SWITZERLAND

POPULATION AND REPRODUCTIVE HEALTH ASSISTANCE OVERALL ASSESSMENT

Although reproductive health is not a priority for the Swiss development aid program, Switzerland has recently made modest increases in its contributions to population programs. Swiss population assistance is largely limited to contributions to UNFPA, UNAIDS, IPPF and other international organizations; these contributions have shown a slow upward trend since the ICPD. The Swiss government appears likely to continue this emphasis on multilateral population assistance, and to focus bilateral efforts on areas such as agriculture, environment and gender where the Swiss aid program has greater expertise. Aid officials also perceive these areas as having a long-term impact on economic development as well as population growth.

1 Development Assistance: Policy and Funding

Switzerland has a long-standing and unique tradition of independence in its foreign policy, as well as in development cooperation. Switzerland is not a member of the United Nations or European Union, and has charted its own course rather than sign on to international agreements regarding development assistance. The Swiss people have voted against membership in the United Nations and the European Economic Area (EEA). Switzerland has not signed on to the UN development aid target of 0.7 percent of gross national product (GNP). In 1992, the Swiss government established its own target of 0.4 percent of GNP, but has yet to reach this goal.

The Swiss development aid budget is low–particularly compared to the wealth of the country as reflected in GNP levels–and likely to continue declining. The volume of Swiss development aid peaked in 1992 at $1.1 billion; annual aid levels have since fluctuated between $700 million and $1 billion. In 1997, the Swiss government provided $839 million in official development assistance, or 0.32 percent of GNP. In that year, Switzerland ranked 14th among 21 donor countries in total volume of development assistance, and ninth in terms of aid as a percentage of GNP. The Swiss government predicts a continuing downward trend in aid levels, resulting in a development assistance to GNP ratio of 0.29 percent by the year 2000.

Coordination of the different agencies involved in Swiss development assistance remains a problem. Swiss development assistance is implemented through two different agencies: the Swiss Agency for Development and Cooperation (SDC), housed in the Federal Department of Foreign Affairs, and the Federal Office for External Economic Affairs (FOEEA), which is part of the Federal Department of Public Economy. The SDC administers technical and financial cooperation and humanitarian aid, and handles approximately 80 percent of total aid disbursements. The FOEEA is the designated agency for economic aid and administers approximately 10 percent of aid disbursements. Coordination between the two agencies remains a continuing issue, as both handle initiatives in the same geographic regions and collaborate with multilateral organizations.

2 The Policy Environment for International Population Assistance

The long-standing neglect of population issues in Swiss aid policy appears unlikely to change given declining aid budgets. Traditionally, population assistance has not been a priority for Swiss overseas development cooperation, primarily because the Swiss government perceives population growth as an outcome of underdevelopment. The SDC has taken the position that support for activities to fight poverty, address basic needs and create a better environment will in turn contribute to declines in population growth rates. Swiss policy also emphasizes that programs related to demographic growth and contraception must respect the "autonomy and cultural values of developing countries." Moreover, since the current economic environment in Switzerland has required a near freeze of the federal budget, large increases in reproductive health spending appear unlikely.

Despite a lack of emphasis on population issues in their bilateral aid policy, the Swiss support the ICPD Programme of Action and contribute to both UNFPA and IPPF. Switzerland officially supports the broad formulation of "reproductive health" agreed on at the International Conference on Population and Development (ICPD) in 1994, in particular the linkages between wider access to education and health services, including family planning, and improved reproductive health care for women. Currently, Switzerland’s support for direct family planning service provision occurs primarily through the funds it provides to UNFPA and IPPF. Over the long-term, Swiss development cooperation policy is reportedly moving towards increased support for the social sectors, including an eventual increase in allocations for reproductive health through the Swiss bilateral aid program.

The SDC has launched an initiative to increase domestic awareness of international population issues through Swiss NGOs. The main NGO in the family planning field is the Swiss IPPF affiliate, l’Association suisse pour de planning familial et d’éducation sexuelle (ASPFES), founded in 1993. ASPFES has been active in advocacy for international reproductive health assistance with both the public and parliamentarians.

