Hague Forum background paper - Chapter 2

Creating an Enabling Environment

30 The ICPD greatly increased political action and public attention concerning population issues and heightened awareness of the many linkages between population and a country's social, economic, and environmental concerns. The paradigm shift that has been spoken of in public policy circles since 1994 refers to the movement away from the conceptualization and practice of top-down policy-making for population issues as numerical demographic concerns and towards a rights-based approach giving centrality to the meeting of reproductive health needs and to the fullest possible involvement of civil society in identifying and prioritizing those needs. The manifestation of this conceptual shift appears in the national development plans, population policies and programmes of action that have been formulated or revised in the wake of the ICPD.

31 The ICPD Programme of Action set out the following objectives and actions on population issues as they relate to development:

  • Population concerns need to be integrated into the formulation, implementation, monitoring and evaluation of all policies and programmes relating to sustainable development, and resource allocation at all levels and in all regions;
  • Governments, international agencies, NGOs and other concerned parties should undertake timely and periodic reviews of their development strategies, with the aim of assessing progress towards integrating population into development and environment programmes;
  • Governments should establish the requisite internal institutional mechanisms and enabling environment, at all levels of society, to ensure that population factors are appropriately addressed within the decision-making and administrative processes of the relevant government agencies responsible for economic, environmental and social policies and programmes;
  • Political commitment to integrated population and development strategies should be strengthened by public education and information programmes and by increased resource allocation through cooperation among Governments, NGOs and the private sector, and by improvement of the knowledge base through research and national and local capacity- building; and
  • To achieve sustainable development and a higher quality of life for all people, Governments should reduce and eliminate unsustainable patterns of production and consumption and promote appropriate demographic policies.2

32 This chapter first considers progress made since the ICPD in integrating population concerns into development strategies and policies. This is followed by a discussion of constraints and challenges encountered and finally provides operational and technical perspectives on further implementation of the ICPD Programme of Action.

Formulating or Revising National Population and Development Policies

33 A significant number of countries have formulated new, and in certain other cases revised existing national population policies or national social and economic development strategies incorporating population issues. Namibia, for example, launched its National Population Policy for Sustainable Development in August 1997. Mexico developed both a National Plan of Development and a Plan of Population for 1995-2000, which identifies the stated population policy as a tool and fundamental reference for the country's social and economic development. In line with the objectives of the ICPD Programme of Action, this programme emphasizes the linkages between population and development. Kenya formulated the Population Policy for Sustainable Development, based on the ICPD Programme of Action, to replace its 1984 population policy. Outlining the development goals that will guide the implementation of population programmes up to the year 2010, the policy incorporates issues addressed in the Programme of Action and emphasizes new concerns, such as population distribution and the environment.

34 Some countries translated the recommendations of the Programme of Action into a new population action plan and related sectoral action plans. In Mali, for example, the Government drafted the Action Plan on Population, 1995-2000, a strategic plan that focuses on the operationalization of the population strategy within the objective of making basic social services more accessible; in addition, the Government created action plans for HIV/AIDS, women's empowerment, adolescent reproductive health and poverty reduction, with programmes that promote the basic health needs of the population and emphasize the goals of the Programme of Action. Senegal adopted a National Plan after the ICPD. Because of the conclusions and recommendations of this plan, the Ninth Plan of Development (Economic and Social Development) 1996-2001 considers population issues in the formulation of its development strategy. In Bangladesh, a National Committee for the Implementation of the Programme of Action was formed, comprising policy makers from within the Government along with representatives of United Nations agencies and organizations, development agencies, national and international NGOs and researchers. The Committee developed a National Plan of Action and a strategic plan for family planning, as well as for the basic health and population sector. The Plan emphasizes human development, with specific developmental goals relating to mortality, education and health, with gender equity and women's empowerment as underlying themes, and also addresses financial sustainability, private-sector and NGO roles, and an examination and update of the National Drug Policy.

Establishing Institutional Mechanisms

Institutional Review

35 Progress made in areas of population policy since the ICPD has often been demonstrated in the establishment of a ministerial body or subcommittee charged with addressing population concerns, and, in particular, with integrating them into national development strategies and policies. Some countries, guided directly by the ICPD Programme of Action, established national commissions to help formulate policies and implement integrated population-related activities. These bodies, usually charged with following up the recommendations of the ICPD Programme of Action, often included representatives from sectoral ministries in social sectors as well as from civil society.

