Post-2015 Financing for Reproductive Health Supplies

Publication date: 2015

Post-2015 Financing for Reproductive Health Supplies Rapid Assessment – Advocacy Mapping KAREN HOEHN, LOU COMPERNOLLE, SIBYLLE KOENIG APRIL 2015 DRAFT DRAFT Recommended Citation Hoehn, K; Compernolle, L and S Koenig. Post-2015 Financing for Reproductive Health Supplies; Rapid Assessment – Advocacy Mapping. Reproductive Health Supplies Coalition. Brussels, Belgium. April 2015 DRAFT This resource is in a draft format and is not to be considered final. Whilst it may be shared, please include this disclaimer upon dissemination. Contact Reproductive Health Supplies Coalition Secretariat Rue Marie-Thérèse 21, 1000 Brussels, Belgium Tel: +32 2 210 0222 Fax: +32 2 219 3363 secretariat@rhsupplies.org Karen Hoehn, International Development and Management Consultant Karen.hoehn@gmail.com DRAFT Abstract Although funding for reproductive health (RH) supplies has been increasing, a significant gap persists, despite recognition that investment in SRH is highly cost-effective. Financing commitments agreed to this July by Heads of State at the Third International Conference on Financing for Development (FfD) will guide national government decision-making on development financing for the foreseeable future. Changes proposed to existing financing arrangements present both threats and opportunities for the continued availability of high quality RH supplies. Available data seem to indicate that financing for ICPD and RH supplies mirrors that for ODA overall. Consumer out-of-pocket payments in developing countries represent the largest source of financing for the ICPD costed package. Funding has been increasing from donor governments for FP and RH supplies. Funding appears to be increasing from domestic sources in developing countries and from private companies, though it’s not clear how much of this is own-source funding rather than donor contributions. The analysis details recommendations on ten key issues in the global Financing for Development discourse which are important for RH supplies advocacy: (1) ODA definition expansion will increase RH supply competition for scarce resources; (2) Better data will be needed to assess the increased use of ODA for private sector investment; (3) Increased use of complex new financing mechanisms present transparency and accountability risks; (4) ICPD must be reaffirmed for its central role in achieving sustainable development; (5) New promises to guarantee social protection, essential public services and universal access require that RH supplies be included in nationally defined programmes; (6) Global funds used to finance new social protection guarantees may improve cost-effectiveness of RH supplies procurement but otherwise present major transparency and accountability problems; (7) Increased domestic development country financing for health requires careful design to enable and not hinder access to RH supplies; (8) Promoting gender equality and women’s participation in the labour market requires full access to RH supplies; (9) the challenges of decision-making decentralization to subnational levels of government will continue; (10) disaggregated RH supplies financing data is essential for improving access and outcomes New financing mechanisms, especially those supporting private sector intervention, will be an important part of future financing. The RH community needs to be better prepared to understand and address them. Although advocacy must take place now, the key issues identified in this report will help inform longer-term interventions to ensure quality, equity, access, and rights. 1POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Contents CONTENTS 1 ACRONYMS AND ABBREVIATIONS 3 ACKNOWLEDGEMENTS 5 EXECUTIVE SUMMARY 6 Findings 6 INTRODUCTION, CONTEXT 9 Sidebar 1: Third International FfD Conference, July 2015 9 Sidebar 2: What are RH supplies? 10 1.1 RH Supplies Financing Needs/Gaps 11 1. REPRODUCTIVE HEALTH SUPPLIES FINANCING 11 1.2 Funding for Population Assistance 12 Sidebar 3: ICPD Costed Package 12 1.3 Funding for Family Planning 13 1.4 RH Supplies Financing 14 Sidebar 4: Further Research Required 14 Sidebar 5: Private Sector Involvement in RH Supplies 15 2.1 Financing Framework 17 2. FINANCING FOR DEVELOPMENT 17 Sidebar 6: Key International FfD Accords 17 2.2 Financing Trends 18 Sidebar 7: Innovative Financing 19 Sidebar 8: Blended Financing 21 3. KEY ISSUES – WHERE RH SUPPLY MEETS FFD 22 Sidebar 9: Main FfD Policy Documents 22 3.1 ODA Definition and Targets 23 Sidebar 10: Global Public Goods 23 3.2 Using ODA to Leverage Private Sector Investment 26 Sidebar 11: Public Private Partnerships (PPPs) 26 3.3 Use of Loans 32 Sidebar 12: Development Bank Loans (Part 1) 32 2POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Sidebar 13: Development Bank Loans (Part 2) 33 3.4 Importance of ICPD Financing for Sustainable Development 37 3.5 Guaranteed Social Protection, Essential Public Services and Universal Access 38 Sidebar 14: Global Financing Facility for Every Woman Every Child 38 3.6 Global Funds 42 3.7 Domestic Public Finance and Tax Revenues 44 3.8 Women’s Labour and Human Capital 46 Sidebar 15: Country Ownership 46 3.9 Devolved Decision-Making 47 Sidebar 16: Sub-national Decision-making for RH Supplies 47 3.10 Transparent Data Collection, Monitoring and Follow-up 48 3.11 Additional Issues 50 4. CONCLUDING REMARKS 51 ANNEX 1: ADVOCACY MAPPING 52 Key development financing events, stakeholders and entry points for RHS advocacy 52 ANNEX 2: ANNOTATED BIBLIOGRAPHY 94 ANNEX 3: METHODOLOGY AND DATA CAVEATS 132 Data Caveats 134 ANNEX 4: PROJECT TEAM 137 ANNEX 5: PROJECT GOAL AND OBJECTIVES 139 ANNEX 6: CRS-REPORTED RH SUPPLIES GRANT PROJECT DISBURSEMENTS* 140 ANNEX 7: POPULATION ASSISTANCE LOAN DESCRIPTIONS 143 ANNEX 8: EXAMPLES OF FAMILY PLANNING PROJECT DESCRIPTIONS IN OECD DAC CRS DATABASE 146 ANNEX 9: REPRODUCTIVE HEALTH SUPPLIES PROCUREMENT CONTRIBUTIONS 148 ANNEX 10: RH INTERCHANGE SUPPLIES TRACKED 149 ANNEX 11: BLENDED FINANCE MECHANISM 150 ANNEX 12: FFD OUTCOME DOCUMENT ZERO DRAFT TEXT ON KEY ISSUES 151 ANNEX 13: SUMMARY LIST OF RECOMMENDATIONS 156 3POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Acronyms and Abbreviations AFDB African Development Bank Group AfDF African Development Fund BMGF Bill and Melinda Gates Foundation CAGR Compound Annual Growth Rate CARE CARE International CDC Centers for Disease Control (US) CIDA Canadian International Development Agency CNCS Mozambique National HIV / AIDS Council CRS Creditor Reporting System of the OECD DAC CYP Couple Years of Protection DAC Development Assistance Committee of the OECD DFID Department for International Development (UK) DKT DKT International (an international nonprofit organization) EWEC Every Woman Every Child FDI Foreign