Funds for Family Planning and Funds for Family Planning and Reproductive HealthReproductive Health

Presentation to thePresentation to theThird International Parliamentarian’s Conference Third International Parliamentarian’s Conference on the Implementation of the ICPD Programme of on the Implementation of the ICPD Programme of

ActionAction

J. Joseph Speidel, MD, MPHJ. Joseph Speidel, MD, MPHUCSF Bixby Center for Reproductive Health Research UCSF Bixby Center for Reproductive Health Research

& Policy& Policy

November 22, 2006November 22, 2006

OutlineOutline

This presentation will include a description This presentation will include a description of:of: Population and reproductive health issuesPopulation and reproductive health issues Funding needs for population work in Funding needs for population work in

developing countriesdeveloping countries Levels and sources of fundsLevels and sources of funds Donor prioritiesDonor priorities Major donorsMajor donors Recommendations for actionRecommendations for action

Population Growth: The Population Growth: The NumbersNumbers

YearYear WorldWorld U.S.U.S.

19501950 2.5 billion2.5 billion 158 158 millionmillion

20062006 6.5 billion6.5 billion 300 300 millionmillion

20502050(projected)(projected)

9.1 billion9.1 billion 420 420 millionmillion

The combined population of Europe and North America is 1 billion.

Growth Growth ratesrates have declined, have declined, but growth of numbers remains but growth of numbers remains

highhigh

YearYearAverage Births Average Births per Woman in per Woman in

WorldWorld

Annual Annual Population Population

GrowthGrowth(millions)(millions)

19501950 5.35.3 4848

20062006 2.72.7 7676

Over 95% of growth is in developing countries.

Lack of access to and use of family Lack of access to and use of family planning is an important cause of planning is an important cause of

population growthpopulation growth

(Annual numbers in millions)(Annual numbers in millions) WorldWorld

PregnanciesPregnancies 210210

Unintended Unintended PregnanciesPregnancies

8080

AbortionsAbortions 4646

Unplanned BirthsUnplanned Births 3434

Population GrowthPopulation Growth 7676

What is reproductive What is reproductive health?health?

The ICPD Definition is a broad The ICPD Definition is a broad concept:concept:

“…a state of complete physical, mental “…a state of complete physical, mental and social well-being and not merely the and social well-being and not merely the absence of disease or infirmity, in all absence of disease or infirmity, in all matters relating to the reproductive matters relating to the reproductive system and to its functions and system and to its functions and processes.”processes.”

Reproductive health services Reproductive health services address:address:

Routine and emergency childbirth servicesRoutine and emergency childbirth services HIV/AIDS/STI prevention and careHIV/AIDS/STI prevention and care Breast, cervical, and uterine cancerBreast, cervical, and uterine cancer Safe abortion?Safe abortion? Comprehensive sexuality education?Comprehensive sexuality education? Infertility?Infertility? Harmful traditional practices?Harmful traditional practices? Breast feeding and infant health care?Breast feeding and infant health care? Post-menopausal care? Post-menopausal care? Male reproductive cancers and diseases? Male reproductive cancers and diseases?

Annual Deaths Related to Annual Deaths Related to ReproductionReproduction

CauseCause NumbersNumbers

AIDSAIDS 2.8 million2.8 million

Unsafe Unsafe ChildbirthChildbirth

515,000515,000

Breast CancerBreast Cancer 375,000375,000

Cervical CancerCervical Cancer 300,000300,000

Unsafe AbortionUnsafe Abortion 78,00078,000

ICPD Estimate of Funds ICPD Estimate of Funds Needed for Population Needed for Population

ActivitiesActivitiesOriginal 1994 ICPD estimate of funding needs Original 1994 ICPD estimate of funding needs

for 2005:for 2005: Family planning: Family planning: $11.5 billion$11.5 billion Reproductive health: Reproductive health: $5.4 billion$5.4 billion HIV/AIDS: HIV/AIDS: $1.4 billion$1.4 billion Basic research and data collection: Basic research and data collection: $0.2 $0.2

billionbillion

Total in 2005: $18.5 billion Total in 2005: $18.5 billion (in 1993 dollars)(in 1993 dollars)