36 Nepal, for example, undertook an extensive response to population issues and concerns after the ICPD. In 1995, the Government established a separate Ministry for Population and Environment responsible for formulating an appropriate population policy, developing suitable programmes, conducting research and, in particular, coordinating population, family planning and related activities with various governmental bodies and NGOs. The Government also formulated and adopted a number of policies and programmes on population and health in line with the ICPD recommendations and objectives.

37 Brazil set up a National Commission on Population and Development in 1995, with representatives from civil society and social development sectors as well as several ministries. By acting as a focal point on both the domestic and international level and playing a key role in the development of policies and programmes, institutions like this commission are strategically situated to permit sufficient integration of population concerns into social and economic development plans and to ensure the monitoring and measurement of the ICPD goals and objectives.

38 In other instances, countries created population divisions or units operating within other ministries, such as within the Ministry of Interior or the Ministry of Planning. In these cases, the integration of population concerns into development strategy is well situated for programming and implementation. For example, Belize established a Population Unit within the Ministry of Human Resources to design and implement a national population and development policy.

39 Some countries updated their pre-ICPD population policies and institutions in response to the Programme of Action. At times, the process of revising the policies and institutions included input from other sectoral bodies. In many cases, the scope and planning of population activities were increased extensively when modified to take into account the goals and recommendations established at the ICPD. Often, this was an ongoing process in the modification and revamping of older institutions and policies. Peru, for example, developed an extensive infrastructure of institutional support in order to address many aspects of population issues raised at the ICPD. The Government dismantled the National Population Council (CONAPO) and transferred its duties to the newly formed Ministry for the Advancement of Women and Human Development (PROMUDEH), with a Human Development Division and a Population Programme Unit to deal directly with population issues. The Government integrated the goals of the ICPD Programme of Action into sectoral plans and programmes, particularly in the health and education sectors, in the course of implementing the National Reproductive Health and Family Planning Programme 1996-2000 and the National Sex Education Programme.

40 Other countries that had pre-ICPD institutional arrangements and mechanisms for addressing population issues modified their structures and/or responsibilities to ensure that they incorporated the goals and recommendations of the ICPD Programme of Action and could, thus, work intersectorally to integrate population concerns into other national concerns. In Egypt, for example, the Government's National Population Council was made responsible for population policy and reform; population strategy and multisectoral planning; population programme management, including monitoring and evaluation; and research studies on population concerns.

41 Indonesia, likewise, is an interesting case-study of how integrating population into development strategies changed after Cairo. Indonesia's Ministry of Population was merged into the National Family Planning Coordinating Board prior to the ICPD. The more substantive duties relating to population were gradually shifted to the university-based Population Studies Centre (PSC). The Government was instrumental in facilitating this institutional shift, using both domestic and international resources to expand and strengthen PSC. More specifically, a collaborative UNFPA project transformed PSC into several newly established decentralized centres that deal with a variety of population and development issues, particularly those relating to family welfare and poverty alleviation.

Decentralization

42 In countries where moves towards decentralization of policy and programming have been taking place, a greater sense of progress has been noted in terms of awareness generated about population issues and their relevance to development. In India, for example, the state, district, and community level have all begun to receive much more information on population and reproductive health issues, which has helped them develop and implement appropriate population programmes for their respective districts and local areas.

43 Pre-existing civil-society institutions can also be valuable tools for decentralization. In some countries, for example, support for improving capacities of universities has proved successful in furthering the ICPD Programme of Action. Particularly in countries with economies in transition, where the Government may be preoccupied with conflict or economic crises, alternative channels for social development such as universities and other organizations of civil society have been important players.

Measurement and Monitoring

44. The integration of population issues into development strategies also requires mechanisms for monitoring and measuring progress towards meeting the goals and objectives set forth in Cairo. Most countries have continued to use traditional demographic and social-service indicators as part of their measurement process. Many augmented these indicators with more detailed reproductive health indicators, such as the proportion of births at which skilled attendants are present, access to contraception, and the adequacy of counselling and follow-up, as well as with wider social-service, environmental and economic indicators.

