Programme of Action

The consequences of resource shortfalls include significant increases in unintended pregnancies, abortions, maternal morbidity and mortality, infant and child mortality, as well as AIDS-related morbidity and mortality. Without a firm commitment to population, reproductive health and gender issues, and the allocation of financial resources, it is unlikely that any of the goals and targets of the Conference or of the Millennium Summit will be met.

The 16-chapter Programme of Action (PoA), adopted unanimously by 179 governments in Cairo on 13 September 1994, reflected the view that the early stabilization of world population would make an important contribution to the achievement of sustainable development, and a consensus that slower population growth could buy more time for societies to combat poverty and protect the environment.

Among other issues, the PoA calls on all countries to make reproductive health care available through the primary health care system; help couples and individuals meet their reproductive goals; prevent unwanted pregnancies and make quality family planning services affordable, acceptable and accessible to all; increase life expectancy; and improve the quality of health care.

In order to achieve these goals, the Key Actions for Further Implementation of the ICPD Programme of Action adopted five years after Cairo urged both developed and developing countries and countries with economic in transition to make every effort to mobilize the agreed financial resources required for the implementation of the PoA. It called on donors to reverse the decline in ODA and to strive to fulfil the agreed target of 0.7 per cent of gross national product (GNP) for ODA as soon as possible.

Financial Targets Agreed Upon In Cairo

The ICPD PoA specified the financial resources, comprising both domestic and donor funds, necessary to implement the population and reproductive health package over the 20 years following the Conference. It estimated that in developing countries and countries with economies in transition, the implementation of programmes in the area of reproductive health, including those related to family planning, maternal health and the prevention of sexually transmitted diseases (STDs), as well as programmes that address the collection and analysis of population data, will cost, in 1993 United States dollars, $17 billion by the year 2000, $ 18.5 billion by 2005, $20.5 billion by 2010, and $21.7 billion by 2015. Approximately two thirds of the projected costs were expected to come from domestic sources and one third, or $5.7 billion in 2000, from the international donor community. For the year 2005, this would mean $6.1 billion.

History Of Population Assistance

International assistance for population activities has come a long way since it first began in the early 1950s, when a small number of private organizations began to provide some $1 million a year to assist several developing countries. Since then, the increasing awareness of the linkages between population factors and development, along with the realization that population growth could threaten sustainable development, has resulted in an expansion of population assistance as more and more countries and organizations began to support family planning programmes, demographic and contraceptive research, and the formulation of population policies.

From its modest beginnings in the 1950s, population assistance had grown to $257 million by the time of the World Population Conference in Bucharest in 1974 and to $547 million by the time of the International Conference on Population in Mexico City in 1984. And on the eve of the ICPD, donors were contributing $1.3 billion to population activities in developing countries.

Trends in Donor Assistance for Population Activities Since 1994

UNFPA collaborates with the Netherlands Interdisciplinary Demographic Institute (NIDI) and, since 1999, with the Joint United Nations Programme on HIV/AIDS (UNAIDS) in the monitoring of resource flows to population activities. UNFPA tracks financial flows that are part of the costed population package of the ICPD PoA: family planning services, basic reproductive health services, STD/HIV/AIDS prevention activities, and basic research, data and population and development policy analysis.

During the process preceding the ICPD and the immediate post-Conference period, there was an increasing flow of resources in the form of donor assistance for population activities. International assistance for population activities increased 54 per cent between 1993 and 1995, from a total of $1.3 billion to $2.0 billion. However, the momentum of Cairo did not last and population assistance hovered near the $2 billion mark from 1995 to 1999, with funding levels actually decreasing for the first time since the Conference in 1997.

Although population assistance peaked at $2.6 billion in 2000, the financial goal of the Conference of $5.7 billion by the year 2000 was not met; the resources mobilized represented roughly 46 per cent of the target agreed upon as the international community’s share in financing the PoA. In 2001, population assistance decreased to $2.5 billion, about 44 per cent of the target, widening the gap between actual assistance and the targets of the Conference. The provisional 2002 figure shows an increase to $3 billion (see table). Despite this encouraging increase, at current funding levels, the target for 2005 appears unlikely to be achieved (see figure 1). However, with significantly increased allocations to population assistance, resources can be made available as was agreed at the ICPD.

