THE NETHERLANDS

POPULATION AND REPRODUCTIVE HEALTH ASSISTANCE
OVERALL ASSESSMENT

The Netherlands’ financial response to the ICPD is one of the strongest among the donor nations. The Dutch government more than doubled funding for population and reproductive health programs between 1994 and 1996. The Netherlands continues to support the delivery of family planning and reproductive health services by channeling a large share of its population assistance to core funding for UNFPA and IPPF. The Dutch government is also expanding support for broader reproductive health initiatives through its bilateral aid program. The political environment in the Netherlands is highly supportive of reproductive health assistance, as evidenced by the government’s willingness to work in controversial areas such as unsafe abortion and adolescent reproductive health services that other donors are often reluctant to fund.

Despite this very positive record, recent changes in the Dutch development aid program warrant some concern. The ongoing transition to a more decentralized aid management system could potentially hinder the development and implementation of new bilateral reproductive health programs. In particular, the effectiveness of new mechanisms for coordination between the Ministry of Foreign Affairs and health program staff in Dutch embassies remains to be seen.

Some policy changes are likely in store for the Dutch foreign assistance program. The Ministry of Foreign Affairs has new leadership following elections in mid-1998. Recent debates have focused on the role of Dutch business in development assistance, and the potential for a shift in geographic emphasis from Africa to Eastern Europe and the former Soviet states. The Ministry’s new leadership has also indicated interest in concentrating Dutch aid in fewer countries and program areas.

1 Development Assistance: Policy and Funding

The volume of assistance provided by the Netherlands is especially significant given the small size of its economy and its population of just under 16 million. In 1997, the Netherlands was the sixth largest source of development aid worldwide, giving over $2.9 billion in foreign assistance. Dutch aid has also long been known for its emphasis on poverty alleviation, economic self-sufficiency and concern for aid effectiveness. The Netherlands is one of very few donor nations to meet and exceed the UN target of allocating 0.7 percent of GNP to development aid. In 1996 and 1997, the Dutch government gave over 0.8 percent of GNP in foreign aid, and is reportedly committed to increasing this percentage to even higher levels.

New directions in the administration of Dutch aid include reorganization of the Ministry of Foreign Affairs, decentralization of authority to embassies and the adoption of financial targets in the development budget. The Dutch coalition government–in power since 1994–has sought to improve coordina- tion among the various ministries involved in foreign affairs, development cooperation and economic affairs. Simultaneously, the government embarked on a decentralization policy which designated Dutch embassies overseas as the main partners for governments and NGOs receiving Dutch development assistance. These changes were designed to enable the Netherlands to better achieve its five main financial targets for the development program:

• allocation of 20 percent of the development aid budget to basic social services;
• allocation of 4 percent of the development aid budget to reproductive health care (as part of the 20 percent goal for basic social services);
• expenditure of 0.1 percent of GNP annually on international nature conservation and environment programs;
• annual expenditure of 50 million Dutch guilders (approximately U.S. $25 million) to pre- serve tropical rainforests; and
• a minimum of 0.25 percent of GNP to be spent on aid to the least developed countries.

To date, the Dutch government has been successful in meeting many of these financial targets. However, the decentralization process was only initiated in 1996, and it is too soon to assess its effectiveness in programming aid funds. In 1997, the Dutch aid program reportedly experienced some bottlenecks in disbursement of funds due to the unfamiliarity of embassy staff with their new responsibilities. In response, the government reduced the number of thematic budget lines and centralized authority for project approval in the Ministry of Foreign Affairs.

2 The Policy Environment for International Population Assistance

Dutch policy initiatives to increase population assistance predate the 1994 Cairo conference. In 1992, the Foreign Minister, Jan Pronk, initiated an internal dialogue regarding the need to strengthen Dutch population policy, which culminated in a published strategy on family planning and reproductive health in development cooperation. However, this policy change did not lead to increases in funding in the short-term. Following the ICPD, the Netherlands initiated further policy reforms to increase actual financial support to reproductive health activities.

In 1995, the Dutch parliament passed a resolution requiring the allocation of four percent of development assistance to reproductive health. Some controversy has ensued regarding how to count resources allocated to HIV/AIDS activities and primary health programs with reproductive health components. Despite these ambiguities, the government reported that it met the four percent goal in 1996. This legislative requirement provides both a strong policy mandate for programming funds in population and reproductive health, and an administrative responsibility to report back to the parliament on these expenditures. The Netherlands thus has one of the most supportive policy environments for population assistance within the donor community.

3 Trends in Funding for Population Assistance

Overall Funding Levels:

Dutch funding for population and reproductive health has increased steadily over the past decade. The Netherlands does especially well when its contributions are considered relative to its population size and wealth. In 1995, the Netherlands was the fifth largest donor in terms of total volume of population assistance; in 1996, it became the second largest donor, contributing $111 million. It also ranks third among donor countries in the allocation of funds for population assistance relative to GNP, spending $280 per million dollars of GNP compared with the average for donor nations of $93 in 1996. In that year, UNFPA reports that the Netherlands devoted 3.4 percent of total development aid to population activities, compared with an average of two percent for the donor community.