Direct Investment FfD Financing for Development FP Family Planning GAVI Global Vaccine Alliance GDP Gross Domestic Product GFATM Global Fund for AIDS, Tuberculosis and Malaria GFE Global Fund for Education GFATM Global Fund for HIV/AIDS, Tuberculosis and Malaria GFF Global Finance Facility for the Every Woman Every Child initiative GFH Global Fund for Health proposed by the SDSN GNI Gross National Income HIV / AIDS Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome IBRD International Bank for Reconstruction and Developmen ICA Foundation International Contraceptive Services Organization ICESCR International Covenant on Economic, Social and Cultural Rights ICIJ International Consortium of Investigative Journalists ICPD PoA International Conference on Population and Development Programme of Action IDA International Development Association IFI International Financial Institution IADB Inter-American Development Bank IMF International Monetary Fund IPPF International Planned Parenthood Federation IUD Inter-Uterine Device 4POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT LDC Least Developed Country LIC Low Income Country MDG Millennium Development Goal MIC Middle Income Country MOH Ministry of Health MSI Marie Stopes International NGO Non-Governmental Organization NIDI Netherlands Interdisciplinary Demographic Institute ODA Official Development Assistance OECD Organization for Economic Development and Cooperation OOP Out of Pocket (expenditures) PAHO Pan American Health Organization PPP Public-Private Partnership PSI Population Services International RH Reproductive Health RHI Reproductive Health Interchange RHSC Reproductive Health Supplies Coalition RMNCAH Reproductive, Maternal, Newborn, Child and Adolescent Health SDG Sustainable Development Goal SDSN Sustainable Development Solutions Network SME Small and Medium Enterprise(s) SRHR Sexual and Reproductive Health and Rights STD / STI Sexually Transmitted Disease / Sexually Transmitted Infection SWAps Sector Wide Approaches TOSD / TOSSD Total Official Support for Development / Total Official Support for Sustainable Development UN United Nations UNDP United Nations Development Programme UNFCCC United Nations Framework Convention on Climate Change UNFPA United Nations Population Fund UNHCR United Nations High Commissioner for Refugees UNICEF United Nations International Children's Emergency Fund UNOCHA United Nations Office for the Coordination of Humanitarian Affairs UNOPS United Nations Office for Project Services UNPEACE United Nations Peacekeeping or Monitoring Mission USAID United States Agency for International Development USDOD United States Department of Defense VFT Vaginal Foaming Tablet WB World Bank WFP World Food Programme WHO World Health Organization 5POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Acknowledgements The authors have many people to thank for making this work possible, starting with Reproductive Health Supplies Coalition (RHSC) Director John Skibiak and the RHSC Innovation Fund proposal review committee, for supporting the analysis. Many colleagues have kindly contributed their time and expertise, without which this analysis would not have been possible. These include: Frans Baneke, Kors Van Beem, Erica Belanger, Aron Betru, Maria Bordallo, Jacqui Darroch, Suzanna Dennis, Anita Deshpande, Colleen Gregorson, James Gribble, Jesse Griffiths, Rachel Hammonds, Denise Harrison, Justine Hsu, An Huybrechts, Michael Kenny, Farouk Mato, Margaret Reeves, Hema Srinivasan, John Hetherington, Peter Schaffler, John Skibiak, John Stover, Johanna Stratmann, Marleen Temmerman, John Townsend, Wendy Turnbull and Renee Van Der Weerdt. The authors would like to specially thank Johanna Stratmann and Peter Schaffler for their co-authorship, on volunteered time, of a manuscript that enabled the authors to start this analysis with a running start on the issues. 6POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Executive summary 2015 marks a critical year in the design of a new development financing architecture: the revision of donor and national development policies, conclusion of the Millennium Development Goal framework and negotiation of new Sustainable Development Goals (SDGs). In parallel, governments around the world are trying to figure out how to mobilize sufficient financing to support sustainable development and the new SDGs. An Outcome Document to be agreed by Heads of State at the Third International Conference on Financing for Development (FfD) in Addis Ababa in July 2015 will guide national government decision-making on financing for development for the foreseeable future. This rapid assessment, funded by the Reproductive Health Supplies Coalition (RHSC) Innovation Fund, is designed to help identify possible implications of the global FfD discourse for Reproductive Health (RH) supplies financing and inform advocacy over the coming months. As the issues highlighted in the analysis are long-standing in duration, the authors hope this report helps instigate a more lasting engagement of RH supplies champions with the power brokers in international finance and economics. Findings The current FfD discourse raises ten major issues of concern for RH supplies financing: 1. As development assistance (ODA) continues to increase, an expanded definition of ODA will increase RH supply competition for scarce resources. 2. Donors will increasingly use ODA to leverage private sector investment. RH supplies champions need better data and information to ensure that this improves RH supplies access. 3. Complex new financing mechanisms, including blended public-private financing and development bank loans will finance sustainable development. Transparency and accountability are very challenging with these instruments, and RH supplies champions must be prepared to intervene to mitigate risks. 4. FfD decision-makers seek to reaffirm commitments to agreed international programmes of action for sustainable development. The ICPD programme of action should be included among those which receive increased funding, to help improve RH supplies access. 5. FfD decision-makers want to provide guarantees for social protection, essential public services and universal access. RH supplies must be included in nationally defined programmes to benefit from this. 6. Global funds are being considered as possible mechanisms to finance the new social protection guarantees. While some multilateral funds improve cost-effective RH supplies procurement on behalf of national governments, transparency and accountability are serious challenges for other global funds. 7. FfD decision-makers want to increase domestic development country financing for health. The design of tax systems and public provision of RH supplies will be crucial to determining whether and how this benefits RH supplies. 