Source of FundsSource of Funds

1/31/3 of funds of funds ($6.1 billion)($6.1 billion) from donors from donors 2/32/3 ($12.4 billion)($12.4 billion) from domestic from domestic

sources in developing countriessources in developing countries

No estimates were made for the cost of other No estimates were made for the cost of other health and development activities included health and development activities included in the ICPD’s Programme of Actionin the ICPD’s Programme of Action

Recent “Costing” ExercisesRecent “Costing” Exercises

Guttmacher/UNFPAGuttmacher/UNFPA UNAIDSUNAIDS UN Millennium ProjectUN Millennium Project Donor Landscape AnalysisDonor Landscape Analysis

Guttmacher/UNFPA: Guttmacher/UNFPA: Adding It Adding It UpUp

$7.1 billion for family planning services in $7.1 billion for family planning services in 20032003

$3.9 billion to meet unmet demand$3.9 billion to meet unmet demand

Estimate includes:Estimate includes: Drugs and suppliesDrugs and supplies Labor and hospitalizationLabor and hospitalization Overhead and capital costsOverhead and capital costs

Overhead/capital costs = 60-70% of totalOverhead/capital costs = 60-70% of total

UNAIDS: Resource Needs 2006-UNAIDS: Resource Needs 2006-20082008

(USD billions)(USD billions)20062006 20072007 20082008 Total forTotal for

2006-2006-20082008

PreventionPrevention 8.48.4 10.010.0 11.411.4 29.829.8

Treatment and careTreatment and care 3.03.0 4.04.0 5.35.3 12.312.3

Orphans/vulnerable Orphans/vulnerable childrenchildren

1.61.6 2.12.1 2.72.7 6.46.4

Program costsProgram costs 1.51.5 1.41.4 1.81.8 4.64.6

Human resourcesHuman resources 0.40.4 0.60.6 0.90.9 1.91.9

TotalTotal 14.914.9 18.118.1 22.122.1 55.155.1

UN Millennium Project: UN Millennium Project: Public Choice, Private Public Choice, Private

DecisionsDecisions

Component Component (USD billions)(USD billions)

20052005 20102010 20152015

Basic RH/FP servicesBasic RH/FP services 13.913.9 19.419.4 24.424.4

STD/HIV/AIDS STD/HIV/AIDS servicesservices

4.14.1 9.79.7 11.111.1

Research/policyResearch/policy 0.30.3 0.80.8 0.40.4

TotalTotal 18.218.2 29.829.8 35.835.8

New Annual Funding Targets for New Annual Funding Targets for 20052005 (adjusted for inflation and program (adjusted for inflation and program

needs)needs)

Family planning: Family planning: $15.6 billion$15.6 billion (up from $11.5)(up from $11.5) Reproductive health: Reproductive health: $15 billion$15 billion (up from $5.4)(up from $5.4) HIV/AIDS: HIV/AIDS: $14.9 billion $14.9 billion (UNAIDS estimate for 2006 (UNAIDS estimate for 2006

with 2/3 to be provided by donors; up from $1.4 billion)with 2/3 to be provided by donors; up from $1.4 billion) Basic Research: Basic Research: $300 million$300 million (up from $200 (up from $200

million)million)

Bottom line:Bottom line: An estimated An estimated $45.8 billion$45.8 billion annually is needed for population activities; annually is needed for population activities; the original 1994 estimate was the original 1994 estimate was $18.5 billion$18.5 billion (in 1993 dollars)(in 1993 dollars)..

