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London, United Kingdom, IPPF, 2015 Oct.  p.With support from the Reproductive Health Supplies Coalition (RHSC) Innovation Fund, the International Planned Parenthood Federation (IPPF) is implementing the National Action for Financing (NAF) project to work with stakeholders to position funding for RH supplies as a critical element in the new development financing architecture. This publication aims to enable stakeholders to understand the implications of the changes and challenges to RH supplies funding. The advocacy messages and tactics described in this document can help influence decision-making, increase funding and improve access to RH supplies and Sexual and Reproductive Health and Rights (SRHR). (Excerpt)
Lancet. 2010 Oct 30; 376(9751):1439-40.This commentary discusses how the pledges to the Global Fund to Fight AIDS, Tuberculosis and Malaria from countries, the private sector, and innovative funding sources have fallen short of the demand estimates, despite the pledged sum being the largest amount ever mobilized for global health. The US $11.7 billion pledge for the 2011-2013 time range is an increase of more than 20% over 2007-2010 and will go toward maintaining programs at their current scale and support further significant expansion of health services in many countries. It explains that the shortfall to meet the $13 billion will result in challenging decisions about which new programs to support and a slower rate of scale-up for new programs.
Stakeholders' opinions and expectations of the Global Fund and their potential economic implications.
AIDS. 2008 Jul; 22 Suppl 1:S7-S15.OBJECTIVES: To analyse stakeholder opinions and expectations of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and to discuss their potential economic and financial implications. DESIGN: The Global Fund commissioned an independent study, the '360 degrees Stakeholder Survey', to canvas feedback on the organization's reputation and performance with an on-line survey of 909 respondents representing major stakeholders worldwide. We created a proxy for expectations based on categorical responses for specific Global Fund attributes' importance to the stakeholders and current perceived performance. METHODS: Using multivariate regression, we analysed 23 unfulfilled expectations related to: resource mobilization; impact measurement; harmonization and inclusion; effectiveness of the Global Fund partner environment; and portfolio characteristics. The independent variables are personal and regional-level characteristics that affect expectations. RESULTS: The largest unfulfilled expectations relate to: mobilization of private sector resources; efficiency in disbursing funds; and assurance that people affected by the three diseases are reached. Stakeholders involved with the fund through the country coordinating mechanisms, those working in multilateral organizations and persons living with HIV are more likely to have unfulfilled expectations. In contrast, higher levels of involvement with the fund correlate with fulfilled expectations. Stakeholders living in sub-Saharan Africa were less likely to have their expectations met. CONCLUSIONS: Stakeholders' unfulfilled expectations result largely from factors external to them, but also from factors over which they have influence. In particular, attributes related to partnership score poorly even though stakeholders have influence in that area. Joint efforts to address perceived performance gaps may improve future performance and positively influence investment levels and economic viability.
Getting down to business. Expanding the private commercial sector's role in meeting reproductive health needs.
Washington, D.C., Population Action International, 1999. 76 p.Around the world, there is an emerging consensus that private enterprise is the engine of economic growth and development. Market forces are widely accepted as the most dynamic and efficient mechanisms for meeting society's demands for goods and services, especially in the productive economic sectors such as agriculture and industry. Even in the social sectors, where governments have traditionally played a greater role, there is growing recognition that the private for-profit sector can help meet the public's demand for education and health care. In reproductive health, as in other areas of health care, the private sector's potential importance lies in the inadequacy of public funding relative to growing needs. New and innovative approaches involving the private sector are required to bridge this gap between stagnating financial resources and the rapidly increasing demand for reproductive health care. Yet in most developing countries, the private sector is not fulfilling its potential to help meet reproductive health needs, often because governments have not created a sufficiently supportive environment. Developing country governments and international donor agencies do not adequately appreciate the private sector's contribution to reproductive health. Most governments and donors lack awareness of how their own policies and programs either encourage or deter the private sector from playing a larger role in reproductive health. (excerpt)
Africa Renewal. 2005 Jul; 19(2):18, 20.Africa deserves and requires more external assistance to ensure the success of its New Partnership for Africa’s Development (NEPAD), argues a special advisory panel on international support for Africa. “NEPAD cannot succeed without a significant increase in support from the international community,” said Chief Emeka Anyaoku, the chair of the panel, who submitted its recommendations to UN Secretary- General Kofi Annan on 3 June. Not only do developed countries need to increase their support in such diverse areas as aid, debt relief, market access and capital flows, says the UN Secretary-General’s Advisory Panel on International Support for the New Partnership for Africa’s Development, but they also must ensure that such backing is coordinated and that progress in one area is not counteracted by shortfalls in another. (excerpt)
Consultative meeting on "Accelerating an AIDS Vaccine for Developing Countries: Issues and Options for the World Bank", Paris, April 13, 1999.
