EUROPEAN UNION

EUROPEAN UNION POPULATION AND REPRODUCTIVE HEALTH ASSISTANCE OVERALL ASSESSMENT

The European Commission (EC) faces many constraints to realizing its enormous potential as a donor in the population and reproductive health field. To date, the bureaucracy of the Commission, which administers the European Union’s development cooperation program, has undermined the impact of its financial support to population programs. The Commission has disbursed only a tiny percentage of the funds committed to population activities. Although formal mechanisms exist for consultation among the different units involved in population activities, effective coordination on policy and implementation has been problematic. This situation is gradually improving as a result of a reorganization in mid-1998, as well as increased informal communication among population program staff.

However, the greatest obstacle to the Commission’s effectiveness in population and reproductive health assistance is the inadequacy of its expertise in this area. Expert staff available to the Commission are limited and often in place only on a short-term basis. Until these problems affecting the quality and efficiency of aid in the population sector are resolved, the Commission will continue to perform below its full potential as a population donor. Moreover, while the Commission claims it has already reached its own year 2000 goal of 300 million ECU (about $347 million) in annual commitments to population programs, annual spending lags far behind and is unlikely to reach that level within the next two years.

1 Development Assistance: Policy and Funding

During the 1990s, the European Commission emerged as the world’s fifth largest source of development assistance. The member states of the European Union (EU) allocate a proportion of their development assistance budgets to the European Commission (EC), the executive body of the EU, for programming and disbursement. In 1996, EU member countries collectively contributed 17 percent of their total aid through the Commission. Over three decades, the level of development aid provided by the Commission has risen steadily, reaching $7.1 billion in 1995 before declining to $5.3 billion in 1997.

Development assistance provided through the Commission is thus complementary to contributions provided directly by member states. In comparing the development assistance contributions of EU member states with those of other large donors, such as the United States or Japan, both their direct aid programs and their contributions through the Commission need to be taken into consideration.

The Commission has a complex structure and process for managing development assistance. Historically, aid provided by the EC has its roots in the 1957 treaty which established the European Economic Community and assigned a special status to its relationship with former European colonies. The EU was formalized in 1992 under the Maastricht Treaty, which created a common market for trade within Europe, but also addresses development cooperation. Within the Commission, four directorates are responsible for external relations. These directorates deal with development cooperation in different regions through various funding instruments.

The Lomé Convention: After gaining independence from the former colonial powers, the Africa, Caribbean and Pacific (ACP) countries negotiated a separate agreement on development assistance with the Commission, formalized as the Lomé Convention in 1975. The convention established the European Development Fund (EDF), which provides aid funds to the 71 ACP signers of the Lomé agreement. The EC establishes separate EDFs for five-year periods with contributions from member states. The current convention–Lomé IV–expires in February 2000 and is currently being renegotiated.

EC aid to ACP countries is based on agreements with each recipient country for a package of technical and financial assistance and trade concessions. Aid to these countries is administered through Directorate-General VIII. Each country negotiates a National Indicative Program of priorities with the Commission and specifies the sectoral focus of EC cooperation. Traditionally, the EC has emphasized infrastructure and economic development rather than the social sectors.

The Lomé Convention also provides for Regional Indicative Programs which cover multiple countries and involve more complex negotiations. These regional initiatives have encountered frequent implementation problems due to the complexity of projects, weak commitment by recipient governments to regional cooperation, and the number of partners involved.

General Budget: The general Commission budget finances development assistance to the Asia and Latin America (ALA) and Southern and Eastern Mediterranean (MEDA) regions, as well as to Central and Eastern Europe and the former Soviet Union, drawing on funds available under special geographic and categorical budget lines. Directorate-General IB administers aid to the MEDA/ALA regions; Directorate-General IA administers aid to Central and Eastern Europe and the former Soviet Union. In 1997, 28 percent of EC aid funds were allocated to Central and Eastern Europe and the former Soviet Union, reflecting a desire to devote a large share of aid to the European region.

