AUSTRALIA

POPULATION AND REPRODUCTIVE HEALTH ASSISTANCE
OVERALL ASSESSMENT

Australian population assistance in 1996 was five times the 1990 level, among the largest percentage increases in donor contributions over this period. However, Australia lags far behind smaller donor nations such as Denmark and Norway in its contributions to population programs, both in absolute terms and relative to GNP. Some of the reported increase in Australian population funding reflects the broader definition of population aid introduced by UNFPA in 1995. Nevertheless, about a third of funding for bilateral and NGO population programs is focused on family planning services. Australia’s strength as a reproductive health donor is largely a reflection of the concentration of these increased resources in Asia and the Pacific, where it has a long-standing presence as a donor and in-depth knowledge of local conditions.

Recent political changes could reverse some of the advances Australia has made as a reproductive health donor. The political environment for population assistance is less favorable than in the past, reflecting both a change in government and active political opposition to family planning assistance programs. Funding for reproductive health is further jeopardized by recent declines in development aid. However, government sources report some recovery in aid allocations planned for the upcoming budget year–and predict that reproductive health funding levels will be maintained.

1 Development Assistance: Policy and Funding

Australia has recently reviewed its long-standing approach to development cooperation in order to improve aid effectiveness. Australia has traditionally been a large bilateral donor to Asian and Pacific countries. The Australian Agency for International Development (AusAID) has focused its efforts on programs to spur economic growth and alleviate poverty in recipient countries. In 1997, the government released the first comprehensive review of Australia’s foreign aid policy in over a decade. The report, commissioned by the Minister of Foreign Affairs, is officially titled One Clear Objective: Poverty Reduction through Sustainable Development, but unofficially referred to as the Simons Report.

The Simons report recommends various reforms to the aid program including a clearer focus on a single objective–long-term poverty reduction. Additional recommendations include: increased aid concentration through "graduation" of more countries from the aid program and reallocation of resources based on need; increased sectoral concentration; untying the aid program from commercial interests; and a greater focus on evaluation and aid effectiveness. If the government implements these recommendations, Australia’s aid program will likely become more focused, both sectorally and geographically.

Despite overall budget cuts, current Australian policy identifies reproductive health as a priority and indicates that funding for the health sector will be protected. As a result sof across the board deficit cutting measures, the government reduced the 1996-97 foreign aid budget by 10 percent from the previous year. These budget reductions were largely realized by discontinuing a relatively ineffective mixed credit scheme designed to benefit Australian business and develop the private sector in recipient countries. However, other areas of the Australian aid program still experienced a budget reduction of about 2 percent.

This decrease brought Australia’s ratio of development assistance to GNP down to a record low of 0.28 percent in 1996 and 1997–well below the 0.4 percent donor average and the 0.7 percent UN target for development aid. However, as funds committed in previous budget years are still being disbursed, actual expenditures on some development programs–as distinct from budget allocations–have declined only slightly and do not yet fully reflect these reductions. Australian government sources predict a reversal of the negative trend in development aid in the upcoming budget year, and project an increase in the aid budget of 0.5 percent in inflation adjusted terms in 1998-99. Still, the anticipated aid to GNP ratio of 0.27 percent will remain significantly below the 1995 level of 0.35 percent.

2 The Policy Environment for International Population Assistance

The current political environment for population assistance in Australia is less favorable than in the past. The policy environment has deteriorated from the early 1990s when the former Labour government initiated a four-year $105 million "Population Initiative" between 1993 and 1996, although key foreign policy officials remain supportive. While the current coalition government has not acted to cut funding for reproductive health programs, there is active opposition to international family planning assistance from a few conservative members of parliament.

However, two recent aid reviews identify population and family planning assistance as among the most cost-effective aid investments available to AusAID. The recent Simons Report recommends that Australia take on an expanded role as a population donor: "population activities, including voluntary family planning, should be at least maintained and possibly increased in real terms in the interests of advancing health, human rights and development objectives…" The Independent Inquiry into Population and Development also endorses this view.

Despite these recommendations, the Australian government has not sustained the pace of recent increases in family planning funding. Australian reproductive health advocates believe that increased allocations to broader health programs have masked declines in actual funding for family planning. The government has officially accepted the recommendations of the Simons report, but with the caveat that funding levels for population activities will be determined by availability of resources in the overall aid budget and "the priorities of partner governments."

AusAID activities in the population sector are governed by a statement of guiding principles and the use of a "population checklist" for monitoring and reporting purposes. The guiding principles emphasize freedom of choice, broad access to reproductive health services, and a commitment to improving quality of care. The population checklist is a tool developed by AusAID–in response to a Ministerial initiative–to screen proposed activities, and for monitoring and reporting purposes.

The checklist focuses on the social appropriateness of the reproductive health intervention, and requires certification as to the voluntary nature of family planning, and the exclusion of abortion-related training and services. Although AusAID supports contraceptive supplies in only a few of its family planning projects, the checklist restricts the use of Australian funds to purchasing pills, condoms, Depo-Provera and two types of IUDs.

