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Matrix of major donor government structures and mechanisms for financing the HIV / AIDS response in low and middle income countries.
Menlo Park, California, Henry J. Kaiser Family Foundation, .  p.Donor governments provide multiple types of financial and other assistance to address HIV/AIDS in low and middle income countries, including grants, loans, concessional loans, commodities, and technical assistance. In addition, international assistance is provided through both bilateral and multilateral channels, and some mix of the two, reflecting donor decisions, capabilities, and preferences. Donor funding strategies and mechanisms also differ across several other dimensions, including funding cycles, regional focus, types of aid recipient, and period over which funding is committed and disbursed. Understanding such differences across donors is important for gaining a fuller picture of the international response to the epidemic. (excerpt)
New York, New York, UNFPA, 2005.  p.Population dynamics and reproductive health are central to development and must be an integral part of development planning and poverty reduction strategies. Promoting the goals of the United Nations Conferences, including those of the International Conference on Population and Development (ICPD), is vital for laying the foundation to reduce poverty in many of the poorest countries. At the ICPD in 1994, the international community agreed that US $17 billion would be needed in 2000 and $18.5 billion in 2005 to finance programmes in the area of population dynamics, reproductive health, including family planning, maternal health and the prevention of sexually transmitted diseases, as well as programmes that address the collection, analysis and dissemination of population data. Two thirds of the required amount would be mobilized by developing countries themselves and one third, $6.1 billion in 2005, was to come from the international community. (excerpt)
IPPF OPEN FILE. 1994 Jun; 1.The 1994 Human Development Report from the United Nations Development Program (UNDP) proposes a 20-20 Human Development Compact based on shared responsibilities between poor and rich nations, whereby poor and rich nations would help unmet basic human development needs such as primary education, primary health care, safe drinking water, and family planning over the next 10 years. This would require an additional US $30 to US $40 billion annually. Developing countries would commit 20% of their budgets to human priority concerns instead of the current 10% by reducing military expenditure, selling off unprofitable public enterprises and abandoning wasteful prestige projects. Donor countries would increase foreign aid from the current average of 7% to 20%. The report will propose a new concept of human security at the World Summit for Social Development to be held in March 1995, calling widespread human insecurity a universal problem. On average, poor nations have 19 soldiers for every one doctor. Global military spending has been declining since 1987 at the rate of 3.6% a year, resulting in a cumulative peace dividend of US $935 billion from 1987 to 1994. But this money has not been expended on unmet human needs. India ordered fighter planes at a cost that could have provided basic education to the 15 million Indian girls now out of school. Nigeria bought tanks from the UK at a cost that could have immunized all 2 million unimmunized children while also providing family planning to nearly 17 million couples. UNDP proposes a phasing out of all military assistance, military bases, and subsidies to arms exporters over a 3-year period. It also recommends the major restructuring of existing aid funds, and proposes a serious study on new institutions for global governance in the next century.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1994; 72(4):639-51.The examination of the external assistance to the health sector quantified the sources and recipients of such assistance in 1990 by analyzing time trends for external assistance to the health sector over the preceding two decades, and, by describing the allocation of resources to specific activities in the health sector. The health sector external assistance data were collected through a questionnaire and follow-up visits to all major bilaterals, multilaterals, and large nongovernmental (NGO) agencies. The three major databases on development assistance were also used: the Organization for Economic Cooperation and Development (OECD) Development Assistance Committee (DAC) annual tables, the Creditor Reporting System (CRS) from OECD, and the Register of Development Activities of the United Nations system. From 1972 to 1980, there was a sustained increase in external assistance by 14% per year. Beginning in 1986, the pace of increase was lower than in the 1970s but had averaged 7% per year in both bilateral and multilateral agencies. In 1990 in developing countries, health external assistance totaled $4800 million, or only 2.9% of total health expenditures in developing countries. 82% of this sum originated from public coffers in developed countries and 18% from private households. Resources to the health sectors of developing countries included: 40% through bilateral development agencies, 33% through United Nations agencies, and 8% through the World Bank and banks such as the Asian Development Bank. Nongovernmental Organizations (NGOs) accounted for 17%, and 1.5% came from foundations. The USA accounted for 27.5% of all assistance, France for 12.9%, and Japan for 11.5%. One quarter of all health sector assistance was paid for by Sweden, Italy, Germany, and the United Kingdom. The study confirms prior findings that health status variables per se are not related to the amount of aid received. Comparing investments to the burden of disease shows tremendous differences in the funding for different health problems. A number of conditions are comparatively underfinanced, particularly noncommunicable diseases and injuries.