2005 ICPD Funding Targets 2005 ICPD Funding Targets (in billions)(in billions)

2005 2005 Projected Projected

ExpenditurExpenditureses

Original Original Target Target

(1993$)(1993$)

% of % of TargetTarget

New New Target Target

BroadenedBroadened**

(2005$)(2005$)

% of % of TargetTarget

Donor Donor ShareShare

$6.1$6.1 $6.1$6.1 100%100% $20.2$20.2 30%30%

DevelopinDeveloping Country g Country

ShareShare

$14.9$14.9 $12.4$12.4 120%120% $25.6$25.6 58%58%

TotalTotal $21.0$21.0 $18.5$18.5 114%114% $45.8$45.8 46%46%** The new target is broadened to include updated estimates for HIV/AIDS and reproductive The new target is broadened to include updated estimates for HIV/AIDS and reproductive health serviceshealth services

Note: Donor share of the total is 1/3, except for the broadened target for HIV/AIDS, which is Note: Donor share of the total is 1/3, except for the broadened target for HIV/AIDS, which is 2/3. 2/3. Adapted from: Speidel JJ. Population Donor Landscape Analysis for Review of Packard

Foundation International Grantmaking in Population, Sexual and Reproductive Health and Rights. Unpublished report 9/6/05: http://www.packard.org/assets/files/population/program%20review/pop_rev_speidel_030606.pdf

Resource Flows for Population Resource Flows for Population ActivitiesActivities

Domestic expenditures in developing Domestic expenditures in developing countries:countries: Largest source of funds for population and Largest source of funds for population and

AIDSAIDS 2005 projection: 2005 projection: $14.9 billion$14.9 billion More than half are out-of-pocket expenditures More than half are out-of-pocket expenditures

by consumersby consumers 78%78% of all domestic funds from both of all domestic funds from both

governments and consumers are expended in governments and consumers are expended in Asia, Asia, 6%6% in Sub-Saharan Africa in Sub-Saharan Africa

Population Assistance from Population Assistance from DonorsDonors

$3.2 billion $3.2 billion in 2002in 2002 $4.7 billion$4.7 billion in 2003 in 2003 $5.6 billion$5.6 billion in 2004 (preliminary) in 2004 (preliminary)

$4.5 billion$4.5 billion from Development Assistance Committee from Development Assistance Committee (DAC) country governments(DAC) country governments

$588 million$588 million from development banks from development banks $434 million$434 million from NGOs and foundations from NGOs and foundations

$6.1 billion$6.1 billion in 2005 (projection) in 2005 (projection)

Increases are almost entirely for HIV/AIDS activities.Increases are almost entirely for HIV/AIDS activities.

Changing Donor PrioritiesChanging Donor Priorities

Funding explicitly for family planning Funding explicitly for family planning decreased from a high of decreased from a high of 55%55% in 1995 to in 1995 to 9% 9% in 2004.in 2004. However, some family planning is now funded However, some family planning is now funded

from the reproductive health category.from the reproductive health category.

Funding for family planning decreased Funding for family planning decreased from from $723 million$723 million in 1995 to in 1995 to $442 million $442 million in 2004.in 2004.

Funds for HIV/AIDS activities increased Funds for HIV/AIDS activities increased 13-13-fold fold to to $2.65 billion$2.65 billion by 2004. by 2004.

Final Donor Expenditures for Final Donor Expenditures for Population Assistance by CategoryPopulation Assistance by Category

Source: http://www.resourceflows.org/index.php/articles/text_item/225

2005 ICPD Funding Targets for 2005 ICPD Funding Targets for DonorsDonors (in billions)(in billions)

2004 Donor 2004 Donor ExpenditureExpenditures Estimateds Estimated

Original Original DonorTargeDonorTarget (1993$)t (1993$)

% of % of TargetTarget

Donor Target Donor Target Adjusted for Adjusted for

Inflation, Inflation, HIV/AIDS & HIV/AIDS &

Repro-healthRepro-health* * (2005$)(2005$)

