Funding Mechanisms for SRHR

1. Funding Mechanisms for SRHR Challenges and Opportunities in the Current Environment Suzanne Ehlers and Mercedes Mas de Xaxás Population Action International Presentation to EuroNGOs Annual Conference 8 June 2006

2. Global Political Context • Polarization around SRHR - Most European governments (especially Denmark, Netherlands, Norway, Sweden, UK) have increased policy strength and funding - U.S. government under Bush administration remains formidable opponent on both policy (Mexico City Policy, abstinence requirements, anti-prostitution pledge) and funding (proposed 18% cut in international FP/RH funding for FY2007) • SRHR on periphery of development agenda - Missing 9th MDG on SRHR, although some related targets in other goals - Improved access to contraceptive supplies one of Millennium Project’s “Quick Wins”

3. Current Aid Framework: Diverse Mechanisms • Poverty Reduction Strategies (PRS) - Initiated by the World Bank in 1999 - Outline national analysis of poverty and strategies to combat it; written by country governments and approved by WB/IMF - WB review showed most PRSPs include policies on RH, but very few include concrete action plans and/or budget; 15% mention RH supplies • Sector-Wide Approaches (SWAp) - Donor funding supports single sector policy and expenditure program under government leadership - 20 countries have SWAp in some form - SWAps can improve health service delivery and capacity building, but have not alleviated larger problem of resource shortfalls • General Budget Support - Broad funding mechanism; generally offered when country systems function well - Limited expenditure tracking mean data on funding for RH are poor

4. Current Aid Framework continued • Country Strategy Papers (CSP) - Summaries of development priorities for countries that receive EC funding - UNFPA review of 70+ CSPs from ACP countries showed attention to maternal and infant health and HIV, but not to family planning • Global Fund to Fight AIDS, TB and Malaria (GFATM) - HIV/AIDS programs have received 56% of Fund’s disbursements (through first 4 rounds) - GFATM distributed 195 million condoms through Dec 2005 - Advocates suggest increased support for RH is possible within GFATM • President’s Emergency Plan for AIDS Relief (PEPFAR) - Authorized by President Bush in 2003 to fund up to $15 billion over 5 years - Actual spending totaled $6 billion in first two years - 20 percent of funding designated for HIV prevention, of which one-third must go to abstinence-until-marriage programs - Allocated $6.4 million for condoms in 15 focus countries in FY2005

5. Innovative Financing Efforts • International Airfare Solidarity Contribution (IASC) - Airline ticket tax launched by France in July 06 to support access by developing countries to quality treatment against HIV/AIDS, TB and malaria - 13 countries will impose the tax in addition to existing ODA budgets - Prevention, including SRH and supplies, should be part of global health definition in UK & France joint study on additional funding through the IASC • International Drug Purchasing Facility (IDPF) - Will channel resources of the IASC to lower the cost of drugs for HIV/AIDS, tuberculosis and malaria, and improve their availability in developing countries - Loose structure, supposed to rely on existing international organizations - IDPF resources should be committed to GFATM, at least in part • International Finance Facility (IFF) - Designed to frontload aid to help meet MDGs - Could provide additional $50b annually in ODA by leveraging money through international capital and bond markets - Proposal has received mixed support from donors, developing countries, NGOs and business

6. Financial Scene • Total funding for SRHR continues to increase, from $3.2 billion in 2002 to $4.7 billion in 2003 (most recent year available). • Almost all increases in SRHR spending are going to HIV/AIDS – which recorded a 40% funding increase from 2002 to 2003. • Meanwhile, funding for basic reproductive health and family planning has stagnated in recent years. • In 2003, donors only provided 46% of the funds they committed at the International Conference on Population and Development. • Data are incomplete and realistic cost estimates must come from the countries themselves.

7. European Union • European Union development assistance for population and RH totaled €638 million in 2004. • Total EU spending on RH broken down: - 43% on HIV/AIDS - 27% on reproductive health - 13% on family planning - 11% on safe motherhood - 6% on policy and management • European NGOs offer technical expertise, initiate resolutions and petitions, educate other NGOs and “watchdog” EU commitments.

8. U.S. • The U.S. provided $1.8 billion for population and RH in 2003, nearly double its 2002 spending. Most of this increase is due to PEPFAR. • The U.S. provided $71 million for contraceptive supplies in 2004, 35% of total donor spending and $6 million more than UNFPA. • The U.S. has spent an average of 9% of ODA on RH over the past three years, although its ODA as a share of GNI remains smaller (average 0.13%) than any other donor country. • Earlier this year, President Bush requested a $79 million funding cut for international FP/RH (not including PEPFAR). If enacted, it would have equaled a 49% reduction from the amount the U.S. spent on international FP/RH ten years ago (adjusted for inflation).

9. Multilaterals • In 2003, the World Bank made loan commitments of $500 million for reproductive health. • UNFPA supplied 32% of total donor funding for contraceptive supplies in 2004. UNFPA remains an important player, but the trend of donors giving UNFPA earmarked funding compromises its ability to have a coherent global program. • Foundations and NGOs are also important donors in SRHR, contributing $300 million and $70 million respectively in 2003.

10. Cross-cutting Challenges • Demand for increased resources and better coordination must originate from the country level. • ICPD funding estimates are incomplete and outdated. • Donors require accountability in new funding approaches. • It is important to agree how success will be measured in new project support. • The U.S. is the largest donor by far in monetary terms, but its policy restrictions significantly reduce the impact of its funding.

11. Opportunities • NGOs can activate their partner networks at the country level to advocate directly to their governments and donors. Civil society should be given a greater role in the design of new funding mechanisms. • Increased donor attention to HIV/AIDS, maternal health, and other related issues provides opportunity for integration with existing SRHR programs. • PRSPs, CSPs, SWAps and other new funding mechanisms should include at least one SRHR-related target, such as increased contraceptive prevalence. • SRHR should be incorporated into innovative new financing mechanisms, such as IASC/IDPF revenues targeted at GFATM.