8. FfD decisions-makers want to promote gender equality and increase women’s participation in the labour market. The difficulty of achieving these without full access to RH supplies must be made clear to those in power. EXECUTIVE SUMMARY 7POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT EXECUTIVE SUMMARY 9. The devolution of decision-making to subnational levels of government will continue. RH champions need to find ways to increase subnational commitment to family planning, supply chain management capacity and responsiveness to community needs in order to ensure RH supply access. 10. FfD decision-makers would like to improve existing data collection, transparency, monitoring and follow-up. Disaggregated RH supplies financing data is essential for improving access and outcomes. This report provides a rapid analysis of how these issues are being discussed by global FfD decision-makers. It reviews the available evidence for ODA as a whole and for RH supplies, where available; analyzes the risks and opportunities for RH supplies inherent in these issues; and provides detailed recommendations for advocacy to address these issues. An advocacy map, detailing key development financing events, stakeholders and entry points for RH supplies advocacy (Annex 1) provides guidance for next steps; and an annotated bibliography of published and unpublished literature addressing the issues of financing for RH supplies (Annex 2) can help guide those who wish to learn more about the topics addressed. Three overarching conclusions can be drawn from this analysis. First: the need for more and better research and transparent data is immense. Reliable and comprehensive data are essential for the RH community to be able to plan and respond to current and future needs. Without transparent and open, good quality information, it is impossible for governments, private sector or civil society know where to allocate financial and non-financial resources. One of the clearest findings of this analysis is that there are simply inadequate data to predict, with a high degree of certainty, specific ways that the changes anticipated by the global FfD discourse will affect RH supplies. Data about donor support for family planning and RH supplies are insufficiently detailed and inconsistently reported on international databases. Knowledge about other crucial sources of financing for RH supplies remains either highly speculative or constrained by the objectives and parameters of focused studies. The collection of detailed and comprehensive information about the costed package of the International Conference on Population and Development (ICPD, See Sidebar) has now been discontinued (UNFPA/NIDI Resource Tracking Project). When it comes to developing country domestic government, domestic private sector or international private sector financing for RH supplies specifically, data are inconsistent, of questionable accuracy or simply lacking. RH champions must seek the support of FfD decision-makers, governments and civil society to ensure adequate resources for collecting, monitoring, analyzing and reporting data on RH supplies funding, especially from international private, domestic public and domestic private sources. Considering the overwhelming information burden and dearth of financing data that can enable government decision-makers and civil society to know how changes in financing for development are affecting funding for RH supplies, the recommendations detailed in Section 3 and Annex 13 can help instigate further discussion and action. Second: new financing mechanisms, especially those supporting private sector and market-like instruments, will play an increasing role in future financing for development. The RH community needs to be better prepared to understand and address these. While donor government development assistance (ODA) has been increasing overall and for RH supplies specifically, there also has been tremendous private sector growth in developing countries, and a corresponding growth of interest in developing country RH supplies markets. With an eye towards the vast untapped private capital being used for commercial development around the world, the current FfD discourse seeks to increase non-ODA sources of financing for sustainable development. This includes direct and indirect support for international private sector financing through both commercial and grant-like loans (See Sidebar); public-private partnerships of various types (See Sidebar); direct market interventions, such as provision of equity and minimum volume guarantees; risk-based instruments, such as credit guarantees or risk insurance; and performance-based instruments such as advanced market commitments. New funding sources that improve access to RH supplies could be very helpful, particularly considering the very large volume of private capital available, and the many women who rely on the private sector for family planning. However, there are many different ways of working with the private sector, and some risk greater moral hazard than others. The proprietary nature of commercial activities, which constrains 8POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT availability of transparent, detailed and reliable information, makes it very difficult to assess the relative benefit of private sector investment in RH supplies compared to alternatives. Increased reliance on non-state entities will commensurately increase the monitoring and accountability burden, which for population assistance, is already insufficiently resourced. Recommendations detailed in Section 3 and summarized in Annex 13 suggest ways for RH supplies champions to mitigate the risks and increase the benefits associated with increased commercial involvement in sustainable development. Third: Advocacy is required in the short term to address the FfD Outcome Document to be agreed in Addis in July. In the long-term though the key issues identified help inform longer term it will be required to help inform interventions at national and sub-national levels to ensure quality, equity, access and rights. The global FfD discourse is moving very rapidly, with tight deadlines for input and document revision, lending urgency to the need for RH supplies intervention. This analysis is designed to inform advocacy for RH supplies advocacy over the coming months. Annex I contains an advocacy mapping that can help RH supplies stakeholders and advocates put the report’s messages and recommendations to immediate use. Structured chronologically, the mapping is intended to support nuanced advocacy interventions, by providing an ‘actionable framework’ in order to influence relevant players at key moments in the FfD decision-making process. It highlights key development financing