45. The countries that have been successfully monitoring their progress in integrating population concerns into development strategies have developed a comprehensive list of indicators and had charged specific ministries, subcommittees or departments with tracking them. Some countries planned to implement a computerized networking system for programme planning -- an important area in which the full availability of data is crucial for the development and execution of appropriate programmes as well as for the tracking of domestic and international resource flows.

46. The accuracy and efficiency of monitoring and measurement have been increased in those countries that have expanded data collection to include a variety of sources, rather than relying on a single source, such as a Demographic and Health Survey (DHS). In Ghana, for example, key reproductive health indicators are tracked through the DHS but are also being gathered from the institutional reports of the Ministries of Health and Education as well as the reports of implementing agencies such as the National Council on Women in Development and academic and research institutions. Other countries have established coordinating committees on reproductive health and family planning policies that monitor all relevant programmes executed by sectoral ministries. In the United Republic of Tanzania, the Government created four institutional structures for the coordination, monitoring and evaluation of the implementation of the national population policy and programme, including the integration of population issues into the development planning process.

Strengthening Information, Education and Communication Programmes

47. No other arena in development more clearly illustrates the importance of the capacity of people to communicate with one another than that of population and reproductive health. The placing of reproductive rights and sexual health at the heart of the population agenda is making the work of those concerned with such issues both more ethical and more politically and culturally complex. A whole range of reproductive rights and HIV/AIDS issues, from domestic violence to female genital mutilation to male sexual responsibility, have crystallized the need for a vigourous and public debate. Such debate depends fundamentally on communication within societies, within families, within communities, and on communication between societies, through political discourse and advocacy. Increasing the flow of information on population issues can have profound effects on many levels of society.

48. Information, education, and communication (IEC) strategies and training relevant to the implementation of the ICPD Programme of Action include the exchange of information on the effects of population on many other socio-economic issues, migration, urbanization and the macroeconomy. They incorporate population issues into educational curricula, public awareness campaigns, research, round tables, training and advocacy activities. The former and simpler strategies of education and persuasion where success was measured by the number of "acceptors" have been replaced by the complexities of choice and rights, where people themselves, and especially women and adolescents, are regarded as the main decision-makers and are entitled to determine what should happen to their bodies and their lives. Although much time and effort are required, IEC strategies can have far-reaching effects on social norms and behaviour and provide opportunities for furthering the gains made at Cairo by educating the public and policy makers about pertinent population issues.

49. The development of information and communications technologies (ICT) presents promising opportunities for addressing global population and reproductive health issues. The current information revolution has resulted in global communication links unprecedented in world history. E-mail for instance has transformed the opportunities available to advocacy NGOs and community organizations to network, lobby, and organize around many population and development issues, not the least in the field of reproductive health and rights. ICTs have great potential in the area of advocacy as well as in encouraging social interaction among all stakeholders and stimulating public debate of population issues.

50. New information and knowledge management technologies have been increasingly operational since the ICPD. For the last five years, key ICPD-related developments included such programmes as POPLINE, POPIN, the Development of On-line Information Service on Population and Environment Linkages, the development of new software, the use of websites and CD-ROMS for media materials, and the Global Knowledge Partnership. These activities have facilitated the systematic collection, analysis, dissemination and utilization of population-related knowledge and promoted information and experience exchange at the national, sub-regional, regional and global levels. At field level, powerful information and communication technologies are being used to empower communities, couples and individuals to make informed decisions. For example, some countries in Asia and Africa are trying out the concept of "cyberbus" and electronic chatrooms, to educate young people on population and reproductive health issues. Many young people have also used telephone hotlines set up by NGOs and health institutions to obtain information and counseling on sensitive issues such as pregnancy, sexual relations, domestic violence, sexually transmitted diseases, including HIV/AIDs. In Bangladesh, mobile telephones have enhanced spousal communication and information on reproductive health among those involved in microcredit programmes offered by the Grameen Bank.

Advocacy Campaigns

51. Many countries have demonstrated their political commitment to integrated population and development strategies through the initiation of advocacy campaigns, either on population as a general issue or on specific reproductive health concerns as a response to the ICPD recommendations on promoting the general reproductive health of all members of society. In some countries, Governments have initiated multifaceted awareness-raising campaigns on these issues. In Brazil, for example, the Minister of Health established a National Day against Maternal Mortality as part of the Safe Motherhood Initiative, a multilateral effort involving the United Nations Children's Fund (UNICEF), Pan American Health Organization (PAHO), UNFPA and the Brazilian Federation of Gynaecology and Obstetrics. In addition, the Government organized "Cairo +5" events to further educate the public, politicians and the private sector on these issues.