[Unpublished] 1999. 7 p.The World Bank’s AIDS Vaccine Task Force sponsored a meeting at the World Bank European office in Paris on Tuesday, April 13, 1999, to consult with key shareholders, bilateral and multilateral donors, and representatives from developing countries on ways that the World Bank could accelerate the development of an AIDS vaccine that would be effective and affordable in developing countries. The 32 participants included representatives from the North and South, from AIDS control programs, foreign affairs ministries, and ministries of finance, both technical experts and policy makers. An issues paper, “Accelerating an AIDS vaccine for developing countries: Issues and options for the World Bank”, served as background for the meeting. (excerpt)
Consultative meeting on: "Accelerating an AIDS vaccine for developing countries: issues and options for the World Bank", Regent Hotel, Bangkok, Thailand, Monday, May 24, 1999. Report.
[Unpublished] 1999 Jun 29. 10 p.The World Bank’s AIDS Vaccine Task Force sponsored a meeting in Bangkok at the Regent Hotel on Monday, May 24, to consult with key Thai policymakers on ways that the World Bank could accelerate the development of an AIDS vaccine that is effective and affordable in developing countries. The 26 participants included representatives from the Ministry of Public Health, the National Economic and Social Development Board (NESDB), the Government Pharmaceutical Organization (GPO), the Food and Drug Administration (FDA), and private vaccine industry. On Tuesday, May 25, briefings were held for UN agencies and for non-governmental organizations. An issues paper, “Accelerating an AIDS vaccine for developing countries: Issues and options for the World Bank”, served as background for the meeting. (excerpt)
Accelerating an AIDS vaccine for developing countries: issues and options for the World Bank. Revised draft.
[Unpublished] 1999 Jul 8. 18 p.This paper reviews what the AIDS Vaccine Task Force has learned to date about the nature of the problem of under-investment in an HIV/AIDS vaccine for developing countries, and summarizes some of the approaches under consideration. Its objective is to launch a discussion within the World Bank, and – critically – with its bilateral, multilateral, and developing country partners, on the best course of action for the institution, given its mandate, its comparative advantages in relation to the other agencies involved in the international effort, and the likely effectiveness of alternative measures for accelerating the development of an HIV/AIDS vaccine for developing countries. (excerpt)
World Bank Task Force on Accelerating the Development of an HIV / AIDS Vaccine for Developing Countries. HIV vaccine industry study, October-December 1998. Draft.
[Unpublished] 2000 Mar 20. 13 p.Industry’s decision to invest in the development of a vaccine is a function of the risks and uncertainty of “cracking the science” to develop a viable product and the promise of the future market and revenue stream. Although vaccines have proven to be one of the most cost-effective intervention available to control disease with measles, polio, Diphtheria-Pertussis-Tetanus, BCG and tetanus toxoid 5 vaccines preventing 3 million deaths per year in developing countries, they represent less than 2% of the total pharmaceutical market. The availability of these vaccines to the world is dependent on the capacity and pricing decisions of industry. Development of new vaccines against diseases such as HIV/AIDS, malaria and tuberculosis will also depend on the investment decisions of industry. Unfortunately, investment in the development of these high priority new vaccines is low. Understanding industry’s perception of the risks and potential returns for specific vaccines is essential for public sector agencies such as the World Bank. With this information, the Bank and other partners can work with agencies and private industry to develop new strategies which “push” the development of these priority products by reducing the cost or risk of investment or “pull” them by providing market incentives. In April 1998, the World Bank created a Bank-wide AIDS Vaccine Task Force to explore the market failure resulting in under-investment in an HIV/AIDS vaccine. The Task Force commissioned a study by Mercer Management to understand the biotechnology, vaccine and pharmaceutical industries’ perspectives on R&D investment in an HIV vaccine for developing countries. The study was conducted during the fall of 1998 and was co-funded by the International AIDS Vaccine Initiative (IAVI). (excerpt)
Preliminary ideas on mechanisms to accelerate the development of an HIV / AIDS vaccine for developing countries.
