BELGIUM

BELGIUM POPULATION AND REPRODUCTIVE HEALTH ASSISTANCE
OVERALL ASSESSMENT

Although Belgium is likely to remain a minor donor in the population field, recent policy developments have improved the chances that the Belgian aid program will more directly address reproductive health needs. The emphasis on family planning and reproductive health in Belgium’s new health strategy shows a late but nonetheless positive response to the Cairo conference. Historically, most of Belgium’s small contribution for population programs has been channeled multilaterally, but Belgium is expanding its bilateral and NGO assistance in this area. The Belgian aid program has yet to demonstrate, however, that it can back up its new policy with increased funding and effective implementation of reproductive health initiatives.

1 Development Assistance: Policy and Funding

Belgium appears poised to fundamentally restructure its development assistance program and formulate new policy priorities, including greater emphasis on population and reproductive health assistance. Belgian development policy historically has tied development assistance to business interests, resulting recently in a series of corruption-related scandals in the foreign aid system.

In response to these events, the Belgian government has reorganized the Administration for Development Cooperation (AGCD), the main agency in charge of administering development assistance. It has also proposed the establishment of an independent agency to implement technical cooperation activities under the oversight of the AGCD. To coordinate Belgian aid efforts in developing countries, the State Secretary for Development Cooperation within AGCD chairs an interministerial working group including the Ministries of Finance, Foreign Affairs, Foreign Trade, Agriculture, Economic Affairs, Science Policy and Defense.

The AGCD continues to grapple with obstacles to its effectiveness, in particular, constraints to the disbursement of foreign aid funds. Only 78 percent of funds committed in 1996 were disbursed in that year, owing to a lack of adequate staff to develop new programs. The recent reorganization plans to address this problem by delegating more authority to directors and unit heads within AGCD to accelerate the pace of decision making and disbursements.

It is still unclear whether ongoing changes in the administration of development programs will ultimately lead to increased levels of foreign aid. Public support for development assistance remains limited as Belgians in general are more concerned about domestic economic and political problems than about international economic cooperation. Belgium’s overall aid levels peaked in the early 1980s and fell to about $764 million in 1997–about 0.31 percent of GNP. Belgium ranked 15th out of 21 donor countries in volume of aid given in 1997. The proportion of development assistance flowing through the bilateral channel has fluctuated between 60 and 70 percent in recent years.

2 The Policy Environment for International Population Assistance

In late 1997, the Belgian government released a new policy for development cooperation which strongly emphasizes family planning and reproductive health as priorities for Belgian assistance in the health sector. The policy statement endorses the ICPD definition of reproductive health and advocates the integration of reproductive health services into the health system in order to increase women’s access to care. The appointment of a physician as Secretary of State for Development Cooperation was an important influence in the development of this new policy. The State Secretary, Dr. Reginald Moreels, is also the former head of the Belgian chapter of the international NGO, Doctors Without Borders.

The political environment for population assistance in Belgium is complex. While the Cairo and Beijing conferences have been an important influence on development policy, increased discussion of population and women’s health issues has been largely within the governmental sphere rather than among the population at large. A predominantly Catholic country, Belgium is home to a vocal minority of religious and right wing parties in Parliament who are active in opposing family planning both at home and abroad.

The government anticipates vigorous parliamentary debate regarding the new development policy, especially the focus on family planning. Despite this anticipated debate, both the development cooperation law and its strong emphasis on reproductive health and family planning are expected to be approved and implemented as planned.

3 Trends in Funding for Population Assistance

Overall Funding Levels:

Belgium’s contributions to population assistance have gradually increased from about $1 million in 1987 to $5.5 million in 1996. This low level of funding ranked Belgium 16th among the top 20 donors to reproductive health programs in 1996.

Multilateral Funding:

Historically, Belgium has allocated the vast majority of these funds to multilateral channels. Belgium makes voluntary contributions to a number of international organizations involved in population and reproductive health. These include UNICEF, the International Union for the Scientific Study of Population, the UN Women’s Fund (UNIFEM), UNAIDS and UNFPA.