events, stakeholders and entry points for RH supplies advocacy in the run-up to the Addis Ababa conference and Post-2015 UNGA high- level event. While the need for advocacy on the specific language of the FfD Outcome Document is urgent, many of the trends described in this analysis began years ago, and their implementation will be rolled out incrementally over the coming years. RH supplies champions have been working over many years to improve their financial and economic policy- making literacy and to ensure more and better financial support where needed. After the July decision- making in Addis Ababa, these efforts must continue and with a greater emphasis on monitoring financial flows by international financing institutions and by national and subnational governments in developing countries. EXECUTIVE SUMMARY 9POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT An estimated 225 million women in the developing world who wish to protect themselves from unwanted pregnancy are not using an effective method of contraception. Lack of access to reproductive health supplies also affects the 204 million women each year suffering from one of the four major curable sexually transmitted diseases. (Singh et al, 2014). At the same time, maternal health supplies, which save lives by preventing or treating the leading causes of maternal death, remain out of reach for many women, particularly for poor, rural, indigenous and other vulnerable women (Yeager 2012). Ensuring access to reproductive health supplies1 and sexual and reproductive health and rights (SRHR) drastically reduces morbidity and mortality while improving related social and economic effects (Stenberg 2014). 2015 marks a critical year in the design of a new development financing architecture: the revision of donor and national development policies, conclusion of the Millennium Development Goal (MDG) framework and negotiation of new Sustainable Development Goals (SDGs). Governments around the world plan to mobilize complex and multifaceted development financing to support sustainable development and the new SDGs. Commitments for financing will be agreed to at the Third International Conference on Financing for Development (FfD) in Addis Ababa in July (See Sidebar). At this meeting, Heads of State and Government will adopt an FfD Outcome Document that will guide national government decision-making on financing for development for the foreseeable future. Changes proposed to existing financing arrangements for development present both threats and opportunities to ensuring the continued availability of high quality reproductive health (RH) supplies. This analysis aims to identify key issues that will affect the full spectrum of RH supplies, including maternal health supplies, where data is available. The Global Financing Facility (GFF) in support of the Every Woman Every Child Global Strategy for Women’s and Children’s Health (EWEC) concretely illustrates how some of these discussions and trends may very soon affect RH supplies financing (See Sidebar on next page). First announced last fall, the GFF business plan has been finalized, with implementation expected later this year. The GFF also presents opportunities and risks, many of which mirror those found throughout the overall FfD discourse. Examples and illustrations from the GFF are cited where appropriate. 1 Although this analysis looks mainly at RH supplies in general and FP specifically, many related direct and indirect costs including human resources, and system and programme development are required to ensure access to RH supplies. INTRODUCTION, CONTEXT Sidebar 1: Third International FfD Conference, July 2015 The third International Conference on Financing for Development (Addis Ababa, 13-16 July 2015) will gather high-level political representatives, including Heads of State and Government, and Ministers of Finance, Foreign Affairs and Development Cooperation, as well as all relevant institutional stakeholders, non- governmental organizations (NGOs) and business sector entities. The Conference will produce an inter-governmentally negotiated and agreed outcome to support the implementation of the post-2015 development agenda, based on assessment of: 1. Progress made toward the Monterrey Consensus and Doha Declaration (See other Sidebar) 2. New and emerging issues in development cooperation and finance. 3. Ways to strengthen the FfD follow-up process. Introduction, Context 10POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT The global FfD discourse is moving very rapidly, with tight deadlines for input and document revision. The issues being debated now will inform both international and national decision-making and will affect funding for RH supplies for the foreseeable future. At the time this project began, the attention of most SRHR stakeholders was focused on substantive, thematic SDG decision-making. Many advocates were focusing on overarching policy issues but willingly deferred on “big picture” financing issues to general development cooperation organizations that were neither knowledgeable about nor motivated to address RH supplies. A few stakeholders were tracking changes to the overall development finance architecture, but none had sufficient resources dedicated to in-depth analysis and preparation. Funding from the Reproductive Health Supplies Coalition (RHSC) Innovation Fund has enabled the rapid preparation of this analytical report to help identify implications of the global Financing for Development discourse for RH supplies financing. This report and its dissemination are the main deliverables of a project (See Annex) planned to help inform targeted advocacy for RH supplies. The analysis has been prepared under very tight time constraints and with a great deal of urgency, as the opportunity arose during the very time when the FfD consultation processes were underway. Due to the late nature and urgency of the analysis, combined with the rapid pace of developments, these findings must be considered preliminary. Section 1 of this report provides a detailed overview of what we currently know about financing for RH supplies globally. It starts with the big picture of population assistance as a whole, then focuses on data supporting trends in funding for family planning, and finally zooms into the detailed information publicly available about financing for RH supplies. Section 2 describes the conceptual framework for the global FfD discourse and outlines development finance trends overall and for RH supplies. Section 3 provides a detailed analysis of major risks and opportunities for RH supplies in the current FfD discourse, and recommends ways to address them. This analysis is designed to inform advocacy for RH supplies advocacy over the coming months. Annex I contains an advocacy mapping