GERMANY

POPULATION AND REPRODUCTIVE HEALTH ASSISTANCE OVERALL ASSESSMENT

Germany has demonstrated significant advances in its population assistance program. In the years following the Cairo conference, Germany has increased funding for population programs during difficult budgetary and economic times, and shifted resources in favor of an integrated and effective bilateral reproductive health program.

These positive developments notwithstanding, Germany faces a number of challenges. Compared with most other large donors, current levels of population assistance are low relative to the size of the German economy. Anticipated cuts in the bilateral aid budget could also negatively affect reproductive health programs. Moreover, German aid officials perceive low demand from developing countries for aid in the population and reproductive health sector to be a constraint to increasing levels of funding.

1 Development Assistance: Policy and Funding

The German government strongly supports development assistance, but the public is more concerned about economic problems closer to home. Public support for foreign assistance in Germany has eroded in recent years owing to concerns about the flagging economy, the high financial costs of German reunification and the fiscal strain of large monetary transfers to Eastern Europe and the former Soviet states. Nonetheless, the present government remains strongly committed to development aid and plans to maintain support for foreign assistance at a high level.

Despite the government’s commitment to foreign assistance, domestic economic problems appear likely to affect the administration of German aid, primarily through cuts in civil service staff at the Ministry for Economic Cooperation and Development (BMZ). However, political pressure is unlikely to result in significant cuts in the aid budget in the near future. Although the German parliament has authority over the foreign assistance budget, the majority parties generally prefer to leave foreign aid allocations to government policy makers. In some circumstances, however, parliamentarians try to influence aid policy through parliamentary debate and formal inquiries to the BMZ.

German development assistance has increased in absolute terms but more slowly than economic growth, resulting in a declining ratio of aid to GNP. With a development assistance program of $5.9 billion in 1997, Germany is the fourth largest donor nation in total aid volume. Germany accepts the UN goal that donor countries should give 0.7 percent of GNP in development assistance. However, it has moved away from this goal as the aid to GNP ratio has slipped from a high of 0.45 percent in 1986 to 0.28 percent in 1997.

Germany’s policy response to another international target–the compact to spend 20 percent of development assistance on the social sectors–has also been weak. To date, allocations to basic education and health remain well below 20 percent of the aid budget, although the population sector has benefited from a modest increase, from 0.75 percent of development assistance commitments in 1990 to 1.28 percent in 1996.

Three different entities are involved in management and implementation of the German aid program. BMZ, the Ministry for Economic Cooperation and Development, has overall responsibility for initiating specific programs in collaboration with recipient governments, and for coordinating and managing development assistance. BMZ staff issue contracts as needed to the German agencies for technical cooperation (GTZ) and financial cooperation (KfW) respectively, to design and implement these programs.

2 The Policy Environment for International Population Assistance

To date, population is not among the top priorities for the German aid program. Germany’s development policy designates poverty, the environment and education as first level development assistance priorities. Advocacy groups are pushing for population to be elevated to a first level priority, anticipating that a higher policy profile would result in increased financial allocations. German development aid officials, however, believe a higher profile for population and reproductive health could be counterproductive in the present political environment, as more visibility could increase the vulnerability of these programs to budget cuts.

A 1991 policy statement on population and family planning still represents official German policy on population assistance. German aid officials view this policy statement as current and congruent with the ICPD agenda, although it does not explicitly use the term reproductive health. The policy statement ties population and family planning to larger economic and social development goals and protection of the environment, and asserts that the ability to control the number and spacing of births is a human right.

There is considerable interest in population issues within the German parliament. In 1998, several parliamentarians introduced a resolution on the need for German development policy to actively emphasize population assistance. The resolution highlights the predicted impact of future population growth on the environment and employment, and endorses the ICPD action plan. The resolution was still under discussion as of mid-1998. The German Foundation for World Population (DSW), the leading German population NGO, has worked to build support for population assistance among parliamentarians and the public.

3 Trends in Funding for Population Assistance

Recent trends in population assistance reported by the German government are difficult to interpret. The BMZ reports its population activities in two categories, which differ from the standard definitions used by UNFPA:

• reproductive health, including maternal health, infant care, information, education and communications, and other projects involving reproductive functions; and

• population-related issues, which include HIV/AIDS, basic health, basic education and women’s empowerment. (Beginning in 1997, HIV/AIDS is considered part of reproductive health.)

According to aid officials, population assistance levels reported to UNFPA understate the true level of German support for reproductive health. While most German aid projects integrate reproductive health within primary health activities, the German government only reports those with an explicit reproductive health focus. In addition, the BMZ provides financial information based on commitments, while UNFPA compiles expenditure data. BMZ officials believe that commitments are a better reflection of long-term policy intentions than expenditure data, which are highly variable from year to year.

German officials also perceive a lack of demand from recipient countries for assistance in the population sector to be a major constraint to maintaining funding levels and developing new programs. Generating such demand is vital to ensure that financial commitments made by BMZ are translated into actual programs.