Belgium’s core contribution to UNFPA fell from $2.3 million in 1996 to $1.7 million in 1997, partly reflecting the falling value of the Belgian franc relative to the U.S. dollar. Contributions for multi-bilateral activities–where Belgium contributes to a specific UNFPA program–peaked in 1995 at $1.1 million and then dropped to approximately half a million dollars a year in 1996 and 1997.

Bilateral Funding:

Belgium is a very small bilateral donor to population programs. In 1995, Belgium began allocating bilateral funds to population assistance and reported approximately $3.2 million of $5.6 million in total population assistance as bilateral expenditures. In 1996, a smaller amount flowed through the bilateral channel–just $1.2 million of total population funding of $5.5 million.

Funding for NGOs:

Recently, the Belgian government has begun allocating funds to NGOs for reproductive health programs. Since 1995, Belgium has provided IPPF with 5 million francs a year, an amount which has declined in U.S. dollar terms owing to exchange rate changes and which represented about $140,000 in 1997. Belgium also co-finances the activities of some Belgian NGOs which are collaborating with developing country NGOs in the areas of AIDS prevention and sexual health education. The shift towards funding NGO reproductive health activities in 1995, even at a low level, is a sign of a positive but still tentative Belgian response to the ICPD.

4 Program Priorities

Geographic Priorities:

Consistent with the government’s overall allocation of development aid, most ongoing bilateral population projects are in sub-Saharan Africa. North Africa, Southeast Asia and the Andean region of South America are lesser priorities. To date, Belgium’s largest reproductive health programs have been in Niger, Morocco, Rwanda, and with the Palestinian Authority. In Bangladesh, Belgium has decided to terminate its bilateral cooperation activities but plans to continue support to NGO programs. The new health strategy proposes to concentrate aid resources in 25 priority countries, mostly in sub-Saharan Africa.

Areas of Program Emphasis:

The newly proposed development cooperation strategy shifts the emphasis within the overall health sector toward family planning and reproductive health. While still emphasizing the importance of primary health care, the policy statement strongly endorses the ICPD platform and highlights the importance of family planning as a key priority for future health sector activities.

A separate health strategy document seeks to integrate reproductive health within a primary health framework. The policy calls for integrated family planning, HIV/AIDS prevention, maternal and child health and information, education and communication components within primary health projects. Over the past decade, Belgian assistance has also supported reproductive health projects in Kenya and Rwanda, as well as STD/AIDS prevention programs in six other African countries.

Belgian aid officials indicate that other bilateral and multi-bilateral initiatives under consideration include several reproductive health projects in West Africa, a project related to trafficking in women in the Philippines implemented jointly by the University of Manila, the University of Ghent and AGCD, and a project in Laos relating to development of a social health system that will include family planning. There are also plans to develop more integrated programs through other sectors, for example, sexual health education programs through initiatives in the education sector.

Staffing:

Belgium does not have a strong cadre of health sector specialists within the AGCD. This is not surprising considering the low level of funding for health programs to date. A 1997 paper on health sector activities reports that 41 Belgian experts work on health sector projects worldwide; no data are available on staff working specifically in population or reproductive health. The majority of health sector staff are assigned to African countries, including 12 in Rwanda and 8 in Niger.

Technical Expertise of Collaborating Institutions:

There are currently no Belgian institutions with the capacity to support the AGCD in implementing international reproductive health assistance programs. Some religiously affiliated NGOs work with local NGOs in developing countries on health-related initiatives, which may include some reproductive health activities. However, these activities are funded out of a separate budget line for NGO collaboration and little information on them is available. A new proposal to support five year programs with such NGOs, rather than fund individual projects, has the potential to strengthen technical collaboration between NGOs and the AGCD in all sectors, including reproductive health.