The Australian Reproductive Health Alliance (ARHA), established in 1995, is the main NGO involved in advocacy for international reproductive health. ARHA’s mandate is to ensure Australian support for the goals of the International Conference on Population and Development. ARHA provides support to the All-Party Parliamentary Group for Population and Development and engages in public education activities aimed at increasing Australian population assistance through both bilateral and multilateral channels.

3 Trends in Funding for Population Assistance

Overall Funding Levels:

Australian funding for population programs has increased dramatically, but it is unclear if current funding levels will be maintained in the future. Australian assistance to population programs rose from about $5 million a year in the early 1990s to about $18 million in 1994–largely as a result of the "Population Initiative." Population assistance levels continued to increase in subsequent years, reaching $32 million in 1996. At this level, Australia provides about $86 per million dollars of GNP in population assistance–roughly comparable to the level provided by the United States, but far below the contribution of the Nordic countries and the Netherlands.

Australian government sources estimate funding for direct population and family planning activities in 1997-98 at about $16 million. According to the government’s own broad definition of population activities, which includes maternal and child health and health worker training programs, the total would approach $29 million. The budget for 1998-99 maintains this level of expenditure on population activities, broadly defined, and allocates an additional $14.6 million to HIV/AIDS programs.

Multilateral Funding:

Australia is a minor donor to most multilateral organizations in the population field. During the 1990s, Australia allocated an average of 50 percent of total population assistance to multilateral organizations. This assistance is spread broadly among various UN and other international health agencies; Australia does not rank as a major donor to either UNFPA or the World Health Organization (WHO).

Australian contributions to UNFPA’s core budget peaked in 1996 at only $2.2 million. The Australian contribution declined to $1.6 million in 1997–ranking Australia 13th among the Fund’s donors. Over the last few years, Australia has also contributed additional funds to UNFPA for specific multi-bilateral programs–over $2 million in 1995 and 1996 but only $226,000 in 1997. Australia also contributes to UNAIDS, the WHO human reproduction research program, and other WHO activities relating to maternal health, safe motherhood and HIV/AIDS.

Bilateral Funding:

Bilateral population funding rose rapidly during the 1990s. Between 1986 and 1993, Australian bilateral funding for population programs fluctuated at a low level–between $1 million and $3 million annually. Following the inception of the Population Initiative and the introduction of an expanded definition of population assistance, reported levels of bilateral assistance increased sharply to $17.5 million in 1995 and then dropped to about $8.5 million in 1996.

Funding for NGOs:

Australia funds several major international NGOs, again at relatively low levels. Since 1995, it has contributed approximately $1.2 million a year to IPPF, although its 1997 contribution fell slightly, to about $1 million. Australia also made small contributions to the International Union for the Scientific Study of Population and the Population Council in 1995 and 1996, but has since discontinued this assistance.

4 Program Priorities

Geographic Priorities:

Australia’s aid program focuses almost exclusively on Asia and the South Pacific. This geographic emphasis is also reflected in its population and health assistance. Australia has identified HIV/AIDS prevention in South and Southeast Asia as a priority area for assistance given rising HIV infection rates, and also seeks to reduce infant and maternal mortality in the region.

Country-specific initiatives include a $17.7 million AIDS/STD prevention program in Indonesia, funded since 1995, which aims to develop HIV/AIDS policy at the local and national level, train staff in STD management, and support STD education and communication activities implemented by NGOs. Other reproductive health initiatives in the region include projects in the area of maternal and child health care in Laos and the Philippines; training in women’s health research in Vietnam; family planning and child health activities in China; and the expansion of family planning services in the South Pacific. Australia also provides support to the national family planning association in Thailand.

Areas of Program Emphasis:

Australian population assistance has a strong emphasis on reproductive health service delivery. Australian assistance has sought to reduce infant and maternal mortality by expanding and improving family planning services, training health workers and supporting information, education and communication programs. In the South Pacific region, where population growth rates remain especially high, Australia’s bilateral program has focused on population policy development and population education, in addition to training of health workers.

Since the Population Initiative concluded in June 1997, AusAID has been reformulating its health and population strategy. The new policy is expected to focus on primary health care, disease prevention including HIV/AIDS prevention and care, and capacity building for local health institutions. Program strategies will emphasize simple, low-cost health interventions, local participation and targeting of those in greatest need. Australian aid officials anticipate the policy will be launched in 1998.

5 Technical Capacity

Staffing:

AusAID’s population and reproductive health programs are managed by the Health Group, which is staffed by five policy officers and three public health advisors. These eight staff members provide policy advice and technical assistance on a range of health issues including reproductive health and population.

Technical Expertise of Collaborating Institutions:

The Australian IPPF affiliate is the major NGO involved in the population assistance program. Eight independent state-level family planning associations have also formed Family Planning Australia, Inc., an umbrella NGO which provides expertise to the overseas aid program.