[Unpublished] 1999 Jul 28. 11 p.The World Bank is fully committed to combat the AIDS epidemic, and has been doing so since 1986 through four fronts: (a) its lending program; (b) its grants program; (c) policy dialogue; and (d) research. Through its lending program, the Bank has financed 81 AIDS projects and project components in 51 countries for a total of US $989 million. Most funding has been through IDA credits. Projects focus on targeted, cost-effective, and efficacious preventive activities, including: information, education and communication (IEC) for behavior change, condom promotion and distribution, sexually transmitted infection (STI) treatment, blood safety, and for the reduction of mother-to-child transmission. Although the focus has been on prevention of HIV infection, some projects also provide treatment for opportunistic infections, tuberculosis, and malaria. Through its Development Grant Facility (DGF), the Bank has provided financing for the WHO Global Programme on AIDS (GPA, the predecessor of UNAIDS) and UNAIDS in the amount of US $18.0 million since FY 1986. The DGF has also contributed to the International AIDS Vaccine Initiative (IAVI), a private, non-profit organization established in 1996 to ensure the development of safe, effective preventive HIV vaccines for use world-wide, contributing a total of US $1.74 million since its inception. The Bank provided an additional US $400,000 to IAVI through the Global Forum for Health. SIDALAC, a Latin American research initiative on HIV/AIDS, received a US $500,000 grant in 1995, and currently receives earmarked funds through UNAIDS of up to US $430,000 per year. And, through its small grants program, the Bank has financed AIDS-related activities in Africa and Asia for a total of US $56,000. (excerpt)
[Unpublished] 2000 Apr. 11 p.Malaria, tuberculosis, and the strains of AIDS common in developing countries kill five million people each year. Over the last 50 years, these diseases have killed six times as many people as have died in all wars. Yet research on vaccines for these diseases remains minimal. This is in large part because R&D on vaccines is a global public good in which no one country has sufficient incentive to invest. It is also because these diseases primarily affect poor countries, and therefore potential vaccine developers believe they will be unable to sell enough vaccine at a sufficient price to recoup their research costs. World Bank president James Wolfensohn recently said that the institution plans to create a $1 billion fund to help countries purchase specified vaccines if and when they are developed. Such a fund could help ensure that there would be a market for malaria, tuberculosis, or AIDS vaccines if they were developed, and thus would create incentives for vaccine research. It could also help ensure that any vaccines developed would be affordable in poor countries. The program would be highly focused on areas of deep poverty and would be highly cost effective. (excerpt)
New York, New York, United Nations Population Fund [UNFPA], 1994. ix, 92 p. (Technical Report No. 16)In 1989, the UN Population Fund (UNFPA) began its "Global Initiative" to estimate "Contraceptive Requirements and Logistics Management Needs" throughout the developing world in the 1990s. After the initial study was completed, 12 countries were chosen for the preparation of more detailed estimates with information on program needs for logistics management of contraceptive commodities, options for local production, the involvement of nongovernmental organizations (NGOs) and the private sector in the supply of contraceptives, condom requirements for sexually transmitted disease (STD)/HIV/AIDS prevention, and financing issues. The fact-finding mission to Viet Nam took place in 1993. This technical report presents a consensus of the findings and conclusions of that mission. After an executive summary and introductory chapter, which discusses population and family planning and the AIDS epidemic in Viet Nam, chapter 2 covers contraceptive requirements including longterm forecasting methodology, projected longterm contraceptive commodity requirements, short-term forecasting and requirements, and forecasting of condom requirements for HIV/AIDS prevention. Logistics management is considered next, with emphasis on public and private organizations which participate in contraceptive distribution, procurement, and allocation to outlets; the reception, warehousing, and distribution of contraceptives; warehousing regulations; the logistics management information system; and monitoring. Chapter 4 deals with contraceptive manufacturing and discusses the regulatory environment and quality assurance, condoms, IUDs, oral and other steroidal contraceptives, and related issues. The fifth chapter presents the role of NGOs and the private sector and discusses mass organizations, social marketing, and future private-sector options, opportunities, and constraints. A financial analysis provided in chapter 6 relays sources and use of funds, trends in financial contributions for 1985-2000, future funding requirements, and contraceptive cost implications for individuals. The final chapter considers condom programming for HIV/AIDS prevention with information given on current status and patterns; projected trends; the National AIDS committee; an overview of international donor assistance; major condom distribution channels and outlets, condom demand-generation activities, forecasting requirements for 1993-2002, and condom supply activities. A summary of key knowledge, attitude, and practice findings about AIDS and condoms is appended as is additional information on contraceptive requirements and condom programming for HIV/AIDS prevention. The report contains 17 tables and 1 figure, and 18 specific recommendations are made for the topics covered.