In the Mediterranean region, between 1990 and 1995 the bulk of aid funds were allocated to humanitarian assistance and food aid. Aid to Asia and Latin America has focused more on the social sectors, including education, women in development and humanitarian aid in Asia, and food aid, rural development and support to NGOs in Latin America. In Central and Eastern Europe and the former Soviet Union, EC programs have emphasized humanitarian assistance, democratization projects and food aid.

Special Budget Lines: Outside of the national and regional programs, the Commission has several special budget lines which can be accessed for support to population and reproductive health activities in all regions. These budget lines are shown above.

Some European NGOs have also successfully accessed additional funds for reproductive health activities through country-specific or sectoral budget lines that do not have a particular health focus. For example, Marie Stopes International (MSI), a British NGO, has obtained funding for reproductive health activities in Cambodia and the West Bank through other budget lines.

2 The Policy Environment for International Population Assistance

Within its overall aid program, the Commission has given greater emphasis in recent years to health policy, health sector reform and drug policy. As a result, the share of aid resources allocated to the health and population sectors has increased between 1986 and 1995 from one percent to almost three percent.

The Commission has also issued several policy statements on population and reproductive health:

• A 1992 communication on population and family planning made recommendations for policy goals and funding targets. The "Communication on Demography, Family Planning and Cooperation with Developing Countries" proposed to double population aid by 1995 and triple aid levels by the year 2000; improve human resources in the population sector within the Commission; and increase coordination of policies and programs among member states, the Commission and recipient countries. The formal resolution resulting from this communication by the Council of the European Union–one of the EC’s legislative bodies–does not reflect these financial targets, but refers to the need for increased resources and improved coordination in the population field.

• In 1994, the Commission announced its intention to increase funding for population programs "more than tenfold" by the year 2000, to $347 million. This target was announced by the Commission’s leadership prior to the ICPD.

• A 1994 resolution summarizes the Commission’s policy on AIDS. The resolution called for 69 million ECU ($US 82 million) in contributions to AIDS programs from 1994 to 1998, under the budget line for AIDS in developing countries. Financial support for AIDS programs has focused on prevention (including improved STD treatment), related health sector support, research and training, technical assistance, and the socioeconomic impacts of the epidemic.

• A further influence on the EC’s policy on population assistance is an all-party Working Group within the European Parliament. The Working Group on Population, Sustainable Development and Reproductive Health, established in 1991, aims to raise awareness regarding the need for integrated approaches in the areas of population, reproductive health, sustainable development, gender equality and the environment, and to provide a forum for ongoing dialogue on these issues. It also seeks to monitor and increase EU resources for programs to address problems related to population, sustainable development and reproductive health.

• In 1998, the Working Group engaged in an intense and ultimately successful advocacy effort to restore proposed cuts in the budget line, "Aid for Population Policies and Programmes in Developing Countries." In the future, it plans to focus on raising awareness within the European Parliament regarding needs in the areas of safe motherhood, refugee reproductive health, and gender-based violence and female genital mutilation. Despite general support for population and reproductive health within the parliament, some conservative members are reportedly uncomfortable with more controversial issues such as sexual and reproductive rights or unsafe abortion

• As of mid-1998, preparation of a new policy paper on reproductive health assistance was underway. The proposed "Communication on Aid for Reproductive Health in Developing Countries" will focus on family planning, safe motherhood, HIV/AIDS and STDs, adolescents and violence against women. The paper, likely to be issued as a formal Commission "communication," is expected to be finalized in 1999.

3 Trends in Funding for Population Assistance

Overall Funding Levels:

Levels of funding provided by the EC for population and reproductive health are difficult to assess precisely. The Commission only began reporting population-related spending to UNFPA in 1996; partial data for 1994 and 1995 are available from other sources. The EC reported spending $14 million in 1996 on population-related projects–a figure considered to be an underestimate of actual spending but currently the only available estimate. Figures for the two prior years reflect only funds allocated through NGOs, at $3.7 million in 1994 and $3.6 million in 1995.