% of % of TargetTarget

Family Family PlanningPlanning

$0.442$0.442 $3.8$3.8 12%12% $5.2$5.2 9%9%

Repro-Repro-healthhealth

$1.227$1.227 $1.8$1.8 68%68% $5.0$5.0 25%25%

STI/HIV/STI/HIV/

AIDSAIDS$2.649$2.649 $0.5$0.5 530530

%%$9.9$9.9 27%27%

Basic Basic ResearcResearc

hh

$0.589$0.589 $0.1$0.1 589589%%

$0.1$0.1 589589%%

TOTALTOTAL $4.907$4.907 $6.2$6.2 79%79% $20.2$20.2 24%24%** The new target is broadened to include updated estimates for HIV/AIDS and reproductive The new target is broadened to include updated estimates for HIV/AIDS and reproductive health serviceshealth services

Adapted from: http://www.packard.org/assets/files/population/program%20review/pop_rev_speidel_030606.pdfhttp://www.resourceflows.org/index.php/articles/275

Bottom LineBottom Line

In spite of recent, large increases in funding for STD/HIV/AIDS, funds needed to address AIDS are inadequate.

Funds for reproductive health, and especially for family planning, are not keeping up with the needs of an increasing number of couples of reproductive ages in developing countries—a projected increase from 1.6 to 2.1 billion between 2005 and 2050.

Additional Detail about the Additional Detail about the Donor CommunityDonor Community

GovernmentsGovernments DAC members provide more than DAC members provide more than 80%80% of all of all

population assistance, population assistance, $4.5 billion$4.5 billion in 2004. in 2004.

Denmark, Norway, the Netherlands, Luxemburg, Denmark, Norway, the Netherlands, Luxemburg, Sweden, Finland, and the U.K. are relatively Sweden, Finland, and the U.K. are relatively generous donors.generous donors.

Japan, Germany, Italy, France, and many other Japan, Germany, Italy, France, and many other donor countries are very far from providing their donor countries are very far from providing their “fair share.”“fair share.”

The U.K. and U.S. are generous donors for HIV/AIDS.The U.K. and U.S. are generous donors for HIV/AIDS.

Governments: The U.S.Governments: The U.S.

The U.S., at The U.S., at $1.8 billion$1.8 billion, remained the , remained the largest donor in 2003, representing largest donor in 2003, representing 48%48% of the resources of donor of the resources of donor countries.countries.

Problems with commitment Problems with commitment and effectivenessand effectiveness

The U.S.:The U.S.: Promotes abstinencePromotes abstinence Bans use of funds for abortion-related Bans use of funds for abortion-related

activitiesactivities Withholds funds from the UNFPA and IPPFWithholds funds from the UNFPA and IPPF Only Only 20%20% of HIV/AIDS funds can be used of HIV/AIDS funds can be used

for preventionfor prevention 1/31/3 of prevention funds must promote of prevention funds must promote

abstinenceabstinence

Problems with commitment Problems with commitment and effectivenessand effectiveness

Other DAC donors:Other DAC donors: Insufficient numbers of population experts to Insufficient numbers of population experts to

design, manage, and program population design, manage, and program population assistanceassistance

Weak NGO sector to implement programsWeak NGO sector to implement programs

Trend to sector wide—rather than program or Trend to sector wide—rather than program or project funding—makes it difficult to target project funding—makes it difficult to target funds on population issues, evaluate results, funds on population issues, evaluate results, and make mid-course correctionsand make mid-course corrections

Development BanksDevelopment Banks

Population growth seldom addressed as a Population growth seldom addressed as a development issuedevelopment issue Not on research agendaNot on research agenda Rarely included in country-based Poverty Rarely included in country-based Poverty

Reduction Strategy Papers (PRSPs)Reduction Strategy Papers (PRSPs) Lack of population experts on Bank staffs Lack of population experts on Bank staffs

hampers programhampers program Bank commitment to Health Sector Reform and Bank commitment to Health Sector Reform and

Sector Wide Approaches (SWAps) makes it Sector Wide Approaches (SWAps) makes it difficult to program and track funding levels for difficult to program and track funding levels for population and reproductive healthpopulation and reproductive health