New York, New York, United Nations Population Fund [UNFPA], 1994. x, 122 p. (Technical Report No. 17)In 1989, the UN Population Fund (UNFPA) began its "Global Initiative" to estimate "Contraceptive Requirements and Logistics Management Needs" throughout the developing world in the 1990s. After the initial study was completed, 12 countries were chosen for the preparation of more detailed estimates with information on program needs for logistics management of contraceptive commodities, options for local production, the involvement of nongovernmental organizations (NGOs) and the private sector in the supply of contraceptives, condom requirements for sexually transmitted disease (STD)/HIV/AIDS prevention, and financing issues. The fact-finding mission to the Philippines took place in 1993. In the introductory chapter of this technical report, the Global Initiative is described and the Philippine Population Program is presented in terms of the demographic picture, the population policy framework, the Philippine Family Planning (FP) Program, STD/AIDS control and prevention efforts, and an overview of donor assistance from 1) the UNFPA, 2) USAID, 3) the World Bank, 4) the Asian Development Bank, 5) the Australian International Development Assistance Bureau, 6) the Canadian International Development Agency, 7) the Commission of the European Community, 8) the International Planned Parenthood Federation, 9) the Japanese International Cooperation Agency, and 10) the Netherlands. The second chapter presents contraceptive requirements including longterm forecasting methodology, projected longterm commodity requirements, condom requirements for STD/AIDS prevention, total commodity requirements for 1993-2002, short-term procurement projections, and projections and calculations of unmet need. Chapter 3 covers logistics management for 1) the public sector, 2) condoms for STD/AIDS preventions, 3) NGOs, and 4) the commercial sector. The fourth chapter is devoted to a consideration of private practitioners and a detailed look at the ways that NGOs relate to FP groups. This chapter also covers the work of NGOs in STD/AIDS prevention and coordination and collaboration among NGOs. Chapter 5 is devoted to the private commercial sector and includes information on social marketing, the commercial sector, and duties and taxes. The issues addressed in chapter 6 are contraceptive manufacturing and quality assurance, including the potential for the local manufacture of OCs, condoms, IUDs, injectables, and implants. The national AIDS prevention and control program, the forecasting of condom requirements for STD/AIDS prevention, and policy and managerial issues are considered in chapter 7. The last chapter provides a financial analysis of the sources and uses of funds for contraceptives including donated commodities, the private commercial sector, cost recovery issues, and regulations and policies, such as taxes and duties on donated contraceptives, which affect commodities. 5 appendices provide additional information on contraceptive requirements, logistics management and costs, the private commercial sector, condoms for STD/AIDS prevention, and a financial analysis. Information provided by the texts and appendices is presented in tables and charts throughout the report.
Intermediating development assistance in health: prospects for organizing a public/private investment portfolio.