that can help RH supplies stakeholders and advocates put the report’s messages and recommendations to immediate use. Structured chronologically, the mapping is intended to support nuanced advocacy interventions, by providing an ‘actionable framework’ in order to influence relevant players at key moments in the FfD decision-making process. It highlights key development financing events, stakeholders and entry points for RH supplies advocacy in the run-up to the Addis Ababa conference and Post-2015 UNGA high-level event. The need for RH supplies intervention in the current FfD decision-making is urgent. However, many key development financing issues have developed over much longer periods of time and will continue to be refined on an ongoing basis as the decisions are implemented over the coming years. The authors hope this report helps instigate a more lasting engagement of SRHR stakeholders with the power brokers in international finance and economics. Sidebar 2: What are RH supplies? Reproductive health supplies are defined in this report as encompassing any material or consumable needed to provide reproductive and sexual health services—including but not limited to contraceptives, drugs, medical equipment, instruments, and expendable supplies for family planning, for prevention and treatment of sexually transmitted infections including HIV and AIDS, and for maternal health and ensuring safe delivery and postpartum care. INTRODUCTION, CONTEXT 11POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT 1.1 RH Supplies Financing Needs/Gaps Policymakers concerned about sexual and reproductive health and rights (SRHR) have known that there is a significant gap in funding and access for reproductive health supplies ever since concerned government and nongovernmental stakeholders gathered to discuss the subject at the Istanbul “Meeting the Challenge” conference in 2001 (Solo 2011). Funding for RH supplies has risen since then, but the gap persists (Stover 2009) despite recognition from world-renowned economists that access to SRH is one of a limited number of investments for which there is robust evidence that benefits are more than 15 times greater than costs (Kohler 2012; Copenhagen 2014). According to the Guttmacher Institute study Adding It Up: Investing in Sexual and Reproductive Health (2014), meeting all women’s needs for modern contraception in the developing world would cost $9.4 billion2 annually, including $2.3 billion in RH supplies, which would require an increase of $5.3 billion over current funding.3 If all need for modern contraception were met, the annual cost of pregnancy-related care for women and their newborns would increase by $13.8 billion to $28.0 billion.4 Fully meeting the need for modern contraception, maternal and newborn health care, antiretroviral care for pregnant women living with HIV and their newborns, and treatment for four major curable STIs would cost $39.2 billion annually, more than a doubling of 2014 spending. (Singh et al 2014; Ross et al 2009) Identifying financial resources available for reproductive health supplies helps assess how the current global FfD discourse may affect future RH supplies funding. In order to capture the best possible information about RH supplies financing trends and gaps, Section 1 starts with the big picture of funding for population assistance overall, then zooms into family planning and then, as precisely as possible, reproductive health supplies. The approach used could be seen as an inverted pyramid (Figure 1). 2 Throughout this report, the $ symbol refers to the US dollar. 3 An important factor underlying the cost increase is the concentration of unmet need in Africa and in low-income countries in other regions. Program and systems [indirect] costs are particularly high because the need to strengthen health systems is greatest in these parts of the world. With all unmet needs satisfied and the quality of contraceptive care improved, the average annual cost per user would increase (primarily due to a rise in indirect costs) from $6.35 to $10.77 (Singh et al. 2014). 4 Including $4.2 billion (a $3.0 billion increase) to provide HIV testing and counseling for all pregnant women, testing for their newborns and antiretroviral therapy for those who need it. REPRODUCTIVE HEALTH SUPPLIES FINANCING 1. Reproductive Health Supplies Financing Figure 1: Current Funding for Population Assistance. Sources: UNFPA 2015; CRS 2015; CHAI 2015 12POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Findings The main finding is that current data challenges5 prevent firm conclusions about existing sources of financing for RH supplies. Data is inconsistent, of questionable accuracy or simply lacking. Reliable and comprehensive data are essential information for the community to be able to plan and respond to current and future need. Without transparent and open, good quality information, how will countries, private sector, civil society and the international system know where to allocate financial and non-financial resources? How will there be adequate tools to hold development actors accountable? The most detailed and comprehensive information available about financing for RH supplies comes from studies that are designed for specific purposes, such as the now-discontinued UNFPA/NIDI Resource Tracking Project and studies conducted by the Clinton Health Access Initiative, Dalberg Global Development Advisors, John Snow, Inc., and private sector market research firms. The quality, detail and reliability of information available in existing international databases suffer due to the fact that the data is provided on a voluntary basis based on different methodologies. Based on the studies and databases reviewed for this report6: › Private consumers in developing countries provide by far the largest portion of funding for the ICPD costed package, which includes RH supplies. They also contribute far more to their SRHR as a percentage of GNI than consumers in wealthy countries. › Donor governments have been increasing their support for family planning and for RH supplies over the past ten years. › Private, for-profit interest in developing country markets for RH supplies has been increasing for several years, especially in countries and regions where there has been rapid economic growth. 