International Population Assistance, by Major Donor Category,
1994-2003
(Millions of United States dollars)

Source: UNFPA, 2003. Financial Resource Flows for Population Activities in 2001 and UNFPA/NIDI Resource Flows project database.

Note: The increased flow of resources after 1994 can, in part, be explained by the new classification system that reflects the costed population package of the International Conference on Population and Development and includes non-family planning reproductive health services and STD/HIV/AIDS activities that were not reported previously. Data for 2002 are provisional; data for 2003 are estimates.

* The 2003 figure for development bank loans is estimated at the 2002 level.

Source: UNFPA, 2003. Financial Resource Flows for Population Activities in 2001 and UNFPA/NIDI Resource Flows project database. Note: Data on actual assistance for 2002 are provisional; data for 2003 are estimates.

A. Trends in Bilateral Assistance for Population Activities, 1994-2003

Developed countries provide the largest share of population assistance. Bilateral assistance increased slowly but steadily, from $977 million in 1994 to almost $2.2 billion in 2002. Most countries reporting 2002 funding levels increased their contributions over 2001. According to preliminary estimates, donors provided $2.3 billion for population activities in 2003.

Population assistance as a percentage of ODA increased steadily from 1.65 per cent in 1994 to 3.18 percent in 1997, after which it declined for two years. The figure began to increase once again in 2000 and 2001, when it stood at 3.24 per cent. Provisional 2002 figures show that population assistance as a percentage of ODA increased to 3.46 per cent. The 2003 figure remains at the 2002 level pending the release of 2003 ODA data (see figure 2). Only a handful of countries contribute the suggested 4 per cent or more of their total ODA for population assistance; in 2002, only five countries did so.

Total ODA declined from $59.2 billion in 1994, reaching a low of $48.5 billion in 1997, increased to $56.4 billion in 1999 and decreased once again in 2000 and 2001 to $53.5 billion and $52.3 billion, respectively. When world leaders adopted the Millennium Declaration in 2000, ODA was at an all-time low as a ratio to donor-country GNP.

Donor countries committed to increasing their ODA to developing countries in the context of the Monterrey Conference, resulting in a 5 per cent increase in ODA in 2002 to $57 billion. Despite the fresh impetus to development assistance provided by Monterrey, current levels of ODA are still well below those needed to achieve the Millennium Development Goals (MDGs) and other internationally agreed development goals. Least developed countries are especially in need of larger flows of aid.

Source: UNFPA, 2003. Financial Resource Flows for Population Activities in 2001 and UNFPA/NIDI Resource Flows project database. Note: Data for 2002 are provisional; data for 2003 are estimates.

B. Trends in Multilateral Assistance for Population Activities, 1994-2003

Multilateral assistance to population activities is provided by the organizations and agencies of the United Nations system, mainly from UNAIDS, UNICEF, UNFPA and WHO. UNFPA is the leading provider of United Nations assistance in the population field, providing support for 144 developing countries in 2002. To avoid double-counting, whatever the United Nations agencies receive for population assistance from OECD/DAC donor countries is considered to be bilateral assistance.

Multilateral assistance, which was $107 million in 1994, decreased significantly for a number of years primarily due to failure on the part of some major United Nations agencies to report their income for population activities. Better reporting and increases in funding saw multilateral assistance increase to $96 million in 2001. With most of the major contributors responding, this figure decreased to $33 million in 2002, reflecting real decreases in funding for population on the part of the United Nations system. It is estimated that funding levels decreased further to $28 million in 2003 (see table).

Loans from development banks totaled $436 million in 1994 and fluctuated over the years, depending on the approval of new project cycles. Bank lending peaked in 2000 at $604 million. In 2002, the World Bank reported lending $328 million for population activities. In the absence of complete data, the 2003 figure for bank lending is estimated at the 2002 level.

C. Trends in Private Assistance for Population Activities, 1994-2003

Private assistance, which has fluctuated over the years, has increased considerably, from $117 million in 1994 to $299 million in 2000. The economic downturn resulted in decreased assistance ($241 million) from foundations and NGOs in 2001, with a number of foundations that provided significant funding for population activities in the past reducing their contributions. The trend was reversed in 2002 as private assistance reached $470 million, but according to preliminary indications, it is expected to decrease to $393 million in 2003.