52. Moreover, the impact of the personal commitment of political leaders to integrating population and development can be seen in countries such as Mexico, where the President publicly presented the National Programme for Sexual Health and Family Planning 1995-2000 through the mass media. This gave a clear message that reproductive health should be a basic part of health services, along with nutrition and vaccination. Some countries reported that presidential candidates included the ICPD Programme of Action in their campaign platforms.

Research/Training/Round Tables

53. Many countries have initiated studies on traditional population issues or initiated a revised national census that addressed the population and reproductive health concerns included in the ICPD Programme of Action. University and international organizations sponsored inquiries into specific population or reproductive health issues, and, in some cases, private-sector companies conducted research on population issues. For example, India's Energy Research Institute conducted a study on demographic concerns.

54. In Mali, an international NGO has been conducting research on migration and urbanization in West Africa and an analysis of the reproductive health situation. Likewise, in some Latin American countries, both the private and public sectors generated a significant amount of research and institutional knowledge about population and development issues. Both academic and governmental institutions analysed national development plans along with programmes on population and public-health sector reform as well as new policies on women and demographic issues.

55. In addition to the UN Regional Economic and Social Commissions meetings, many countries have held meetings or round tables on ICPD+5, or "Cairo in Action", to measure progress in implementing the Programme of Action and to garner continued support for integrating population issues into other sectors of policy planning and development. In Burkina Faso, for example, the Government has promoted the adoption of a wider development strategy, with a consideration of demographic trends particularly in regard to women and access to reproductive health services, by holding a round table on social-sector activities, including population and development.

Implementing Regional Initiatives to Promote Population and Development

56. Several regions, through their Economic and Social Commissions, have held meetings on the ICPD Programme of Action, drafted their own regional programmes of action, and developed, implemented, and strengthened regional networks for cooperation and coordination of population and development activities.

Africa

57. The Economic Commission of Africa (ECA) held a series of regional conferences as a follow-up to the ICPD and as a means of assessing benchmarks in the integration of population concerns into the various development plans of the region. ECA developed its own country inquiry for assessing national implementation of the Dakar/Ngor Declaration and the ICPD Programme of Action. At the most recent follow-up meeting in Addis Ababa in September 1998, ECA reviewed progress in the region as a whole and the trends and specific perspectives in the 36 countries that responded to the survey. Participants at the meeting, including Governments, international organizations, donors and NGOs, reviewed African experiences in the implementation of the ICPD Programme of Action and the Dakar/Ngor Declaration and arrived at 75 recommendations covering the full range of topics included in the ICPD+5 discussions.

58. The policy issues that emerged as those of prime importance to the region were related to strengthening support for policy development and programming of HIV/AIDS-prevention and related services, and recognizing and increasing the role of NGOs and the private sector in addressing population concerns. The meeting urged the adoption of appropriate population policies by those countries that have not done so and the establishment of adequate policy and programme coordinating mechanisms, in particular, those for South-South cooperation. The ECA regional recommendations also proposed policy development in regard to adolescents and youth in all aspects of reproductive health programming. The findings of the ECA questionnaire and recommendations will be formally reviewed at future regional ECA and African Population Commission meetings as well as at the Organization of African Unity (OAU) Summit of Heads of State in June 1999.

Arab States and Western Asia

59. The Economic and Social Commission for Western Asia (ESCWA) and the League of Arab States met in Beirut in September 1998 to review the ICPD Programme of Action, the Amman Declaration and activities surrounding their implementation and adaptation to policies and programmes in the region. Member States proposed future actions on population and development strategies and comprehensive reproductive health policies and programmes. The representatives reaffirmed their commitment to the goals of the Programme of Action to integrate population into national development strategies and mentioned the importance of considering access to and the quality of reproductive health care and of addressing unmet needs resulting from age, gender and social status, all within the context of the economic restructuring occurring in the region. The recommendations call upon Governments to encourage the development of comprehensive reproductive health policies and programmes, paying attention specifically to STDs, violence against women and children, harmful cultural practices such as female genital mutilation (FGM), and male involvement in family planning and reproductive health. The report also calls for international and intersectoral collaboration to create reliable indicators and mechanisms to measure progress in implementing programmes of action, particularly the integration of population into development strategies and national social development plans.