[Unpublished] 1991.  p.Jose G. Rimon, II, Project Director for the Johns Hopkins University Population Communication Services (JHU/PCS) Center for Communication Programs, visited Finland to attend a NORPLANT planning meeting. Meeting discussion focused upon issues involved in expanding NORPLANT programs from pre-introductory trials to broader national programs. Financing and maintaining quality of care were issues of central importance for the meeting. Participants included representative from NORPLANT development organizations, the U.S. Agency for International Development, the World Bank, and other donor agencies. Mr. Rimon was specifically invited to make a presentation on the role of information, education, and communication (IEC) on NORPLANT with a focus upon future IEC activities. The presentation included discussion of the need to develop a strategic position for NORPLANT among potential customers and within the service provide community, the feasibility of global strategies positioning in the context of country-specific variations, the need to identify market niches, the need for managing the image of NORPLANT, and the need to study IEC implications in terms of supply-side IEC, content/style harmonization, materials volume, and language and quality control. Participants collectively agreed to develop an informal group to address these issues, concentrating upon universal issues potentially addressed on a global scale. A meeting on strategic positioning is scheduled for August 19-20, 1991.
AMERICAN JOURNAL OF PUBLIC HEALTH. 1990 Oct; 80(10):1188-92.Health trends since 1950 in both developed and developing countries are classified and discussed in terms of causative factors: socioeconomic development, cross-national influences and growth of national health systems. Despite the vast differences in scale of health statistics between developed and developing countries, economic hardships and high military expenditures, all nations have demonstrated significant declines in life expectancy and infant mortality rates. Social and economic factors that influenced changes included independence from colonial rule in Africa and Asia and emergence from feudalism in China, industrialization, rising gross domestic product per capita and urbanization. An example of economic development is doubling to tripling of commercial energy consumption per capita. Social advancement is evidenced by higher literacy rates, school enrollments and education of women. Cross-national influences that improved overall health include international trade, spread of technology, and the universal acceptance of the idea that health is a human right. National health systems in developing countries are receiving increasing shares of the GNP. Total health expenditure by government is highly correlated with life expectancy. The view of the World Bank and the International Monetary Fund that health care should be privatized is a step backward with anti-egalitarian consequences. The UN Economic Commission for Africa attacked the IMF and the World Bank for promoting private sector funding of health care stating that this leads to lower standards of living and poorer health among the disadvantaged. Suggested health strategies for the future should involve effective action in the public sector: adequate financial support of national health systems; political commitment to health as the basis of national security; citizen involvement in policy and planning; curtailing of smoking, alcohol, drugs and violence; elimination of environmental and toxic hazards; and maximum international collaboration.
In: Methodological foundations for research on the determinants of health development, by World Health Organization [WHO]. [Geneva, Switzerland], WHO, Office of Research Promotion and Development, 1985. 1-7. (RPD/SOC/85)Health development planning is part of overall development planning and is influenced by the total development process. Those dealing with health planning may present the health sector's development as the most important aspect of development whereas there may be more urgent problems in other sectors. All socioeconomic plans aim at improving the quality of life. There is some correlation between spending on health programs and the health indices. The health indices are poor in countries which accord low priority to health. A table gives measure of health status by level of GNP/capita in selected countries. No direct correlation appears between income and mortality. This paper examines the functions of health development planning; health development plans; intersectoral collaboration; health information; strategy; financial aspects; implementation, evaluation and reprogramming; and manpower needs. A health development plan usually includes an analysis of the current situation; a review of the immediate past plan and previous plans; the objectives, strategy, targets and physical infrastructure of the plan; program philosophy with manpower requirements; financial implications; and the role of the private sector and nongovernment organizations and related constraints. The main health-related determinants include: education, increased school attendance, agriculture and water, food distribution and income, human resources programs and integrated rural development. The strategy of health sector development today is geared towards development of integrated health systems. Intercountry coordination may be improved with aid from the WHO. Health expenditures in countries including Bangladesh, India and Norway is presented.