1.2 Funding for Population Assistance There is no single source of information providing a global overview of all sources of RH supplies financing. In order to understand RH supplies financing globally, many different data sources must be combined with proxy measures and extrapolation. This results in a rough picture, with many caveats. To see the whole picture, one must start with the only integrated global financing analysis for population assistance as a whole. The best global picture of financing for population assistance comes from the work of UNFPA 5 Annex 13 highlights some of the major caveats to keep in mind regarding the data presented here. 6 See annotated bibliography in Annex. Sidebar 3: ICPD Costed Package The “costed package” specified in the ICPD Programme of Action (paragraph 13.14) enables ICPD resource tracking in four major categories of population assistance. › STIs and HIV/AIDS, which includes condom distribution, represents about 65 percent of ICPD donor funding. › Basic reproductive health represents about 23 percent of ICPD donor funding. › Family planning, including most RH supplies, represents about 9 percent of ICPD donor funding. › Basic public policy administration and research represents about 3 percent of ICPD donor funding. See Beekink (2014) for a detailed description of methodologies used in estimating the “costed package” for the ICPD Programme of Action. REPRODUCTIVE HEALTH SUPPLIES FINANCING 13POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT / NIDI Resource Tracking project, which for many years has prepared detailed analyses of financing for the so-called “costed package” (See Sidebar on previous page) of the ICPD Programme of Action (Beekink 2014). Figure 2 depicts the latest global overview for the whole ICPD costed package, by financing source (UNFPA 2014; Hoehn et al 2015 in press). As Figure 2 illustrates, consumer out-of-pocket payments in developing countries appear to account for the single greatest source of financing for the ICPD costed package, followed by developing country governments7. Donor governments also contribute a meaningful portion of aid for the ICPD costed package. The UN system, World Bank Group, philanthropic foundations and non-governmental organizations (NGOs) contribute very little to the overall ICPD costed package. 1.3 Funding for Family Planning To identify financing for RH supplies specifically, one can study the Family Planning purpose (sector) code within the OECD DAC Creditor Reporting System (CRS) online database. This freely available8 online database provides detailed information on aid activities, such as sectors, countries and project descriptions for bilateral, multilateral and private donors’ aid (ODA) and other resource flows to developing countries. Family Planning in the OECD DAC Creditor Reporting System includes: › Family planning services including counseling › Information, education and communication (IEC) activities › Delivery of contraceptives › Capacity building and training A search of the CRS database shows a steady increase in bilateral government funding for family planning from 2009 to 2013, the last year on record. Family planning disbursements increased by 36 percent, from $487.3 million in 2009 to $662 million in 2013. See Figure 3 for details. Donor governments are the main entities reporting family planning disbursements (payments) in the CRS.9 UNFPA and the European Union Institutions together provided $42 million in 2012 and $34 million in 2013, but it’s important to keep in mind that their resources – as is true for all multilaterals – also come principally from donor governments. Development 7 Some experts consider the methodology for determining out-of-pocket payments to be controversial. For a detailed explanation of the methodology please see the original Resource Flows report or Beekink, E. Projections of Funds for Population and AIDS Activities, 2013-2015. The Hague, 2014. 8 See https://stats.oecd.org/Index.aspx?DataSetCode=CRS1 9 Countdown 2015-Europe (2013-2014, 2015) reports that some European bilateral donors do not disaggregate FP disbursement reporting within comprehensive SRHR. REPRODUCTIVE HEALTH SUPPLIES FINANCING Figure 2: ICPD Costed Package Financing in 2012 (millions $). Sources: UNFPA/NIDI Resource Flows project 14POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Sidebar 4: Further Research Required The tremendous gaps in evidence found during this time-limited analysis point to additional research needed. These include: › Analyze pre-2013 FP project descriptions in the CRS to identify multi-year RH supply trends › Gather and analyze donor-funded projects and their budgets to assess overall cost-effectiveness and impact for RH supplies › Gather data from tax authorities and other sources on private sector and PPP financing; identify cost-effective practices › Identify the source of nonprofit funds for RH supply procurement › Gather and analyze World Bank / IDA loan projects and their budgets to determine the relative cost- effectiveness of those loans as a financing instrument banks and private philanthropy are able to report their disbursements on the CRS, but none have reported any family planning disbursements over the past few years.10 Private sector information is not gathered or reported on the CRS. So, while the CRS is the only entity collecting and reporting information on aid flows globally, very little certainty can be derived from the CRS about what these other important sources of financing for development offer for population assistance, family planning or RH supplies. 1.4 RH Supplies Financing Data reported to OECD DAC In attempt to identify how much of the projects reported in the CRS included some funding (disbursement) for RH supplies specifically, the authors reviewed the approximately 1500 family planning-coded project descriptions in the database for 2013. Eighty grant project disbursements do mention supplies, products, commodities, contraception, pharmaceuticals or method-mix specifically. Those eighty projects reported total project disbursements of worth $86.5 million, or about 12.5 percent of total family planning project disbursements, detailed in Annex 6. In all cases, those project grants were from donor country governments. Grantees included international NGOs, national NGOs, civil society, public sector / recipient governments and unspecified others. The CRS data is insufficient. It does not reveal any insights about domestic government or private sector financing, domestic or international, other sources of data are required to complete the picture of RH supplies financing. It also reports significantly lower contributions to projects including RH supplies than data sources that are focused specifically on RH supplies. Data reported to the Reproductive Health Interchange (RHI) The Reproductive Health Interchange11 managed by UNFPA provides access to harmonized data on contraceptive orders and shipments for over 140 countries. The data claim to reflect over 80 percent of contraceptive supplies provided by major donors over the last several years, worth more than $2.3 billion (RHI online 2015). RHI data 10 Exception: the African Development Fund (AfDF) disbursed $12.5 million in loans in 2009. 