Washington, D.C., Family Health, 1980 July 23. 162 p.The objective of this study is to identify and assess the potential role of intermediary organizations in furthering AID health assistance objectives. The 1st section of this report is an introduction to the potential roles of intermediaries through health assistance via the private voluntary community. A background of the private voluntary organizations is discussed along with some of the constraints that may impede their activity, such as competing interests, values and priorities. The following section defines what is and should be an intermediary organization along with examples of certain functions involved; a discussion of the experience of AID in the utilization of intermediaries follows. 3 models of utilization of intermediaries are analyzed according to the rationale involved, strategy, advantages and constraints. The 3rd section attempts to define and identify AID's needs for programming its health assistance in regard to primary health care, water and sanitation, disease control and health planning. A detailed analysis of the potential roles of intermediary organizations is discussed in reference to policy development, project development and design, project implementation, research, training and evaluation. The 4th section identifies the programming strengths and interests among listed private voluntary organizations in the US. The 5th section discusses the potential of intermediaries in health assistance in reference to the options for funding them in health and the constraints to direct AID funding of intermediary organizations. The last section discusses a series of recommendations made in regard to the development and funding of an international effort to marshall private resources in support of health assistance. Problems and constraints, as well as resources and opportunities, for the development of this international effort are further discussed.
London, FPA, 1972. 48 p.Currently, public authorities pay for almost 2/3 of the family planning consultations conducted by the Family Planning Association, and this is the most significant development since the publication of the last Family Planning Association Report. Additionally, more local health authorities are operating direct clinic and domiciliary services. The Family Planning Association handed over the management of 39 clinics to public authorities in the 1971-1972 year. However, despite this progress, family planning service provision by public authorities throughout England continues to be uneven in quality and extent. Spending by local health authorities for each woman at risk varies from 1 penny per woman at risk in Burnley (excluding the city of London) to 179 pence at Islington. In addition to the problem of inconsistency in spending, there appears to be no immediate prospect of a comprehensive family planning service - one that is available to all, is free of charge, and is backed by an adequate education campaign. Although government help for the extension of domiciliary family planning service is impressive, it should not obscure the false economies in spending on other contraceptive delivery services such as general practitioners, specialist clinics, and specialized advisory centers. Until the government announces the details of its plans for family planning services within the National Health Service beginning April 1974, the Family Planning Association's own detailed planning cannot be exact. The Association's basic policy continues to be to turn over the responsibility for the management of clinic and domiciliary contraceptive services as quickly and as smoothly as possible to the public authorities. Already there is concern that some clinic services managed by public authorities may become less attractive, particularly to young people, and that differences in the quality of service will increase under local public management as well as that backup services will be neglected. Also existing is the realization that the public authorities do not do enough to attract people to the use of contraception.
AFRICA HEALTH. 1997 Nov; 20(1):7.UNAIDS has launched an 'HIV Drug Access Initiative' in the Ivory Coast, Uganda, Chile, and Vietnam; the pilot project will attempt to improve access to HIV drugs. Public and private sector efforts will be coordinated. The Glaxo Wellcome, Hoffman-La Roche, and Virco pharmaceutical companies will participate. Each country will 1) adapt its present system with regard to HIV and 2) establish both an HIV drug advisory board and a non-profit company which will import the drugs. Health ministries within each country will be required to find sources of funding for the programs. Uganda will probably use funds from its sexually transmitted disease (STD) program, which is supported by the World Bank; the Ivory Coast will combine corporate contributions, new tariffs, and non-profit insurance system monies into a 'solidarity fund.' UNAIDS funds will be used for oversight and evaluation. UNAIDS also released a review of 68 studies which examined the impact of sex education on the sex behavior of young people; it indicated that, in 65 of the studies, sex education did not increase the sexual activity of youth. UNAIDS concluded that quality programs helped delay first intercourse and often reduced the number of sexual partners, resulting in reduced rates of STDs and unplanned pregnancy. UNAIDS further concluded that effective sex education should begin before the onset of sexual activity, and curriculums should be focused. Openness in communicating about sex should be encouraged, and social and media influences on behavior should be addressed. Young people should be taught negotiating skills (how to say 'no' to sex and how to insist on safer sex).