Multilateral Funding:

The Netherlands has traditionally channeled a high proportion of its population assistance through multilateral institutions. In 1996, 78 percent of Dutch population funding went to multilateral organizations. UNFPA has reported a steady increase in Dutch contributions between 1993 ($28.3 million) and 1997 ($44.4 million), when the Netherlands became the second largest contributor to the Fund. The Dutch are also contributors to other multilateral organizations that implement health and population programs, such as WHO, UNICEF, the World Bank, the EC and UNAIDS.

Bilateral Funding:

It is difficult to assess trends in Dutch bilateral population assistance. According to UNFPA, Dutch bilateral population assistance increased to $21.7 million in 1995 (25 percent of total population assistance), up from $2.2 million in 1994. This dramatic increase can be largely attributed to the broadened definition of population assistance introduced by UNFPA in 1995. However, in 1996, UNFPA reported that the Dutch bilateral share of assistance dropped to 11 percent (approximately $12 milwqlion), although overall population assistance increased to over $111 million. It is unclear whether this decline in the share of bilateral assistance is real or simply a reflection of inconsistencies in reporting. Changes in the administration of Dutch bilateral development aid–in particular, the new policy of decentralization–may also have affected the efficiency of disbursements for population as well as other activities.

Funding for NGOs:

Dutch contributions to IPPF consistently increased during the 1990s. However, in 1997, the dollar value of the Dutch contribution declined owing to the falling value of the guilder relative to the U.S. dollar. In 1998, IPPF expects to receive $3.9 million from the Netherlands in core funding (maintaining the 1997 level), and an additional $900,000 for capacity building and training activities with its national affiliates.

4 Program Priorities

Geographic Priorities:

The concentration of Dutch population aid funds in sub-Saharan Africa reflects the larger emphasis of the aid program on poverty alleviation and the targeting of aid to the poorest nations. In 1995, Africa received the largest share of resources (49 percent) allocated to population and reproductive health programs. Much smaller shares of population aid went to Asia (17 percent), Latin America (15 percent), and Europe and the Middle East (which together received less than 5 percent.)

Areas of Program Emphasis:

The Dutch government recently identified the following priority areas within reproductive health: safe motherhood, adolescent sexual health, unsafe abortion, refugee reproductive health, and AIDS and other STDs. Recent policy statements also indicate a shift in focus to addressing the broader problems of health systems rather than providing direct support for health services. This policy change is likely to benefit safe motherhood programs, since it shifts the emphasis from village level services to the capacity of health systems, including facilities available at the district level for emergency obstetric care.

5 Technical Capacity

Staffing:

The recent reorganization and decentralization of the aid program have resulted in significant changes in technical staffing. Several Dutch embassies have appointed health specialists to assist with programming aid funds at the country or regional level; in early 1998, there were 8 such specialists worldwide. In the remaining embassies, women in development specialists handle reproductive health programming. At the Ministry of Foreign Affairs in The Hague, a single technical expert in reproductive health is assigned to the social and institutional development section. In addition, the Ministry has a full-time staff person monitoring its substantial reproductive health assistance to multilateral organizations. Mechanisms for formal coordination between these ministry experts and health specialists in the field are evolving slowly following the reorganization.

The new decentralization scheme gives embassies the flexibility to access technical assistance in reproductive health through either the Ministry or outside consultants. However, the newly hired health experts are working on a contract basis rather than as part of the permanent civil service structure. As such, they are less likely to provide continuity in technical assistance or to contribute to the development of long-term institutional capacity within the Dutch foreign aid system. This arrangement is under review and, according to Ministry officials, likely to change in the near future.

Technical Expertise of Collaborating Institutions:

To date, the Ministry of Foreign Affairs has not allocated a significant share of population resources through the bilateral channel, or utilized Dutch institutions extensively to support its reproductive health programming. Still, several Dutch institutions have the potential to play a more significant role in bilateral cooperation activities:

• The World Population Foundation (WPF) is well known as an advocate for Dutch population and reproductive health assistance. WPF is also involved in population and reproductive health projects. It supports local organizations in developing countries by helping design and manage projects, and mobilizes funding for such projects by working closely with donors–especially UNFPA, the World Bank and the European Commission.
• The Royal Tropical Institute (KIT), a well known medical research institution, currently works with core support from the Dutch government in the field of international health. KIT currently has partnerships with reproductive health research institutes in Benin, Egypt and Burkina Faso.
• The Rutgers Foundation, the Dutch IPPF affiliate, has recently established an international branch and is beginning to utilize its expertise in adolescent sexual health in new program initiatives in Eastern Europe.
• The Netherlands Interdisciplinary Demographic Institute (NIDI) has a contract with UNFPA to track global resource flows for population programs. While it receives some government contracts in the area of demographic research, NIDI has little expertise in reproductive health service delivery.

In the future, it is possible that Dutch NGOs could play a more substantial role in implementation of bilateral reproductive health programs. However, the increasing decentralisation of the Dutch aid system and the requirement that programs be initiated in the field are major obstacles to the greater involvement of Dutch NGOs, given their limited overseas presence. Meanwhile, other development NGOs in the Netherlands have demonstrated only limited interest in reproductive health activities.