60. Several of the countries of the region reported that comprehensive national strategies had been developed, including social development strategies that take into account equity and access to basic social services, create new economic opportunities, strengthen government awareness of issues such as poverty and catalyse efforts to rehabilitate social sectors. The ESCWA recommendations also emphasize advocacy for decision makers and officials in charge of programme implementation and the importance of intersectoral coordination among reproductive health service providers, including NGOs, the private sector and public health institutions.

Asia and the Pacific

61. The Economic and Social Commission for Asia and the Pacific (ESCAP) held a meeting in March 1998 to review the implementation of the ICPD Programme of Action and the Bali Declaration on Population and Sustainable Development. The forum gave the countries of the region an opportunity to demonstrate their commitment to fulfilling the goals of the Programme of Action and the opportunity to identify key actions that should receive urgent attention from all development partners. The meeting also considered the various structural reforms that countries of the ESCAP region were undertaking to adjust to and benefit from the opportunities posed by globalization. In all, the Asia-Pacific Regional Meeting generated 63 recommendations for future action and one resolution, which asserted the need for mobilization of human and financial resources for further implementation of the ESCAP regional population and development goals. The resolution endorses the utilization of South-South cooperation and NGOs as alternative mechanisms to governmental institutions.

62. The 63 recommendations for actions in the policy and institutional framework include addressing the issues of international migration, gender equality and equity, and the setting of explicit priorities within reproductive health care, adolescent health and the role of civil society. The ESCAP meeting concluded that progress had been made in implementing the ICPD Programme of Action but challenges remained, including that of balancing the role of government in the planning and provision of services with the private sector's capacity for the funding and provision of services. The ESCAP nations recognized that using the market mechanism for the provision of services would be an important step in further implementing the ICPD Programme of Action, particularly in terms of addressing inequities. The primary resolution calls for a report on the progress of the region in securing further human and financial resources for population and development policies and programmes to be presented at a follow-up conference in the year 2002.

Central and Eastern Europe and the Commonwealth of Independent States

63. The countries of the Economic Commission for Europe (ECE) considered in this discussion are primarily the countries of central and eastern Europe and the states of the former Soviet Union -- the Commonwealth of Independent States (CIS). As a follow-up to the ICPD, the countries with economies in transition gathered for a UNFPA-sponsored workshop on population policy and programmes in the region, hosted by the Romanian National Commission for Statistics, in Romania in May 1995.

64. The population issues of most concern highlighted at the meeting were the high rate of abortion, low use of family planning, unsafe abortion as a leading cause of maternal morbidity and mortality, and the level of infertility among large proportions of the female population. Countries also reported extremely high levels of STDs especially among adolescents, and low levels of quality of care and of IEC on reproductive health care both within the service-provider community and the wider public. Most of the countries did, however, possess some key advantages in pursuing population and development goals, including high levels of literacy due to an emphasis on education, with equal access for women and men, and developing private-sector channels for health-service delivery. Although progress has been registered since 1995 in addressing many of these issues, significant obstacles still remain in many of these countries to fully implement the ICPD Programme of Action.

65. In December 1998, the ECE held a regional meeting in Budapest, Hungary, on ICPD+5 follow-up. The meeting provided an opportunity to review progress made in implementing the ICPD Programme of Action under five priority themes: fertility, family and gender issues; reproductive rights and sexual and reproductive health; mortality and health; population ageing; international migration. The conclusions of the meeting cover these themes, while briefly mentioning international cooperation.

Latin America and the Caribbean

66. In 1996, the draft Regional Plan of Action approved at the twenty-fifth session of the Economic Commission of Latin America and the Caribbean (ECLAC) became the Latin American and Caribbean Regional Plan of Action on Population and Development, after being further developed following the outcome of the ICPD. It describes activities, including round tables held in conjunction with UNFPA, on issues such as adolescent reproductive health, reproductive rights and the implementation of reproductive health programmes, and population and macroeconomic links. A follow-up conference in Aruba in May 1998 demonstrated the continuing political commitment of countries in the region to furthering the ICPD goals and recommendations through the establishment of national plans, declarations of principles concerning population and sustainable development, sectoral plans and programmes, and the creation of population units or commissions to formulate and coordinate policies and programmes.