Washington, D.C., Population Action International, 1996 Sep. 13,  p. (Population Action International Occasional Paper No. 2)This paper presents recent trends in donor contributions for international population assistance. The 1994 International Conference on Population and Development (ICPD) spurred a number of donor governments, including the US, to make major new commitments to fund population programs. This commitment is reflected in the large increase in spending between 1993 and 1994. However, recent US cuts to international population assistance have been a major blow to overall population aid levels. This diminished US role could undermine support for population aid in other industrialized countries. For now, the rapid expansion of bilateral programs in important donor countries like Germany, Japan, and the UK has offset the US cuts to some extent. Private foundations have also re-emerged as a significant funding source, while the regional development banks and the European Union (EU) remain largely untapped as sources of population funding. The downturn in overall development assistance has stalled the momentum developed from the ICPD, hindering the chances of reaching the ICPD funding goals. The extent to which each of the following countries provides international population assistance is described: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Ireland, Italy, Japan, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, UK, and the US. The contributions of the EU, the World Bank, the Asian Development Bank, the Inter-American Development Bank, and private sources are also described.
Family planning and maternal and child health in the World Bank's Population, Health and Nutrition Program.
In: Health care of women and children in developing countries, [edited by] Helen M. Wallace, Kanti Giri. Oakland, California, Third Party Publishing, 1990. 548-61.Since 1969, the World Bank has been involved in lending programs for population, health research, and policy formulation. The department designation has undergone changes. The population, health and nutrition (PHN) Department is now the Population and Human Resource Division (PHR) in Country Departments. There are now country PHR divisions supported by 4 technical regional units with PHN expertise. 2% of the entire Bank's lending supports population and health activities. Lending has gradually increased and projections for 1989 are $500 million for 10 projects. In addition, the Bank has been involved with policy dialogue: the Bank has helped to raise the issue of slowing population growth in sub-Saharan Africa through conferences, workshops, and information dissemination at all levels. The importance of their work is in developing an environment for creating demand for family planning and primary health care. More projects are in Africa, but more dollars are in Asia (e.g., India and Pakistan). Improving maternal-child health is more acceptable to Middle Eastern, Latin American, and African countries than focusing on fertility reduction per se. Initial programs centered on expanding basic health services; now it also includes improving efficiency, effectiveness, and rural outreach. Recommendations are to target population groups, improve client/private interaction, flexibility in implementation based on client feedback, and utilization of nongovernmental organizations (NGOs). In 1988, civil projects constituted only 10-40% instead of 40-80% of project resources. Sponsorship serves another function of PHN, including WHO's Reproductive Research Program, Safe Motherhood Conference in 1987 and initiatives, the Task Force for Child Survival, and increasing technical abilities of NGOs.
POPULI. 1993 Jun; 20(6):6-7.The UN Population Fund (UNFPA) assists population programs and activities in 140 countries, with field offices in 95 countries and country directors in 59. Its staff of 801 worked last year on a budget of US $225 million. An evaluation of the Fund's operations was sponsored by the official development agencies of Canada, Finland, and Germany in 1992 and early 1993. Conclusions are based upon reviewed documents, interviews, meetings, and case studies of programs in Bangladesh, Bolivia, Brazil, Egypt, Indonesia, Kenya, and Senegal. Generally, the Fund has succeeded in establishing credibility and promoting population as a critical development issue, but its close ties and dependence upon the sanctions and participation of host governments have kept the Fund from maximizing the potential of nongovernmental organizations (NGO) and the private sector to implement projects. Projects are either supported because of government pressure or are not executed by the best executing agencies; only very limited project execution is conducted through the private sector of NGOs. The Fund should instead encourage competition among UN agencies, NGOs, and private companies interested in executing projects. The Deputy Executive Director agrees with these findings, but holds that their relationship with governments is the result of the UN requirement that the Fund work at the invitation of and through host governments. UNFPA-supported country programs have also relied too heavily on other UN agencies to execute projects which have suffered from poor project management and inadequate and/or poor technical support. Moreover, the evaluation revealed that the UNFPA is overextended and should emphasize helping countries which have already tried to move forward with their population programs. Countries should demonstrate need for assistance in addiction to the proper attitude and practices.