UNFPAUNFPA

In 2005, UNFPA’s budget of In 2005, UNFPA’s budget of $565 million$565 million supported work in supported work in 148 countries148 countries.. Most countries received from Most countries received from $0.5-$3 $0.5-$3

millionmillion Only 13 countries received more than Only 13 countries received more than $5 $5

millionmillion Only India, Indonesia, and Peru received Only India, Indonesia, and Peru received

more than more than $10 million$10 million

Bottom LineBottom Line

As the only organization providing As the only organization providing technical assistance and funds to many technical assistance and funds to many countries, and the only organization countries, and the only organization acceptable in some countries for these acceptable in some countries for these purposes, UNFPA has a unique and purposes, UNFPA has a unique and important role.important role.

FoundationsFoundations

Foundations, predominantly those Foundations, predominantly those based in the U.S., gave about based in the U.S., gave about $434 $434 millionmillion in 2005 for population in 2005 for population activities. activities.

83%83% of funds were provided for of funds were provided for international or global purposes.international or global purposes.

Bottom LineBottom Line

U.S. foundations are an important U.S. foundations are an important source of funds for a broad array of source of funds for a broad array of population work.population work.

With close to With close to 80% 80% of funds coming from of funds coming from only only 66 foundations, this source of foundations, this source of funding is vulnerable to a change in funding is vulnerable to a change in priorities on the part of just a few priorities on the part of just a few foundations.foundations.

Why Population Work Lost Why Population Work Lost SalienceSalience

Success Success of family planning and declining birth of family planning and declining birth ratesrates

U.N. projections of population growth ending about 2050U.N. projections of population growth ending about 2050

Low fertilityLow fertility in most developed (and a few developing) in most developed (and a few developing) countriescountries

The ICPD The ICPD criticized past population work and advanced a criticized past population work and advanced a less focusedless focused “new paradigm”“new paradigm” of reproductive health of reproductive health

The influence of vocal The influence of vocal anti-abortion activists, conservative anti-abortion activists, conservative religious leaders, religious leaders, and and conservative think tanksconservative think tanks

The The AIDS crisisAIDS crisis suggest that population growth is less suggest that population growth is less importantimportant

The influx of funds for HIV/AIDS work has co-opted the The influx of funds for HIV/AIDS work has co-opted the personnel and attention of many NGOs and health ministriespersonnel and attention of many NGOs and health ministries

““Donor fatigue”Donor fatigue”

An Action Agenda: An Action Agenda: Recommendations for Recommendations for

ParliamentariansParliamentarians Work to ensure that population and related Work to ensure that population and related

reproductive health (RH) issues are considered reproductive health (RH) issues are considered important and integral to important and integral to donor and national donor and national development strategiesdevelopment strategies..

Increase Increase commitment and resourcescommitment and resources to family to family planning and other areas of population/RH work.planning and other areas of population/RH work.

Support Support sustainedsustained research and advocacy research and advocacy to to ensure that the resource needs for population/RH ensure that the resource needs for population/RH work are realistic, recognized, and acted upon.work are realistic, recognized, and acted upon.

Every country should have an Every country should have an organizationorganization carrying out research and advocacy.carrying out research and advocacy.

An Action Agenda: An Action Agenda: Recommendations for Recommendations for

ParliamentariansParliamentarians Advocacy to strengthen population/RH work at Advocacy to strengthen population/RH work at

the the World Bank, regional development banks, and World Bank, regional development banks, and the UNFPA.the UNFPA.

Support research and pilot studies to develop Support research and pilot studies to develop practical ways of practical ways of integrating family planningintegrating family planning and and reproductive health into STD/HIV/AIDS programs.reproductive health into STD/HIV/AIDS programs.

Seek out and address Seek out and address critical factors that limit critical factors that limit population/RH programspopulation/RH programs, such as:, such as: Contraceptive suppliesContraceptive supplies

The lack of a compelling body of research that would The lack of a compelling body of research that would convince economists and development planners to convince economists and development planners to address population issuesaddress population issues

Training of population experts.Training of population experts.