D. Expenditures for Population Activities by Geographic Region,
1994-2003

Approximately 140 countries and territories benefited from population assistance each year during the period from 1994 to 2003. With the exception of 1994, sub-Saharan Africa, which includes the majority of the least developed countries, has consistently been the largest recipient of assistance. The next largest recipients of population assistance have been: Asia and the Pacific, Latin America and the Caribbean, Western Asia and North Africa, and Eastern and Southern Europe. Global and interregional population activities have been receiving an increasingly larger share of total population assistance over the years, from 14 per cent in 1994 to 44 per cent in 2002.

E. Expenditures for Population Activities by Category of Activity,
1994-2003

Consistent with the call by the ICPD for integration of services, funding for basic reproductive health services increased, with fluctuations, from 18 per cent in 1995 to 24 percent in 2002, while explicit funding for family planning services decreased, fluctuating between 55 per cent and 24 per cent during the same period. Consistent with the rapid spread of the HIV/AIDS pandemic, funding for HIV/AIDS activities has increased sharply since 1995, from 9 per cent of total population assistance to 42 per cent in 2002. Funding for basic research activities decreased steadily from 1995 to 2001, from 18 per cent to 8 per cent, but increased to 10 per cent in 2002. According to estimates for 2003, funding for HIV/AIDS increased to 49 per cent of the total, while that for family planning, reproductive health and basic research decreased (see figure 3). Although in absolute dollar amounts, funding for reproductive health and basic research activities also increased since 1995, the largest and increasing proportion of total population assistance goes to fund HIV/AIDS activities.

F. Expenditures for Population Activities by Channel of Distribution, 1994-2003

Over the years, over 40 per cent of all population assistance was channeled through NGOs. In 1997, 1998 and 2000, the NGO channel accounted for at least 50 per cent of the resource flow. A total of 60 per cent of population assistance flowed through the NGO channel in 2001 and 59 per cent in 2002. The bilateral channel accounted for about one quarter of population assistance, except in 1995, when immediately following the ICPD, it accounted for 37 per cent of assistance. It stood at 22 per cent in 2002. The multilateral channel was strongest in the pre-Cairo years but declined from 31 per cent in 1993 to 23 percent of population assistance in 2000 and 18 per cent in 2002.

Source: UNFPA, 2003. Financial Resource Flows for Population Activities in 2001 and UNFPA/NIDI Resource Flows project database.

Note: Data for 2002 are provisional; data for 2003 are estimates.

Trends in Domestic Expenditures for Population Activities

On the basis of responses received from the UNFPA/NIDI surveys, government expenditures for population activities were $2.3 billion in 1997, $2.5 billion in 1998, $3.5 billion in 1999 and $1.5 billion in 2001. The much lower expenditures in 2001 are largely due to the fact that a number of countries with large populations did not reply to the survey for fiscal year 2001. As was the case with donor assistance, the level of domestic expenditures for family planning services declined, while those for basic reproductive health services and HIV/AIDS activities increased.

Results suggest that domestic expenditures, which averaged annually around $8 billion in the years 1997-2000 declined to $7 billion in 2001. Estimates for 2003, adjusted for decentralized government expenditures in one large country, indicate that developing countries mobilized $11.7 billion in 2003.

Most domestic resource flows originate in a few large countries. Many countries, especially those in sub-Saharan Africa and the least developed countries, are simply unable to generate the necessary resources to finance their own population programmes and rely almost entirely on donor assistance.

Resources for Other Population-Related Activities

Both donor and developing countries have indicated that a significant amount of resource flows goes to other population-related activities that address the broader population and development objectives of the agenda of the ICPD but that have not been costed and are not part of the agreed target of $17 billion for 2000.

Since they are not part of the costed population package, funding for such activities is not included in the calculations of international population assistance and domestic resources for population. If the amount of resources spent on these activities were added to expenditures for the costed population package, the overall level of support for the ICPD PoA would be considerably higher.

