Report of the Round Table on Ensuring Reproductive Rights and Implementing Sexual and Reproductive Health Programmes Including Women’s Empowerment, Male Involvement and Human Rights.

Kampala, Uganda
22-25 June 1998

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EXECUTIVE SUMMARY

The aims of the Kampala Round Table were to identify strategies that have emerged since the International Conference on Population and Development (ICPD) in ensuring reproductive rights and in making sexual and reproductive health programmes operational; to identify successes and constraints in policy, legal, administrative, managerial, strategic and financial aspects; and to agree on actions needed to accelerate progress towards achieving the goals of the ICPD.

The Round Table recognized that sector-wide progress in policy formulation has occurred in several countries, while work to improve specific aspects of policies and of implementation has started in others. Where there is political commitment to the principles of sexual and reproductive health and rights and gender equality and empowerment of women, progress is occurring in collaboration between governments and civil society. Effective and empowered women’s movements, other mass movements and non-governmental organization (NGOs) are proving vital to ensuring progress in policy development and implementation in areas such as the establishment of greater understanding and will for developing rights-based policies.

While various elements of reproductive health care are available in many countries, the implementation of comprehensive integrated services has advanced slowly. Traditionally vertical administrative structures, compartmentalized budgets and personnel prevent intersectoral collaboration and coordination among ministries in numerous countries.

Within integrated and comprehensive reproductive health, three central issues have emerged as global concerns that have not received universal and balanced investment: meeting the need for family planning; ensuring maternal health (including the reduction of unsafe abortion); and reducing infant mortality and morbidity; and preventing and treating sexually-transmitted diseases (STDs), including HIV/AIDS. Although much remains to be done in these areas, the central commitment is to reduce verticality of programmes and integrate all aspects of reproductive health in the context of primary health care and health sector reform.

Technologies are seriously inadequate in STDs, including HIV/AIDS. Few women can protect themselves and their partners. Although the female condom exists and is beginning to be made available, simpler diagnostic tests and single dose treatments remain unavailable.

The challenge of Cairo continues to be the integration of or better collaboration between different institutional structures, transformation of existing facilities, improvement of logistic systems and training to ensure appropriate and effective care. The means to meet the challenge involve the structural and strategic reorientation of health systems and financing. Integration is not just a matter of adding services to family planning programmes. Another challenge is to overcome social barriers to access, including men’s understanding of their roles and responsibilities of women’s health.

The Round Table experts reached consensus on the following actions needed:

- In health sector reform, emphasis must be given to ensuring sexual and reproductive health for all people at the highest achievable standard of care, and to mobilizing the necessary resources. Equity is a necessary prerequisite to achieving the right to health.

- Continue and promote the reorientation of the health system to ensure that sexual and reproductive health policies, strategic plans and all aspects of implementation are rights-based, cover the life cycle and serve all. This requires that the public health system be open to inputs from civil society in the content and delivery of services and information. The public health system should make partnerships with civil society in the spirit of collaboration with equals.

- Continue and promote health system structural reform involving infrastructure, human resource development, financing, to achieve both coverage and quality. Changes in systems will have to be incremental and phased according to resource availability. They should also be determined by a participatory consultative process and designed on the basis of the longer term strategic plan.

- Increased investments should be made in management of service provision including:

Structural integration of reproductive health services or functional integration, including effective referral systems and training in supervision.
Maximized use of existing resources to provide high quality services, increase resources to upgrade standards of care and perform continuing evaluation. Governments should establish regulations and quality assurance mechanisms that ensure standards for high quality health services for the public and private sectors.
Training service providers to improve their technical skills, interpersonal communications and supportive supervision. Training should also prepare providers to communicate clearly with empathy and with respect for human rights, gender equality (including violence against women) and dignity and to provide dignified care.

- Provide more resources for groups to network: build alliances, involve the media, undertake advocacy, promote public education to create a favorable environment for the ICPD Programme of Action policy development and implementation; develop the capacity of groups to participate in policy development and implementation; and ensure that groups can help in monitoring policy implementation.

- Empower people to uphold their sexual and reproductive rights and health. Information provided should be relevant and easily understandable. Content must include common human experience such as sexuality and power relations between men and women, including violence.

- Create an enabling environment through participatory processes at all levels of society for women’s empowerment and male involvement in promoting sexual and reproductive rights in a human rights framework. This requires the adoption of a gender perspective that accounts for the different realities and constraints which women and men face in their lives. Programmes for women are an initial and essential means through which gender inequalities and inequities can be addressed.

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