New York, New York, Population Council, Center for Poplicy Studies, 1985 Aug. 42 p. (Center for Policy Studies Working Papers No. 113)This analysis of family planning program funding suggests that current funding levels may be inadequate to meet projected contraceptive and demographic goals. Expenditures on organized family planning in less developed countries (excluding China) totaled about US$1 billion in 1982--about $2/year/married woman of reproductive age. Cross-sectional analysis indicates that foreign support as a proportion of total expenditures decreases with program duration. Donor support to family planning in less developed countries has generally declined from levels in the late 1970s. This is attributable both to positive factors such as program success and increased domestic government support as well as requirements for better management of funds and the worldwide economic recession. Foreign assistance seems to have a catalytic effect on contraceptive use only when the absorptive capacity of family planning programs--their ability to make productive use of resources--is favorable. The lower the stage of economic development, the less visible is the impact of contraceptive use or fertility per investment dollar. On the other hand, resources that do not immediately yield returns in contraceptive use may be laying the foundation for later gains, making increased funding of family planning programs an economically justifiable investment. The World Bank has estimated that an additional US$1 billion in public spending would be required to fulfill the unmet need for contraception. To increase the contraceptive prevalence rate in developing countries to 58% (to achieve a total fertility rate of 3.3 children) in the year 2000 would require a public expenditure on population programs of US$5.6 billion, or an increase in real terms of 5%/year. Improved donor-host relations and coordination are important requirements for enhancing absorptive capacity and program performance. A growing willingness on the part of donors to allow countries to specify and run population projects has been noted.
International Journal of Health Services. 1985; 15(2):275-99.Until the mid 1960s, Latin American health system reflected the skewed distribution of wealth in the region: most health resources were found in curative care medicine and were concentrated in the capital cities, where they primarily served the needs of the elite. For many countries, however, the 1964 Pan American Health Organization's (PAHO) efforts to introduce health planning, intended as a 1st step in rationalizing the health sector, marked a fundamental turning point in the structural development of their delivery systems. Guatemala, however, was and remains an exception. Its technocrats have proven unable to plan effectively; no single entity is responsible for health sector planning, and the 5-year plans have come to consist of disjointed mini-plans, each reflecting the aims, desires and goals of a particular vested interest group or institution. The Guatemalan oligarchy has proven unwilling to appropriate the resources necessary to effect change. The reforms that have been made have been the products of bilateral and multilateral agencies such as the InterAmerican Development Bank, USAID, UNICEF, Kreditanstaldt and PAHO, which have conceptualized, promoted, designed, built and underwritten them. Those changes have not altered the fundamental structure of the system, but instead have been tacked onto it, and exemplify what may be termed additive reform. The government of Guatemala's own commitment to these outside agency funded projects is reflected in the recurrent shortfall of current or operating funds, and in the rapid depreciation of facilities. Evidence suggests that without the continued sponsorship, support, and guidance of the bilateral and multilateral agencies, even these additive reforms will not last.