New York, New York, UNFPA, . 88 p.The UNFPA Annual Report provides a regional review of programs, including those that are interregional, a sectoral review, and other activities. The sectoral review covers family planning (FP), IEC, basic data collection, the use of population research for the formation of policy and development planning, women in population and development, special program interests, and population and the environment. Other activities include promotion of awareness and exchange of information, policy and program coordination, staff training and development, evaluations, the International conference on Population and Development, technical cooperation among developing countries, procurement of equipment and supplies, and multibilateral funding of population activities. The appendices include a glossary of terms, the 1991 income and expenditure report, government pledges and payments for 1991, project allocations in 1991 by country and region, governing council decisions for 1991, and 16 resolutions. In spite of the doubling of population from 2 billion in 1960 to 4 billion in 1990, there is optimism because of progress in country's formulation of population policy and programs, i.e., FP use has increased to 51% from 12% to 14% in 1971, and the average number of births has declined 37% from 6 (1965-70) to 3.8. This progress has been accomplished within a short generation, at low cost, and with 70% of the contributions coming from users and country governments in declining economic circumstances. The challenges ahead are dealing with mass poverty and environmental degradation. Actions to reverse the trends should be to change development priorities, attach poverty directly, shift to cleaner technologies, improve the status of women and girls, and include population in development planning. Highlights of 1991 are that income increased 5.6% and pledges 7.2%. The project expenditure rate was 80.6% vs. 80.1% in 1990, and the resource utilization rate was 102.1% vs. 100.2% in 1990. The number and cost of new projects was lower than in 1990. 55 countries were given priority status. Programs were reviewed in 28 countries. There was a 2% increase in professional women staff to 41%.
London, England, International Planned Parenthood Federation [IPPF], 1992 Mar. iv, 81 p.Participants at the October 1991 IPPF seminar on Program Sustainability through Cost Recovery addressed the challenge of continuing to provide even more family planning (FP) services to the poorer segments of society while at the same time ensuring program survival. Field reports indicated a variety of funding sources, including user fees, social marketing programs, income generating schemes unrelated to FP, service agreements with the public sector, and private sources. Fees comprise the most common means of recovering FP program costs, but there is substantial diversity based on the income of the user, location of the service, and type of service provided. In view of field reports presented at the workshop, 6 broad recommendations were developed: 1) any approach to program sustainability must place the needs of the clients first; 2) sustainability should be an integral part of the organization's longterm strategic plan; 3) cost-effectiveness is a requirement; 4) periodic analyses of service costs, overhead costs, and costs per unit of output should be undertaken to monitor cost-effectiveness; 5) greater inter-IPPF cooperation and sharing of experiences should be encouraged; and 6) a business plan is essential for cost recovery. In countries where family planning acceptance is low and donor funds are available, FP associations are urged to focus on resource development rather than cost recovery from users. FP associations that provide health education services are encouraged to derive income from the sales of IEC materials or seminar fees. In some cases, higher fees can be charged for specialized services such as infertility counseling, but care must be taken to avoid diverting the program's emphasis from the primary task of managing the family planning program. The cost recovery schemes selected--fees, sales, insurance, or community fundraising--should always be consistent with the association's role in the national population program.
DEVELOPMENT FORUM. 1992 May-Jun; 20(3):1, 3.Interviewed by Development Forum, the director of UNCED's New York office, Jean-Claude Faby, who has been intimately involved in the negotiations preceding the Earth Summit, discusses his view of the process and expectations of global meeting. Faby explains that during the preparatory process, nongovernmental organizations (NGOs) have played an instrumental role. For example, women have raised issues concerning women, and their efforts are reflected in Agenda 21, the action plan of the Rio Declaration. Although describing the NGOs' critical assessment of the process as a health impatience, Faby notes that the issues to be confronted in Rio are some of the most complicated and vexing environmental and development problems facing the world community. Faby explains that the business community, an important player in the issues at hand, has also taken an active role in the negotiations. Faby acknowledges that the negotiations have witnessed a rift between North and South over the language of the document, a debate that will probably continue during the summit itself. Some of the issues of contention are military spending (a particularly concern of NGOs) and the North's high level of consumption, which the South insists must be addressed. Faby also discusses the issue of implementation and funding following the conclusion of the summit. Although implementation would require some $125 billion (a relatively modest figure), Faby expects that no neat funding package will emerge from Rio. In fact, funding will be one of the primary concerns of the Rio follow-up. Concerning the institutional follow-up of the summit, some are calling for the formation of a new institution, while others oppose such a move.