67. The ECLAC subregional headquarters for the Caribbean is responsible for follow-up action and support with respect to the implementation of the Caribbean Subregional Plan of Action on Population and Development, which presents the contents of the Regional Plan of Action and the ICPD Programme of Action from the Caribbean perspective and which serves as a further guide to action for countries in the subregion. Technical assistance provided to countries of the subregion in areas such as applied research has been geared to the specific needs and concerns of these countries, which include international migration, the impact of immigration on small islands and coastal areas, the role and importance of family remittances from abroad, return migration and adolescent health. Data for the policy and programmatic activities were systematically collected and disseminated as part of the regional socio-demographic data bank.

Constraints

68. Despite the progress observed, implementation of the Programme of Action has been uneven because of the many constraints and challenges countries face. They include limited financial and human resources, competing priorities, limited institutional infrastructure, insufficient intersectoral coordination, inadequate measurement/monitoring mechanisms, economic crises and civil unrest.

Limited Financial and Human Resources

69. One of the most widely recognized constraints encountered in the implementation of the Programme of Action was the limited amount of financial and human resources, including the lack of trained personnel to create and implement population and development policies. Human resource management limitations appeared in many ministries that were greatly overburdened due to an employee base that was insufficiently skilled and trained for the considerable work flow in the social and economic development sectors.

70. Countries that have made institutional and programmatic changes in the years following Cairo often mentioned dwindling resources as a reason for changes becoming less dynamic or even unsustainable. This constraint was illustrated by the countries in which population ministries or similar institutional bodies have no operational capacity, often due to a lack of funding.

Competing Priorities

71. The interdependence of population issues with macroeconomic, environmental and other development issues made the pursuit of the goals and recommendations of the ICPD Programme of Action essential. However, Governments often face priorities that compete with integrating population into development strategies. In some developing countries and countries with economies in transition, population issues have been seen as independent of, or secondary to, economic growth or poverty alleviation. Thus, there is a need for more awareness creation and advocacy activities on the links between population and other development issues.

72. Research studies conducted by independent international institutions show that up to 98 per cent of funds allocated for development activities are spent on sectors other than population.3 Population issues such as those discussed at Cairo -- especially the empowerment of women, schooling of girls and, more generally, the integration of population into development strategies -- can be overshadowed by more immediately pressing economic or environmental concerns.

Limited Institutional Capacity

73. A significant number of the countries covered by the UNFPA ICPD+5 Inquiry cited the limited institutional infrastructure or the lack of politically empowered sectoral bodies capable of addressing integrated population and development issues as constraints. For example, some countries reported that a national commission on population and development had been established, but it was created without the support of an overarching planning system or national development plan. In other cases, the governmental ministry or body established or charged with addressing population issues had no decision-making power or formal mechanisms to measure progress towards achieving the goals and objectives set forth at the ICPD.

74. Many countries in Africa and Asia reported that a lack of coordination between ministries or institutions had made incorporating the policy aspects of the Cairo agenda extremely challenging. In only a very few cases, did the countries surveyed mention that relevant sectoral agencies had either reviewed or actively participated in developing and implementing a new population or development strategy or action plan. This has also been reported in other regional and subregional reviews of post-ICPD activities aimed at implementing the Programme of Action.

Lack of Data and Monitoring Mechanisms

75. Many developing countries and countries with economies in transition reported that implementation of the ICPD Programme of Action was constrained both by a lack of data or information and by inadequate measurement or monitoring mechanisms. Many countries with economies in transition, especially the newly independent states, lack census data and the capacity to undertake a census.

76. Many countries cited as major constraints the lack of systematic mechanisms for monitoring ICPD goals, the difficulty in obtaining disaggregated reproductive health and basic social indicators, and/or inadequate or insufficient data and analytical systems. This challenge can arise in countries where DHSs or censuses are not conducted regularly, where they are carried out by different agencies, or where the data are collected and analysed by different agencies or organizations. In addition, the various bodies responsible for collecting and analysing the data may be constrained by limited resources and technical capacity.