3 Trends in Funding for Population Assistance

Overall Funding Levels:

Switzerland has reported significant increases in funding for population programs with the broadening of the definition of population assistance after the ICPD. Swiss funding for population activities increased slightly between 1990 and 1994 from $6.4 to $8.2 million. In 1996, Switzerland reported $16 million in reproductive health-related funding, representing more than a doubling in population assistance since 1994. This increase appears to reflect the change in the definition of population activities to include basic reproductive health and STD/HIV prevention. The SDC reports $13 million in reproductive health-related funding in 1997, of which roughly $10 million was allocated to core population and family planning activities, including contributions to UNFPA and IPPF.

Switzerland is unlikely to reach its fair share of the ICPD year 2000 goal for donor contributions to population programs. Although Switzerland signed on to the ICPD Programme of Action, even with modest increases in funding it is unlikely to achieve its $78 million share of the ICPD goal for donor contributions (estimated by calculating Switzerland’s proportional share of GNP). Achieving this goal would require an almost five-fold increase in budget allocations between 1996 and 2000.

Multilateral Funding:

Most Swiss population assistance is channeled through multilateral organizations, but these funds represent a tiny share of the overall aid budget. Switzerland has repeatedly stated that its main contribution to ICPD goals is through funding of multilateral agencies like UNFPA, UNAIDS, the WHO human reproduction research program and the World Bank, all of which provide broad support to reproductive health programs. In 1997, contributions to these institutions amounted to just 1.5 percent of total Swiss development assistance. Switzerland’s U.S. dollar contributions to UNFPA have fluctuated around $7 million from 1994 to 1997, an increase from $5.8 million in 1993.

Bilateral Funding:

A very small share of bilateral health spending goes to reproductive health. According to SDC officials, only two percent of bilateral health expenditures in 1997–about $700,000–were allocated to basic health services and health programs relating to reproductive health, family planning and HIV/AIDS control and prevention.

Funding for NGOs:

In recent years, the Swiss contribution to IPPF has been stable or increasing in Swiss francs, but has declined in U.S. dollar terms. Switzerland’s support to IPPF–the main international NGO in the population field–declined in U.S. dollar terms from approximately $819,000 in 1995 and 1996 to $670,000 in 1997. The national currency contribution remained stable at a million Swiss Francs annually during this period, though, reflecting a change in exchange rates rather than a deliberate reduction in funding.

4 Program Priorities

Geographic Priorities:

The SDC concentrates its development assistance activities in fewer than 20 countries worldwide. Only about half these countries have health as a priority sector for intervention: Benin, Chad, Mali, Madagascar, Mozambique, Nepal and Tanzania, as well as the entire Sahel region. In addition, in Bangladesh, the Swiss support health activities, although health is not formally considered a priority sector. In Latin America and Asian countries other than Bangladesh and Nepal, the Swiss do not work directly in the health sector but are involved in collaborative initiatives such as cofinancing of UNFPA activities in Vietnam. Swiss aid officials report that "most health projects develop reproductive health activities," but currently there is no formal inventory of reproductive health activities funded by the Swiss aid program.

Areas of Program Emphasis:

Switzerland has no tradition of bilateral assistance in the population and reproductive health sector. Its bilateral aid program has focused instead on areas which the Swiss see as closely related to population issues–poverty alleviation, environmental conservation, income generation and institutional and social development. As part of plans for a gradual increase in social sector spending, SDC is considering allocating more funds for reproductive health, safe motherhood, adolescent health, basic education and "gender balanced development."

5 Technical Capacity

Staffing:

Staff resources at the SDC in the health sector are very thin. Currently, fewer than two full-time technical staff have specialized training in public health. Most operational responsibility is delegated to local offices in the field. These offices may employ local health specialists, especially where health is a priority sector for the Swiss aid program, as in Mozambique.

Technical Expertise of Collaborating Institutions:

Thus far, there is little involvement of Swiss NGOs in population and reproductive health assistance. Most large development NGOs in Switzerland have expertise in maternal and child health or basic health services, rather than family planning and reproductive health. These NGOs for the most part do not collaborate with the Swiss aid program on reproductive health related initiatives. ASPFES, the Swiss family planning association, has the potential to expand its advocacy role and become involved in the future as a technical assistance or implementing agency for Swiss bilateral reproductive health activities. However, the formal development of such a relationship has yet to occur.