World Development. 1985 Apr; 13(4):557-69.In August 1984, the second International Conference on Population took place in Mexico City. The substantive discussions confirmed that the population-development debate of the 1970s has faded and that the center of influence within the population movement has shifted from the West toward the developing countries. They also pointed toward a growing commitment among the developing countries to address population issues and probably led to an increased willingness among the developed nations to continue providing sizeable financial aid for this purpose. Overall, they suggested that large United Nations gatherings are not inevitably prevented from yielding results of substantive significance by the political haggling that so often plagues them. (EXCERPT)
Washington, D.C., World Bank, 1984. 13 p.An overview of the global economy is provided, with particular attention to the 3rd world, and focusing on 4 economic issues that deserve priority in 1984 and for some years to come: improving economic policy and performance in the industrial countries; liberalizing trade; reviving international capital flows; and improving economic policy in the developing countries. According to the Organization for Economic Cooperation and Development, the industrial countries as a group are likely to achieve economic growth of 3.5% in 1984, up from 2.25% in 1983 and negative growth in 1982. The World Bank estimate is that the developing countries will average growth of 3-3.5% in 1984, up from less than 1% in 1983 and less than 2% in 1982. Yet, since population is growing more than 2% a year in the developing countries, average per capita income actually fell in 1982-83 and will increase only modestly in 1984. Economic conditions vary greatly among the developing countries. 1 priority issue, clearly, is improved economic policies and performance in the industrial countries so that they can translate their current recovery into sustained and noninflationary growth. To move from recovery into a sustained period of economic expansion, the industrial countries need to create an environment conducive to structural change. Sustained and rapid growth will require further liberalization of international trade, and this is another priority issue. Barriers to trade must be reduced, including trade between the industrial and developing countries. Trade with developing countries is vitally important to the industrial countries. For the developing countries, growing exports to the industrial countries are essential for the recovery of growth and credit worthiness. For the world's low income countries, particularly sub-Saharan Africa, effective programs of official development assistance are essential. So the World Bank will continue to urge governments to increase their International Development Association (IDA) contributions. Strengthening IDA will be difficult, but it is essential. The slump in commercial bank lending and direct investment, along with very slow growth in official lending and development assistance, has forced the developing countries to cut imports. Looking ahead, it is expected that most developing countries will continue to be able to import more than they export and that the negative net transfers for medium- and longterm lending from private sources will continue to decline gradually. The debt crisis has had a most damaging effect on the private sector in the developing world. Developing countries must pursue economic policy reform urgently and tenaciously, for it is absolutely fundamental to the resumption of their economic and social progress.
Paris, Development Centre of the Organisation for Economic Co-operation and Development, 1981. 106 p. (Development Centre Studies)This study examines various institutional aspects of the manner in which developing countries supported by aid agencies are identified, financed, and appraised, arguing that adequate domestic capacity for policy analysis, resource allocation, project selection and management is indispensable, yet donors, lenders, and recipients have not always succeeded in building the required institutions and systems. In part this is because the issue has been regarded as too sensitive. It is also partly because its long run importance has not been recognized. In addition it is argued that this is a major reason for the mutual disenchantment with aid. As the 1980 decade begins the situation is serious, for aid weariness has passed into a state of quiet crisis. Aid is not the issue it used to be when it was believed that a level of 1% of gross national product (GNP) would make a significant difference, and in particular when there was hope for a 2% level once the original commitment was fulfilled. World Bank estimates suggest that the average level of aid will at best reach 0.35% in the mid 1980s. In the developed nations disbelief in development assistance is spreading as a consequence of their own reduced growth and a lack of evidence of the effectiveness of aid except as humanitarian relief. The developing countries increasingly regard aid as a substitute, however important, for changes in the international system which could provide a sufficient condition for development. During the course of the study, 6 major questions are addressed: to what extent have project appraisal techniques been adopted by administrative units in developing countries, given the pressure to use them as a way to ensure a more efficient use of aid; to what extent do factors other than decision making techniques predetermine the outcome of investment appraisals; in which ways do project selection methods influence the development of the institutions where they are applied; does the present emphasis on poverty require development of new types of institutions and how far should project selection criteria be adapted to meet the multiple goals of rural development; how can external manpower, in the form of consultants, best be used to develop domestic institutions, and can external assistance be used to strengthen these institutions and hence project selection and what form might this take. The study is based on experience gained with the Swedish International Development Authority and during secondment in 1973-76 to the Development Centre of OECD for work on project analaysis in developing countries. 1 chapter describes the project selection process in the developing countries of Brazil, Nigeria, Peru, Tanzania, and Thailand. Subsequent chapters dealt with the role of bilateral and selected multilateral agencies and rural development planning.