Multilateral Funding:

The Commission does not contribute core support to multilateral organizations in population or other sectors. However, it is collaborating with UNFPA on a special NGO reproductive health initiative in Asia (see below), and is supporting costs incurred by UNFPA for coordination of this activity.

Bilateral Funding:

Commission funds for country-level programs are potentially the largest source of EC funding for population activities, but are difficult to track. These funds flow through the European Development Fund (for Lomé Convention countries) and from the general Commission budget. The Commission reports an increase in population funding disbursed through the EDF from $7.3 million in 1994 to $10.7 million in 1996. No consolidated data are currently available on funding under the general budget for population programs in other regions. Under the special budget line, "Aid for Population Policies and Programs in Developing Countries," the Commission disbursed about $4.5 million in 1996.

Funding for NGOs:

As noted above, NGOs can access Commission funds through several different budget mechanisms. In 1994 and 1995, the Commission reported funding for NGO population programs at $3.7 and $3.5 million. Given the complexity of the Commission budget and lack of systematic reporting of disbursements, expenditures on NGO programs in 1996 and beyond remain difficult to estimate. However, Commission staff currently compiling data on reproductive health expenditures report a steady upward trend between 1994 and 1997. The Commission has also initiated a major new reproductive health program in Asia involving NGOs.

Another recent development relating to NGOs is the establishment in 1997 of the Cofinancing Support Program, which aims to assist NGOs in improving the quality of their funding proposals. The program is represented in each member state and maintains a central liaison office in Brussels. It provides assistance to NGOs in preparing proposals and reports relating to funds available under the main NGO budget line for cofinancing of development projects, B7-6000.

4 Program Priorities

Geographic Priorities:

Commission resources for population activities are concentrated primarily in Asia, which in 1996 accounted for 46 percent of population spending. In the same year, the Commission supported population projects in Bangladesh, India, Indonesia, Nepal, Pakistan, the Philippines, Thailand and Vietnam, in addition to several regional Asian initiatives. Western Asia and North Africa received the next largest proportion of funding at 20 percent of the total, including projects in Egypt, Jordan, Morocco, Palestine, Tunisia, Turkey and Yemen. The Commission allocated a smaller share of total population expenditures to sub-Saharan Africa, Latin America and to global or interregional projects.

Areas of Program Emphasis:

In 1996, EC population and reproductive health spending had a strong focus on STD/HIV activities. Of the $14 million the Commission reported to UNFPA in population assistance, over $11 million (80 percent) went to STD/HIV projects. In addition, 12 percent went to family planning activities and 7 percent to other reproductive health initiatives.

Staff in Directorate-General VIII are working to integrate reproductive health into larger health sector projects and the policy dialogue on health sector reform. The directorate provides aid under the terms of the Lomé Convention, which mandates a key partnership role in priority-setting for signatory countries in the Africa, Caribbean and Pacific regions. Commission staff observe that most of these countries do not identify population as a priority sector for cooperation with the Commission, preferring to request assistance in this sector from donors more closely identified with technical expertise in this area. Partner countries also more frequently request assistance for HIV projects than for other reproductive health activities.

Moreover, a substantial proportion of health sector assistance provided under the Lomé Convention goes to direct support to health sector budgets in signatory countries. Directorate staff see a role for the Commission in raising population and reproductive health concerns in policy discussions with governments in these countries relating to this budget support. For example, efforts are underway to strengthen the focus on reproductive health in health financing and policy reform, and to include contraceptive supplies in essential drug programs. The directorate has appointed a consultant to recommend strategies for strengthening the focus on reproductive health in health sector policy dialogue, a sign it is taking this responsibility seriously.

Recent projects initiated by Directorate-General IB provide an indication of approaches the Commission is using in other regions.

