UNFPAState of World Population 2004
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Action Priorities

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Resources for Implementing the Programme of Action
Priorities for Action

Resources for Implementing the Programme of Action

The ICPD Programme of Action was the first international consensus document to include estimates of the cost of implementing specified interventions.(3) It defined a basic programme of priority actions to be undertaken in the primary health system, including:

  • Family planning and infrastructure for service delivery;

  • Additional reproductive health services (including prenatal care, normal and safe delivery; information, education and communication about reproductive health—including STIs, human sexuality and responsible parenthood, and against harmful practices such as female genital cutting— prevention of infertility; counselling, diagnosis and treatment of sexually transmitted infections; and referrals, education and counselling for complications of pregnancy and delivery);

  • Prevention of STIs including HIV/AIDS;

  • Data, research and policy development for population and reproductive health.

The annual cost of this intervention package was estimated at $17.1 billion in 2000, increasing to $18.5 billion in 2005, $20.5 billion in 2010 and $21.7 billion in 2015. The consensus reached was that developing countries would mobilize two thirds of the requirements out of domestic resources and that donor countries would provide international assistance on the order of one third of the total.

The Programme of Action noted that these estimates would be reviewed over time,(4) and that additional resources would be needed at different levels of health systems and for supportive interventions in areas such as education, mortality reduction, women’s empowerment and social participation.

NEW PROJECTIONS. After the ICPD, other cost estimates were generated for the broader development agenda. The 20/20 Initiative for meeting basic social service needs, endorsed by the World Summit for Social Development in 1995, called on developing countries to devote 20 per cent of their national budgets for health, education and other social aspects of development, and on donor countries to allocate 20 per cent of their development assistance to these areas. The Commission on Macro-economics and Health estimated total requirements for a priority set of health interventions in low-income countries at $66 billion per year.(5)

Within reproductive health, an estimate of $7-10 billion needed annually for a comprehensive package of HIV/AIDS prevention, treatment and care was presented to the UN General Assembly Special Session on HIV/AIDS in 2001. Subsequent analyses increased that projection.(6) It was estimated that $9.2 billion per year would be needed by 2005 to implement key interventions and develop infrastructure. The prevention components of these estimates were only marginally higher than the ICPD estimate.(7)

New estimates of requirements for the total HIV/AIDS package are now being developed to reflect both the continuing spread of the pandemic and the need for additional funds to strengthen health infrastructure in order to deliver needed services.

This example demonstrates the dynamic nature of resource projections, as intervention priorities are adjusted to local conditions and implementation costs and system requirements are better understood. Costs of the transition to new planning, management and service delivery systems are always hard to anticipate.

Linking HIV/AIDS prevention with reproductive health programmes is a priority policy concern.(8) New vertical programmes addressing HIV/AIDS have startup costs for dedicated management systems and other institutional requirements.(9) While it is easier to track resource flows for special vertical programmes (rather than having to tease out targeted costs from general health system budgets), integrated programming can address multiple needs and capitalize on synergies between different components, while providing the advantage of economies of scale.(10)

Despite the inherent difficulties in tracking resource flows, UNFPA regularly reports on funding for the ICPD basic population and reproductive health package. Donors in 2003 contributed about $3.1 billion, just 54 per cent of the Programme of Action’s donor commitment for 2000 and 51 per cent of the requirement for 2005.

Developing country domestic expenditures for the package in 2003 were estimated at $11.7 billion. However, a large proportion of this outlay comes from a few large countries such as Brazil. China, India, Indonesia and Mexico. Many countries—particularly the poorest, with low per capita expenditures on health—depend mainly on donor funding for their family planning, reproductive health, HIV/AIDS and population-related data, research and policy needs.(11)

The constraints on progress are not only financial. Exchange of information and technology and other forms of technical assistance will be needed so that resources can be most effectively deployed.

HUMAN RESOURCE NEEDS. Progress cannot be accelerated and quality cannot be improved unless programmes can recruit, train and retain staff. Different positions require different skills—technical medical training, counselling abilities, community outreach capacity, supervisory and managerial talents, etc.—and these are frequently in short supply. Civil service salaries are often insufficient to attract the most capable men and women.

Expanding the range of coverage of programmes also requires the ability to ensure that people are available where needs are greatest—often in settings that are remote or lacking amenities. Each of these human resource challenges must be addressed systematically, usually within the context of overall system reform.

COMMODITY NEEDS. Additional progress cannot be made without provision of the essential commodities needed to implement programmes. UNFPA, in collaboration with other major donors, has worked to ensure a reliable supply of quality reproductive health drugs, equipment and supplies.

It is estimated that donors today supply much less than their historical share of contraceptive commodity costs: in the early 1990s, donors provided 41 per cent of commodity requirements, about twice what they provide today. Due to this funding shortfall, systems have had to be developed to handle emergency requests from countries to prevent stockouts and shortages.


Nicaragua’s 2003 National Development Plan is a good example of how countries can integrate population dynamics in the national policy and planning process.

Drafted with technical assistance from UNFPA, the plan notes that population growth and internal and external migration all have important implications for poverty reduction. It calls for improved demographic data collection systems, employment creation, and a special focus on young people’s needs for reproductive and sexual health education and services.

The plan has influenced other development processes the Government has participated in or initiated, including the drafting of a Poverty Reduction Strategy Paper, the formulation of the UN Development Assistance Framework, identification of actions needed to meet the MDGs, and national plans on population, youth and development. It has also led to fruitful dialogue among national policy makers in various sectors of development work, and to local collaboration among different sectors, notably in providing adolescent services. See Sources

MILLENNIUM DEVELOPMENT GOALS. The UN Millennium Project(12) is giving priority to needs-based assessments of resource and capacity requirements to attain the MDGs over the next 11 years. The expert assessments recognize that the availability of reproductive health services (including family planning, safe motherhood and prevention of sexually transmitted infections) is central to achieving the MDGs.(13)

Achieving the MDGs will therefore require multisectoral investments, including investments in population and reproductive health.

Resources (both from donors and within national allocations) for implementing the ICPD and achieving the MDGs must be significantly increased, but the resources must be used effectively. In the changing institutional landscape of decentralization and devolution of decision-making authority in the social sectors, this will require development of skills and capacity at national and lower administrative levels. Many countries, particularly the poorest, lack sufficient financial and human resources; serious plans are needed to overcome these constraints.

Donors reaffirmed their aspiration to provide international assistance at a level of 0.7 per cent of their gross national product at the Funding for Development conference in Monterrey, Mexico, in 2002. Only five donor countries have reached that level of support.(14)

To attain the MDGs and the critically important goals of the ICPD, and make serious progress in reducing the many dimensions of human poverty, past commitments to development assistance must move from declarations of good intentions to active partnerships and investments.

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