External Factors

77. In countries where domestic markets were weak or experiencing recessions, the funding and maintenance of sufficient trained personnel in the relevant ministries became a central issue. This situation was often coupled with emigration of skilled personnel, causing further pressure on constrained ministries and sectoral agencies. Clearly, these situations cannot be corrected without attacking their root causes, making policy programming and implementation virtually impossible in the short term.

78. Many countries undergoing rapid structural changes and those in intense political and economic stress have witnessed a significant increase in the amount of civil and political unrest over the last few years. Wars related to ethnic strife, political conflicts and economic hardship have resulted in growing public health problems and a breakdown in the infrastructure to deal formally with population and reproductive health issues.

Information Gap

79. The "information gap" between the rich and poor and between gender is stark and the distribution of new information and communication technologies is even less equal. Access for information means access to power and most societies continue to exclude women. The domination of Internet by men has also been a source of consistent criticism since its inception. Despite such lack of access, the Internet has had a major impact in enabling the civil society organizations to organize themselves and campaign. In developing countries, there is a race for harnessing technologies for knowledge, information and networking and for increasing participation of and interaction with the public. Women's organizations are increasingly understanding and seizing the strategic importance of new technologies for exercising the full benefits of reproductive rights. "The freedom to have access to spaces other than the bedroom and the kitchen, and to fully and safely be able to act in other public spaces is key to women's full participation in the world's future" argues Marie-Helene Mottin-Sylla, of the NGO Enda Tiers Monde in Senegal. Furthermore, it is the private sector that is driving the information revolution and population advocates are often absent from the discussions in which key global and national communication policies are being shaped.

Further Action Required

80. Governments should fully acknowledge the linkages among population, reproductive health, macroeconomic and other sectoral issues and the need for national policy and programme planning mechanisms that take the interdependence of these issues into account.

Institutional Strengthening

81. Governments should elaborate strategic frameworks that encourage and support intersectoral collaboration and coordination as a way of expanding the depth and scope of the attention given to population issues.

82. Governments should continue or begin the process of decentralization in population and development programme planning and implementation and should provide the necessary support to carry out the process effectively. Many countries that have begun the shift to decentralization in sectoral programmes and policies cited the continuation of this trend as a key opportunity for beginning or continuing to carry out the goals of the ICPD Programme of Action.

83. All stakeholders in the population and development field need to define clearly their roles and responsibilities in implementing the goals and recommendations adopted in Cairo.

84. Governments should strengthen their collaboration with civil society, including NGOs, in population and development planning, implementation and monitoring and evaluation, taking into account their comparative advantages and complementarities.

85. Governments should allocate more resources to strengthen existing institutions or to create new ones that address population issues in order to ensure that the institutional framework is adequate to achieve the ICPD goals.

Technical and Human Resources

86. Governments should work together with NGOs and the private sector to ensure that the appropriate technical resources are present, i.e., skilled, trained personnel and adequately funded programmes, that will allow the full integration of population into development planning.

87. Governments, NGOs and other civil-society representatives should work to establish a sustainable base of well-informed and adequately trained personnel within the government and health sectors in order to support population and development policy and programmes.

IEC and Advocacy

88. Governments, as well as NGOs and private-sector actors, should initiate and increase awareness-raising activities that mobilize support for integrated reproductive health; women's empowerment; and economic, environmental and other social welfare programmes.

89. Governments should strengthen national networks and coalitions for advocacy, targeting multiple audiences ranging from national leadership to the grass-roots level, for the goals and recommendations of the ICPD Programme of Action, in cooperation with civil-society organizations. They should nurture networks that link senders and receivers, citizens and decision-makers, public and private sectors, communication professionals, community and mass media, and opinion leaders.

90. Governments, as well as NGO and private-sector actors, should avail themselves of the opportunities offered by the new participatory and open paradigm of the Global Information Society. ICTs offer new processes and tools for advocacy communication in support of the ICPD Programme of Action. State-of-the-art tools include inter-active and inter-linked websites, the production of localized, more attractive and interactive population data, electronic archives, distance learning systems, and electronic conferences.

Research and Data

91. Governments, as well as civil society organizations, should engage in strategically focused research to improve the effectiveness and efficiency of population and reproductive health programmes. Timely availability of research results and their effective application in programme design should be stressed.

92. Governments and civil society, including academic or technical institutions, should work together to provide and share integrated and comprehensive data that are manageable and sustainable.

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