• In 1996, the Commission committed 200 million ECUs ($253 million) in support of an initiative in India to improve the national family welfare program. The EC’s assistance complements efforts by the World Bank and other donors to shift the emphasis of the family welfare program from the delivery of family planning services to more comprehensive reproductive health services. This major sector reform program includes support for managerial and financial decentralization, community participation, client-oriented approaches and efforts to improve quality of care, access to services and program evaluation.

• The Reproductive Health Initiative in Asia is a new program funded by the Commission in collaboration with UNFPA. The 25 million ECU ($28 million) initiative was formalized in 1997 with the objective of addressing family planning and sexual health issues in partnership with non-governmental organizations. It will support projects in seven countries implemented by European NGOs in partnership with local NGOs in these countries over a three-year period.

The program aims to support ICPD goals by emphasizing improved access to services, special attention to gender issues and reproductive rights, strengthening of NGO capacity and South-South NGO cooperation. The initiative recently completed its first year planning phase, which has identified adolescent reproductive health needs as a program priority. NGO partners in Europe and participating Asian countries have submitted proposals, and the initiative will begin funding project activities in early to mid-1998. The program also has a "regional dimension" involving data collection, research and evaluation.

Although these two highly visible initiatives in Asia take an integrated approach to reproductive health assistance, data for 1996 indicate that over 90 percent of reproductive health-related expenditures in Asia supported more focused HIV/STD programs.

5 Technical Capacity

Staffing:

Despite the rapid expansion of Commission staff in the early 1990s, expertise in the social sectors is still limited. Both directorates with primary responsibility for development work have a mix of permanent and contract staff at headquarters; in addition, significant numbers of staff are assigned to EU "delegations" or country offices. However, in both directorates, only a handful of technical staff work on population and reproductive health-related programs.

A budget ceiling imposed by the European Council of Ministers has prevented recruitment in population and reproductive health as well as other areas for several years. Recruitment of more external technical consultants is under discussion, but this will not address the need to develop long-term technical capacity within the Commission.

Technical Expertise of Collaborating Institutions:

The Commission has access to a broad range of expertise through collaborating institutions throughout Europe. Many European NGOs with expertise in reproductive health have accessed EC funding for projects or are in the process of negotiating agreements to do so, either through the NGO cofinancing budget line or the Asia Reproductive Health Initiative. The Asia initiative in particular has developed a new model of "coordinated" NGO programming that encourages collaboration and information exchange among NGOs working in a particular country. European NGOs involved in this project include Marie Stopes International, CARE, the International Planned Parenthood Federation, the German Population Foundation (DSW), Save the Children Fund (UK), the Dutch World Population Foundation and many others.

The availability of NGO expertise is less of a constraint to the Commission’s effectiveness than the difficulties these NGOs experience working with the EC. European NGOs have found the bureaucracy of the directorate structure difficult to navigate, and have experienced long delays in approval of proposals and even payment for work completed. For European NGOs working in partnership with developing country NGOs, these delays present serious obstacles. Local partners lose patience with a system that can take years to process a proposal. In other instances, local circumstances are dynamic and needs change significantly between development and approval of a particular project. Commission staff are working to overcome these problems and improve the administration of NGO project proposals. As European NGOs gain experience working with the EC, they have also become more familiar with its procedures and the pace of approval for funding for reproductive health and HIV/AIDS projects is reportedly improving.

Plans to establish a new administrative and financial service cutting across directorates represent a further effort to increase the Commission’s efficiency. A major reorganization in mid-1998 created a new department, called the Common Service Unit (SCR). This department consolidated technical support and legal, contractual and financial management functions previously handled separately by the directorates involved in development cooperation. This new division, with about 650 staff, is one of the biggest in the Commission. A reform of the current budgeting system is expected to accompany these organizational changes, with funding likely to be provided on a program basis, rather than by applications to specific budget lines.