Overview of Issues in Resource Mobilization

A number o f issues have arisen since Cairo that, if not adequately addressed, will impede full implementation of the Conference agenda. Chief among them are the lack of adequate resources, the continued dependence of many developing countries on population assistance, and the need to ensure that limited resources are used as efficiently and effectively as possible to serve those most in need.
- Lack of adequate resources. Many low-income developing countries cannot generate the necessary resources to implement population and reproductive health programmes.
- Competing development priorities. Poor countries are faced with many competing development priorities. Many of them simply cannot afford to make the necessary investments in population.
- The changing face of development cooperation. Development is no longer universally viewed as the business of specialized bilateral and multilateral aid agencies. There is an increasing belief that financing for development encompasses much more than aid. It includes mobilizing domestic financial resources, mobilizing international resources; international trade; increasing international financial and technical cooperation for development; addressing international debt; addressing systemic issues in the international monetary, financial and trading systems.
- Political commitment to the Cairo agenda. The new focus of Cairo requires changes at policy, institutional and managerial levels to reorient population policies in order to focus on a human rights approach and on the need to provide adequate information and services. Governments and civil society must be willing to commit themselves to the process of integrating population and development strategies and operationalizing the concepts of reproductive health and reproductive rights.
- Impact and efficiency of resource use. Given limited financial resources, issues of cost effectiveness and programme efficiency become more salient. It is not sufficient for resources to be mobilized, both donors and recipients must make sure that the resources are used for the benefit of all, but especially poor people. Coordination of donor policies and identification of funding gaps is also essential.

CONCLUSION

A. Progress in Resource Mobilization

The Conference goal of mobilizing $17 billion by the year 2000 was not met, and the gap between the target level of resources required and that actually made available remains wide. Resources directed to the implementation of the ICPD PoA have increased since 1994 but not at the level required to implement the Cairo objectives. Both donors and developing countries fell short of the agreed targets. It is estimated that, in 2003, donor funding stood at just over $3 billion, and domestic resources were estimated at $11.7 billion. Although the increase is seen as an encouraging sign indeed, for many least developed countries, the lack of adequate funding remains the chief constraint to the full implementation of the PoA and to attaining the goals of the Cairo agenda.

B. Key Areas Requiring Further Attention

Funding has not been as forthcoming as expected or required, greatly jeopardizing the achievement of the Cairo goals. To accelerate the implementation of the Cairo agenda, especially its financial resource targets, a number of key areas should be addressed:
- Strengthening political will and commitment to implement the financial targets of the ICPD as an integral part of the implementation of the Millennium Development Goals and the mobilization of new, additional and sustained resources to fully implement the ICPD PoA. Acceleration of resource mobilization advocacy efforts is essential to renew national commitments to the Cairo agenda and to ensure that sufficient funding is available from both donor and developing countries to achieve the financial targets;
- Establishing an effective partnership of donor and recipient countries, one based on mutual trust and performance and, in addition, on country ownership and donor coordination in support of country goals and the strengthening of collaboration between donors and recipients to avoid duplication, identify funding gaps and ensure that resources are used as effectively and efficiently as possible;
- Enhancing the role of the private sector in the mobilization of resources for population and development. Civil society, especially women’s NGOs, can play an important role in monitoring population expenditures and trying to ensure that Governments achieve financial targets and equity objectives.

C. Challenge

The challenge before the international community is to mobilize additional resources, both donor and domestic, to achieve the targets of the ICPD. It is particularly important to reach the ODA target of 0.7 per cent of GNP and to ensure that appropriate resources are allocated to population and reproductive health in the new funding and programming mechanisms such as the Sector-Wide Approaches (SWAps) and poverty reduction strategy papers. And looking forward, the 10-year review of the implementation of the ICPD PoA will be a useful input to the five-year review of the implementation of the Millennium Declaration in 2005.

This newsletter is issued by the United Nations Population Fund (UNFPA) in its capacity as secretariat for the biannual International Parliamentarians' Conference on the Implementation of the ICPD Programme of Action (the first conference was held in November 2002, in Ottawa, Canada). These dispatches are intended to highlight important developments taking place around the world so that parliamentarians can be kept informed of and learn from the successes, setbacks and challenges encountered by their fellow parliamentarians 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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