Report of the Seminar on Programme Sustainability through Cost Recovery, Kuala Lumpur, Malaysia, 21-25 October, 1991.
London, England, IPPF, 1991. 15,  p.In the face of widespread user acceptance, rapidly growing demand, and developing country financial constraints, family planning associations must learn how to operate more efficiently and mobilize new resources with a view to ensuring greater long-term sustainability. Cost recovery was therefore identified as a means of maximizing the use of limited resources, improving program quality, strengthening management, and making service providers more accountable to clients. This document reports results from seminar participants organized to share the benefits of cost recovery with the international community, and to review policy and management issues. Reviewed in the seminar were country experiences with cost recovery, working group discussions on the definition of sustainability, the cost framework of family planning, determining user fees and clients' willingness to pay, preconditions for setting user fees, prerequisites for social marketing, models for cost sharing with the government and private sector, and country case studies from the Gambia, India, and Kenya. Those programs attaining highest self-sufficiency were aided by strong government commitment to either support family planning or to not impede program progress. Also helpful were a businesslike approach to service provision, a strong promotional campaign, organizational structure conductive to effective resource management, and resolve to try diverse approaches. In concluding, the importance of placing the customer first, cost-effectiveness, cost analysis, strategic planning, inter-FPA cooperation, and business plans are mentioned.
FRONT LINES. 1989 Dec; 6, 13.Projects supported by the Directorate for Population (S&T/POP) of the U.S. Agency for International Development and aimed at increasing for-profit private sector involvement in providing family planning services and products are described. Making products commercially available through social-marketing partnerships with the commercial sector, USAID has saved $1.1 million in commodity costs from Brazil, Dominican Republic, Ecuador, Indonesia, and Peru. Active private sector involvement benefits companies, consumers, and donors through increased corporate profits, healthier employees, improved consumer access at lower cost, and the possibility of sustained family planning programs. Moreover, private, for-profit companies will be able to meet service demands over the next 20 years where traditional government and donor agency sources would fail. Using employee surveys and cost-benefit analyses to demonstrate expected financial and health benefits for businesses and work forces, S&T/POP's Technical Information on Population for the Private Sector (TIPPS) project encourages private companies in developing countries to invest in family planning and maternal/child health care for their employees. 36 companies in 9 countries have responded thus far, which examples provided from Peru and Zimbabwe. The Enterprise program's objectives are also to increase the involvement of for-profit companies in delivering family planning services, and to improve the efficiency and effectiveness of private volunteer organizations in providing services. Projects have been started with mines, factories, banks, insurance companies, and parastatals in 27 countries, with examples cited from Ghana and Indonesia. Finally, the Social Marketing for Change project (SOMARC) builds demand and distributes low-cost contraceptives through commercial channels especially to low-income audiences. Partnerships have been initiated with the private sector in 17 developing countries, with examples provided from the Dominican Republic, Liberia and Ecuador. These projects have increased private sector involvement in family planning, thereby promoting service expansion at lower public sector cost.
[Unpublished] 1991. Presented at the Demographic and Health Surveys World Conference, Washington, D.C., August 5-7, 1991. 22 p.A supply-demand approach is used to estimate total and unmet demand for family planning in Indonesia over the last decade. The 1976 Indonesia Fertility Survey, the 1983 Contraceptive Prevalence Survey, and the 1987 National Contraceptive Prevalence Survey form the database used in the study. Women under consideration have been married once, are aged 35-44, have husbands who are still alive, have had at least 2 live births, and had no births before marrying. High demand was found for family planning services, with the proportion of current users and women with unmet demand accounting for over 85% of the population. Marked improvement in contraceptive practice may be achieved by targeting programs to these 2 groups. Attention to unmotivated women is not of immediate concern. Women in need of these services are largely rural and uneducated. Programs will, therefore, require subsidization. The government should gradually and selectively further introduce self-sufficient family planning programs. User fees and private employer service provision to employees are program options to consider. Reducing the contraceptive use drop-out rate from its level of 47% is yet another approach to increase contraceptive prevalence in Indonesia. 33% drop out due to pregnancy, 26% from health problems, 10% because of method failure, 10% from inconveniences and access, and 21% from other causes. Improving service quality could dramatically reduce the degree of drop-outs.