[Unpublished] . 10 p.At this time the urgent need for a wide spectrum of population activities in developing countries is fully recognized as the legitimate concern of governments and the international community. Technical cooperation and financial assistance are provided to these countries from a large variety of intergovernmental, governmental, and nongovernmental sources of international population assistance. This discussion of international population assistance reviews the following: current levels of population assistance; sources of population assistance; types and areas of assistance; and setting priorities. Total international assistance for population activities amounted to only about US$2 million in 1960 and US$18 million in 1965. It increased rapidly to US$125 million in 1970 and to an estimated net amount, excluding double counting, of around US$450 million in 1970. In 1981 it passed the half billion dollar mark. This marked increase in population assistance is an indication of the growing commitment of many governments and international organizations concerned about collaborating in and contributing to tackling the urgent population problems of the developing world. Nearly 100 governments contributed in 1979 to international population assistance, but the major share comes from less than a dozen countries. The largest contributor, the US, provided US$182 million for population assistance in 1979 amounting to nearly 4% of its total net official development assistance. Over 120 developing countries, or nearly all such countries, received population assistance in some form in 1979. Almost all of them were supported by the UN Fund for Population Activities (UNFPA). The International Planned Parenthood Federation (IPPF) provided support for family planning associations or programs in around 80 developing countries. Almost all donors make their contributions to population assistance in grants, but a few governments also make loans available. Around 72% of total international population assistance is provided in support of family planning activities. The region of Asia and the Pacific received the largest part of the population assistance to countries, namely 50%, followed by Latin America, 19%; Africa, 11%; and the Middle East and Mediterranean, 7%. More and more attention is being devoted to setting priorities in assistance to population programs. This is due, in part, to the fact that the amount of population assistance has not increased sufficiently in recent years to keep up with the growing needs.
Sources of population and family planning assistance. Fontes de assistencia populacional e de planejamento familiar.
Population Reports. Series J: Family Planning Programs. 1983 Jan-Feb; (26):J621-655.This document assesses the current status of population and family planning assistance throughout the world and provides brief sketches of the available sources including national governments, intergovernmental agencies such as the UNFPA and other UN entities, and nongovernmental funding, technical assistance, or funding and technical assistance organizations. The descriptions of aid-granting organizations describe their purposes, sources of funding, and activities, and give addresses where further information may be sought. At present about $100 million of the US $1 billion spent for family planning in developing countries each year comes from individuals paying for their own supplies and services, over $400 million is spent by national governments on their own programs, and about $450 million comes from developed country governments and private agencies. Over half of external assistance appears to be channeled through international agencies, and only a few countries provide a substantial proportion of aid bilaterally. In the past decade several governments, particularly in Asia, significantly increased the share of program costs they assumed themselves, and the most populous developing countries, China, India, and Indonesia, now contribute most of the funding for their own programs. Although at least 130 countries have provided population aid at some time, most is given by 12 industrialized countries. The US Agency for International Development (USAID) is the largest single donor, but the US share of population assistance has declined to 50% of all assistance in 1981 from 60% in the early 1970s. Governments of Communist bloc countries have made only small contributions to international population assistance. Most governmental asistance is in cash grant form, but loans, grants in kind, and technical assistance are also provided. Private organizations give assistance primarily to other private organizations in developing countries, and have been major innovators in research, training and service delivery. Loan assistance is provided by the World Bank for combined health, nutrition, and population projects as well as poupulation education. Although international population assistance from donor governments and private organizations increased from about $165 million in 1971 to about $445 million in 1980, the increase in constant value was only about 10% after inflation. About 2/3 of international assistance goes to family planning services and contraceptives; other activities receiving support are basic data collection, research, and IEC. Greatly increased expenditures will be needed if population stability is to be achieved.