UNITED KINGDOM

POPULATION AND REPRODUCTIVE HEALTH ASSISTANCE
OVERALL ASSESSMENT

Britain’s technical capacity, innovation and effectiveness as a population donor have grown substantially during the past decade. Increasing numbers of health and population staff in the field, a commitment to innovative programs and effective technical cooperation with collaborating institutions have resulted in a population program that is widely considered to be well managed and results oriented. Britain is one of only a few donors funding projects in such leading edge areas as post-abortion care, sexual violence, vesico-vaginal fistula prevention as well as core family planning, safe motherhood and adolescent reproductive health services. The British aid program also supports a mix of projects emphasizing public, private and NGO involvement in reproductive health.

Despite strong political support, significant increases in funding for reproductive health assistance appear unlikely. The current government has maintained the strong support for reproductive health assistance shown by the previous government. Yet although the government has pledged to increase its assistance in this area, it is committed to maintaining overall budget levels established by the previous government for at least two years. Moderate increases in funds for population and reproductive health programs may still be possible through reallocation of existing aid resources. However, much larger increases will be needed if Britain is to reach its "fair share" of the year 2000 ICPD goal for donor assistance, based on its proportional share of donor country GNP.

1 Development Assistance: Policy and Funding

Britain has entered a new era with the election in 1997 of a Labour government committed to strengthening aid to developing countries. Over the course of a decade, British development aid levels had steadily eroded. In 1995, British development assistance, adjusted for inflation, was at the lowest level since 1987. While the British government has endorsed the United Nations’ target of allocating 0.7 percent of GNP to overseas development assistance, the British ratio had been moving in the opposite direction–falling from 0.45 percent in 1985 to 0.26 percent in 1997.

The new government plans to reverse these trends. The elevation of the former British Overseas Development Administration (ODA) to Cabinet level status as the Department for International Development (DFID) was among the first policy changes made by the government. Under the leadership of Clare Short, the new Secretary for International Development, DFID issued a White Paper on international development in November 1997 entitled "Eliminating World Poverty: A Challenge for the 21st Century." The White Paper–the first such policy document issued in over twenty years–emphasizes poverty elimination as the central goal of the British aid program. It also abolishes the Aid and Trade Provision (ATP), a controversial mixed aid and credit facility which combined development objectives with commercial opportunities for British businesses.

2 The Policy Environment for International Population Assistance

The Labour government’s strong commitment to reproductive health assistance builds on the previous government’s policy. Using the slogan "Children by Choice not Chance," the previous government emphasized improved access to reproductive health services, particularly for the poor in developing countries. The emphasis on reproductive health by the current government thus represents an evolution of earlier policy rather than a departure. While the outlook for reproductive health assistance appears promising, no dramatic changes in funding or program directions have been announced to date.

Clare Short has made numerous public statements in support of reproductive and sexual health, access to family planning and safe abortion. The new aid policy paper endorses a number of international targets for the year 2015, including halving the proportion of people living in extreme poverty, halving child mortality, reducing maternal mortality by 75 percent, and ensuring universal access to reproductive health services. Some preliminary changes in program emphasis have followed the change in government, including increased attention to maternal and adolescent sexual health, and a shift from support to small projects to country-level partnerships involving a sector-wide approach.

3 Trends in Funding for Population Assistance

Overall Funding Levels:

Despite declining levels of overall development aid, reproductive health assistance has been rising since 1986. According to UNFPA, British population assistance increased 70 percent between 1994 and 1995, although it is unclear how much of this increase is attributable to the broader definition of population assistance used in reporting expenditures following the ICPD.

In conjunction with the Cairo conference, the British government announced it expected to commit more than £100 million to population assistance over the two-year period 1995 to 1996. The government more than fulfilled this pledge, committing over £184 million over this period. The British government also claims that expenditures on reproductive health–including the British share of expenditures by the World Bank and European Commission–meets its goal of spending four percent of development aid on population and reproductive health.

However, if Britain’s "fair share" of the ICPD year 2000 target is estimated based on its share of donor country GNP, current levels are clearly lagging. In 1996, the United Kingdom spent $106 million on population assistance; the British will need to increase this contribution three-fold to reach their share of the year 2000 goal for donor assistance.

Multilateral Funding:

The British government has increased its contributions to population programs through key UN organizations. Contributions to UNFPA have more than doubled since 1993, when the U.K. provided $10.8 million in core funds. In 1997, the U.K. was the seventh largest contributor to the UNFPA, contributing a total of $23.1 million in core funding plus an additional $2.4 million for multi-bilateral projects. In a recent announcement, Tony Blair, the British Prime Minister, pledged a 28 percent increase in core funding for UN agencies in 1998. UNFPA expects to receive about $26 million in core funding and an additional $5.6 million in funding for multi-bilateral programs. Britain makes much smaller annual contributions to the Joint UN Program on HIV/AIDS and the WHO human reproduction research program, to which it is the largest single contributor.