Overall Funding Levels:

German population assistance levels almost tripled from 1990 to 1995, but declined sharply in 1996. German population assistance levels rose steadily from $47.5 million in 1990 to $145 million in 1995, when Germany ranked second among all donor countries in its contributions to population programs. In 1996, Germany slipped to fourth place with a contribution of $96 million. Moreover, the German contribution to population activities in 1996 represented only 1.26 percent of total development aid, compared with the average allocation for donor countries of 2.0 percent. Germany also lags behind other donors in the volume of population assistance it provides relative to the size of its economy. In 1996, Germany provided $41 in population assistance per million dollars of GNP–down from $60 in 1995, and a fraction of the $371 contribution made by Denmark, the most generous donor.

Multilateral Funding:

Both the volume and share of German population assistance channeled through multilateral organizations declined in the 1990s. During the 1980s, Germany consistently allocated more than half of total population assistance to multilateral organizations. Since 1990, this trend has changed; by 1996, only about a third of German assistance to population programs passed through multilateral channels, reflecting an across-the-board cap on contributions to UN organizations imposed by the budget committee in the parliament.

Germany contributed approximately $32.5 million to UNFPA in 1995; although the government maintained the level of funding in German currency in 1996, the dollar value of these resources was considerably diminished by exchange rate losses. In 1997, BMZ reduced German contributions to UN agencies owing to overall budget cuts; as a result, UNFPA received only $24.3 million–a reduction of 28 percent from the previous year. In 1998, the contribution to UNFPA appears likely to remain stable in German currency, but to decline even further in dollar terms.

Bilateral Funding:

German resources for population assistance are increasingly being channeled through the bilateral aid program. In 1990, only 33 percent of German population assistance was administered bilaterally. As the share of multilateral assistance has declined, the share of German population assistance flowing through the bilateral aid program has risen, reaching 74 percent in 1995. The German government has a strong preference for managing its own development aid resources; the former minister of development cooperation had stated publicly that German bilateral assistance is more "efficient" than other channels, including the European Commission with its problems with project planning and disbursement of funds. This trend towards increasing bilateral funding and reducing multilateral allocations could change, however, as a result of the 1998 elections.

Funding for NGOs:

The level of German contributions to national and international NGOs is also low. In 1996, Germany channeled only 9 percent of its population funding through NGOs. The International Planned Parenthood Federation (IPPF) has been the main recipient of German contributions to NGO population programs. Germany’s contribution to IPPF increased throughout the early 1990s, but declined from $5.8 million to $4.6 million in 1996 and 1997; it will likely remain at this level in 1998.

4 Program Priorities

Geographic Priorities:

German population assistance is concentrated in sub-Saharan Africa. The German technical cooperation agency–GTZ–is implementing reproductive health initiatives in Africa involving family planning service provision, adolescent sexual health education, and reproductive health services delivered through integrated family health or district/rural health programs. In addition, Germany makes some large financial commitments in the poorer Asian countries, namely Bangladesh, Nepal and India, and in El Salvador and Paraguay in Latin America.

Areas of Program Emphasis:

The German aid program favors integrated programs with strong reproductive health components. German aid officials do not see reproductive health as defined at the Cairo conference as a discrete program focus. Moreover, they view integrated programs that include reproductive health as more likely to succeed than programs focusing solely on family planning or other reproductive health needs. German technical cooperation in the area of health systems development and reform also includes an emphasis on family planning and reproductive health. Germany does not fund abortion services in any of the projects it supports.

In Africa, projects implemented by GTZ in Kenya, Malawi and Zimbabwe focus more narrowly on community-based contraceptive education and distribution, and are exceptions to Germany’s general approach of integrating reproductive health within larger health sector initiatives. The German aid program also funds more focused social marketing programs, which aid officials view as an effective intervention in both family planning and AIDS prevention. Germany has supported contraceptive social marketing activities in Indonesia, Pakistan, the Philippines, Rwanda and India, through KfW, the German financial cooperation agency.

5 Technical Capacity

Staffing:

Government-wide staff reductions have affected the Ministry of Economic Cooperation and Development. Currently, only 3 staff persons in the BMZ are responsible for support to all health, reproductive health and education projects. As the technical cooperation agency, GTZ has fared better, with 5 technical staff in Germany and 38 in the field who work exclusively on population-related issues.

Technical Expertise of Collaborating Institutions:

The private and NGO sectors in Germany have very limited capacity to provide technical support to population activities. The BMZ currently implements projects overseas primarily through its quasi-governmental affiliates, KfW and GTZ. In several instances, KfW has contracted with a U.S. NGO, Population Services International, for technical assistance related to the social marketing of contraceptives, a field where no significant European technical capacity yet exists. From the Ministry’s perspective, there is a need to strengthen the expertise of German and European organizations in population and reproductive health.

However, the German government has made no real effort to build technical capacity among existing German NGOs, or to create mechanisms to access external technical consultants as the British aid machinery has done. Significantly, the German Foundation for World Population (DSW), which has initiated some reproductive health projects in developing countries in addition to its advocacy work, supports these activities with funds from corporate and international sources rather than from the German government.