Britain has also sought closer collaboration with the European Commission (EC) in the area of health and population assistance. The British government has seconded a permanent staff member to EC headquarters in Brussels to work on managing and developing mechanisms for EC support to reproductive health programs. This staff appointment has reportedly contributed to smoother processing of NGO funding applications to the EC for reproductive health projects.

Bilateral Funding:

The bulk of increases in British population assistance funds has been channeled bilaterally. While the British government has increased multilateral contributions, bilateral funding levels have grown even faster, significantly increasing the share of population assistance allocated through bilateral programs. In 1987, only six percent of British population assistance was allocated to bilateral programs; in 1995, almost half of population funding was channeled through the British bilateral aid system.

Funding for NGOs:

The British aid system also supports a number of special NGO initiatives in reproductive health. The "Joint Funding Scheme" cofinances activities of British NGOs that target poor communities; a special provision under this program waives the cofinancing requirement and allows 100 percent grant support for population and reproductive health projects. Spending on reproductive health activities through this program has risen from about $650,000 in 1992 to $2.5 million in 1996.

The United Kingdom was also the third largest contributor to IPPF in 1997, although its contribution declined 18 percent from the previous year. Britain also provides restricted funding to IPPF for specific projects, such as the Vision 2000 Fund projects in India, Cameroon and Bangladesh, the development of new infrastructure and training for family planning associations (FPAs) in Europe and the former Soviet Union, and an external review of IPPF’s work in China.

4 Program Priorities

Geographic Priorities:

The British aid program has traditionally given priority to low income developing countries (particularly in Africa), and countries with historical ties to Britain. Population assistance is even more concentrated in low income countries than general development assistance; in 1996, 64 percent of reproductive health assistance went to Africa, compared with 31 percent to Asia, 3 percent to Latin America and 2 percent to Europe and Central Asia. Some observers criticize the overall British aid portfolio for being too widely dispersed across countries–about 160 in 1996.

Twenty-two countries have been identified as priority partners for reproductive health programming.

Areas of Program Emphasis:

The British population assistance program closely reflects the broad ICPD definition of reproductive health. The aid program has a strong focus on adolescent sexual and reproductive health, STD and HIV prevention, prevention of maternal morbidity and mortality, and addressing the unmet need for family planning services. In addition, girls’ education, promotion of gender equality and reproductive rights, and prevention and care of the consequences of sexual violence, female genital mutilation and vesico-vaginal fistula are important priorities.

Britain also has a strong commitment to developing new approaches to reproductive health. This commitment is demonstrated by the Innovations Fund, earmarked for financing innovative or action-oriented research, and efforts to improve reproductive health service quality or widen available contraceptive choices. In 1996, the Innovations Fund financed seventeen such ventures for a total cost of about $500,000. These projects include social marketing efforts, initiatives to introduce emergency contraception, and support for private sector provision of reproductive health services.

Britain is among the few donors who provide substantial support for contraceptive commodities. In 1996, the British aid program spent close to $10 million on contraceptive commodities of all kinds. In response to individual government requests, DFID regional offices handle most commodity-related programs, including procurement and shipping of contraceptives at bulk prices. The British government also supports special programs to introduce new contraceptives, such as the female condom, into diverse settings. In 1997, DFID arranged two large shipments of female condoms to Zambia and Zimbabwe.

5 Technical Capacity

Staffing:

British staff expertise in health and population is concentrated in the field, while a small core of technical staff provide support and direction from London. The allocation of field staff is heavily weighted toward Africa, which has as many health and population experts as Asia and Central Europe combined. Field staff bear primary responsibility for coordination at the country level with other donors working in reproductive health. Efforts at donor coordination vary significantly by country, depending on the extent of population-related donor activity.

Technical Expertise of Collaborating Institutions:

The network of reproductive health institutions collaborating with the British aid program has evolved and matured over the past decade. The British aid program has undertaken special initiatives to foster the development of technical capacity among NGOs and academic institutions, including phasing out the long-standing practice of providing general support to cooperating organizations. The new approach to building "consultancy organizations" closely mirrors the U.S. model of providing restricted or project-specific funding to collaborating agencies, usually on a competitive basis.

Recently established "resource centers" in collaborating institutions provide a mechanism to access technical expertise in reproductive health. In 1996, DFID provided $9.5 million to specific reproductive health resource centers, to "access, develop and expand expertise of UK professionals, build NGO capacity and conduct public information activities." Options, a subsidiary of Marie Stopes International (MSI), currently administers the Resource Center for Reproductive Health, while International Family Health, another NGO, manages the HIV/AIDS and STD resource center. DFID indicates plans to eventually combine these two centers.

DFID has also funded training through the resource centers for prospective consultants in areas such as social marketing of contraceptives, where British technical know-how is still limited. This trend towards building the capacity of the technical institutions which support the British reproductive health program is expected to continue–with an increasing focus on development of expertise in developing countries. Available technical resources are thus likely to grow both in number and in depth of expertise.