11 See www.myaccessrh.org/rhi-home *Accessed online 26 March 2015 Type 2004 2009 2010 2011 2012 2013 Total ODA Commitments 89.5 509.7 609.2 671.6 727.7 665.0 Total ODA Disbursements 107.0 520.0 491.8 585.1 732.6 753.3 Grant Commitments 87.8 509.7 609.2 671.6 727.7 662.0 Grants Disbursed --- 487.3 446.9 547.6 565.6 687.3 Figure 3: Family Planning Funding Trends (millions $) Source: OECD DAC Creditor Reporting System* REPRODUCTIVE HEALTH SUPPLIES FINANCING 15POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT REPRODUCTIVE HEALTH SUPPLIES FINANCING comes from the central procurement offices of major contraceptive donors and other organizations that procure contraceptives. A detailed list of supplies reported through the RHI can be found in Annex 10. Donor governments At $254 million in 2013, the volume of RH supplies purchased was 2.5 times greater than ten years prior. Eighty-six percent of that volume was reported procured by external governments (international public financing), and the rest by international private nonprofit sources. This compares with $279 million in donor supported RH supply costs reported by CHAI for 2013. (CHAI 2015) Developing country governments Developing county domestic spending for RH supplies appears to be increasing, though it is not clear whether those resources are purely domestically sourced (eg, general revenue) or whether donors are contributing those funds specifically for RH supplies (Dowling 2007; Gribble 2010). The RHSC commitments database also indicates a considerable increase in national financial commitments to RH supplies (RHSC 2014) in the past half-decade. A John Snow, Inc. survey in 2014 indicated that most countries surveyed (66 percent) do have a government budget line item for contraceptives and most (77 percent) have allocated funds for contraceptive procurement. Among countries reporting using government funds, two-thirds used internally generated funds and one-third reported used funds from other governments. The number of countries with a government budget line item for contraceptives increased over the previous year, even if there was essentially no change in the number of countries allocating funds to procure contraceptives. (JSI 2014) The World Health Organization’s Global Health Expenditure Database shows intermittent reproductive health reporting from only a few countries since the adoption of the ICPD PoA. Only a few countries sporadically reported reproductive health expenditures under the National Health Accounts RH sub-account methodology, which WHO no longer recommends. To address this deficiency, the independent Expert Review Group on Information and Accountability for the UN Secretary General’s Commission on Women’s and Children’s Health recommended strengthening resource tracking at the national level in developing countries, but this aim has proven unattainable (Hoehn 2014; World Health Organization 2013). Private non-profits All the private entities reporting on RH Interchange are nonprofit organizations. It is not known whether the RH supply purchases reported to the RH Interchange by private entities were funded through own-source financial flows, as these nonprofits report significant support from private philanthropy and donor governments. Figure 4 illustrates the respective Sidebar 5: Private Sector Involvement in RH Supplies “Private sector” refers to all providers, suppliers, and ancillary and support services not managed by the public sector, including commercial or for-profit entities, non-profit organizations, community groups, informal vendors, doctors, pharmacies and hospitals (Armand et al, 2007). In addition to innovating, manufacturing and disseminating RH supplies, the private for-profit sector has contributed philanthropy, corporate social responsibility and shared value creation through price reductions. To date there has been no comprehensive empirical review of the contribution of the private sector to RH supplies. The overall impact of the private sector is complex and poorly understood, backed by mainly anecdotal evidence. Nearly 40 percent of women in Sub-Saharan Africa and Asia rely on the private sector for family planning (Mitchell 2013). 16POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT percentages of private donor, sales/programme revenue and government income, as reported in these organizations latest available financial reports. As a proxy measure12, they suggest that a very large portion of these procurements is likely to be funded or subsidized by donor governments. Companies Rapid economic growth in developing countries in recent years has stimulated pharmaceutical company interest and increased contraceptive sales, compared with countries where markets are comparatively settled. The Clinton Health Access Initiative reports that for-profit suppliers met the contraceptive needs of 76 million women in the 69 FP202013 countries in 2013. Supplier shipment data collected by CHAI indicate that the corporate market for product-based modern methods of contraception grew from 2011-2012, then declined in 69 countries in 2013. (CHAI 2015). The Asia Pacific region reportedly has the world’s fastest growing pharmaceutical market, followed by Africa and Latin America (IMS Health 2013). Pharmaceutical company research provided to the authors in confidence has found major contraceptive sales nearly tripling from $119 million in 2009 to $292 million in 2012 in Africa (North Africa, South Africa and French West Africa) and the Middle East. Various market research sources, using different methodologies, predict that the global contraceptive market may more than double from $8.5 billion in 2005 to close to $20 billion in 2020.14, 15 12 Annual reports are a very rough proxy measure, including total income and expenditure, not just RH supplies. 13 See www.familyplanning2020.org 14 Market research companies measure the market differently. Some include hormonals while others include condoms, implants, patches, rings and IUDs. This makes estimating overall market size tricky. 15 An anonymous source has reported that while donors paid around $2.62 per Couple Year of Protection (CYP) across methods (UNFPA 2012) from 2006 to 2011, the average retail price was $104. REPRODUCTIVE HEALTH SUPPLIES FINANCING Percent of Total Annual Income Organization** Private donors Sales / Fees Government / Public DKT International – 2014 14% 65% --- IPPF - 2013 --- --- 95.5% MSI – 2013 21% 44.6% 25% Population Services International (PSI) – 2013*** 18.7% 81.4% Figure 4: Private Sector RH Interchange Contributor Income Source* * Multilateral funds are assumed to come originally from government and are included in the Government / Public column. DKT does not report government income separately in its total revenue, but it does thank DFID, the Dutch government, the government of India, UNFPA, USAID and USDOD for their support. For MSI, other nonspecified grant income is assumed to from private sources, because government donors are named and enumerated. ** The organizations listed here have had the opportunity to correct and clarify this information. *** For PSI, a very small amount of “Other and Contributions” comes from private sources; most comes from product sales. PSI “Government/ Public” income comes from multilaterals, which are funded by governments. 17POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT In the coming months, UN Member States will negotiate the final parameters of the Post-2015 Sustainable Development Agenda and the Sustainable Development Goals (SDGs), which require financing. At the Third International Conference on Financing for Development (FfD) in Addis Ababa in July (See Sidebar), Heads of State and Government will adopt an FfD Outcome Document intended to guide national government decision-making on financing for development for the foreseeable future. Their agreements on the overall architecture for financing development will shape how governments approach financing for development and how they prioritize the sources, amounts, modalities and thematic / sectoral approaches to financing development worldwide, including the SDGs. In 2013, the UN General Assembly established an intergovernmental committee of 30 experts to propose financing strategies to mobilize resources for sustainable development. This Intergovernmental Committee of Experts on Sustainable Development Financing (Intergovernmental Committee) framed the current global Financing for Development discourse by describing the tremendous finances needed for poverty eradication and sustainable development. The report indicated that trillions of dollars are needed for infrastructure, credit for small and medium enterprises in developing countries, and global public goods including climate. It estimated the cost of a global safety net to eradicate extreme poverty at $66 billion per year, not including costs for health, education and hunger eradication. (Intergovernmental Committee August 2014). See Sidebar for additional information about the key Intergovernmental Committee reports. 2.1 Financing Framework The Intergovernmental Committee report identifies five major building blocks for financing sustainable development: › Domestic public financial flows: funding from government in the country of final funds destination › Domestic private flows: funding from non-government in the country of final funds destination › International public flows: funding from a government other than the country of final funds destination › International private flows: funding from non-government sources outside the final funds destination › Blended financial flows FINANCING FOR DEVELOPMENT Sidebar 6: Key International FfD Accords FfD decision-making this year is part of a broader and longer-term process that began many years ago and addresses more issues than how to finance the SDGs. The 2002 Monterrey Consensus reaffirmed that donor governments should provide 0.7 percent of Gross National Income (GNI) in official aid. The 2008 International FfD Conference in Doha reaffirmed Monterrey aid targets, while emphasizing the importance of mobilizing domestic public and private resources, international private resources. It called for improved trade deals, debt restructuring mechanisms and the need to reform the international financial system and institutions. Aid Effectiveness The 2005 Paris Declaration and High Level Forums on Aid Effectiveness in Accra (2008) and Busan (2011) emphasized country-ownership and partnership between donor and developing country governments and with civil society. 2. Financing for Development 18POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT FINANCING FOR DEVELOPMENT The data summarized in Section 1 show how difficult it is to get a clear, comprehensive and detailed picture of financing for RH supplies in the categories framing the global FfD discourse. In addition, financial flows quickly become mixed. Funds spent in support of RH supplies by multilaterals, companies, nonprofits or domestic developing country governments quite often originate from or are subsidized by international public / governments, so you can’t easily add figures from different sources. For example: › Donor governments fund domestic and international companies and non-profit organizations for research and development of RH supplies technologies; for purchase, dissemination and sales of RH supplies; and for actions to improve access to RH supplies. NIDI (2014) estimates that 42 percent of donor funding for population assistance was channeled to non-governmental organizations in 2013. No estimate was provided regarding donor assistance for corporate research and development, though a 2013 DSW fact sheet indicates that Europe’s donors contributed €2.1 billion to research and development on Poverty- Related and Neglected Diseases between 2007-2012. › Donor governments fund multilaterals, which may in turn buy supplies from international private companies; support domestic government efforts to increase RH supply access; or support domestic or international non-profit organizations with that mission. NIDI (2014) estimates that 29 percent of donor funding for population assistance was channeled to multilaterals in 2013. › Donor governments fund domestic governments bilaterally, which may use those funds in turn to purchase products from domestic or international companies or provide support to domestic or international nonprofit organizations for actions to improve access to RH supplies. NIDI (2014) estimates that 29 percent of donor funding for population assistance was channeled directly to developing country governments in 2013. Identifying the original source of the funds, and tracking their path to the end user, is essential to assessing the implications of FfD decisions and their cost-effectiveness in achieving desired aims. 2.2 Financing Trends Domestic public (government) financial flows increasing for development overall; may be increasing for RH supplies. Public domestic finance in developing countries more than doubled between 2002 and 2011, from $838 billion to $1.86 trillion. Most of this took place in middle income countries (MICs). In low-income countries (LIC), tax revenues also doubled, but remained insufficient for sustainable development. UNPFA/ NIDI (2014) estimate that domestic governments contribute about 22 19POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT percent of financing for the entire ICPD costed package. Domestic governments appear to be increasing funding for RH supplies, but evidence is mixed whether that is due to increasing own-source domestic government support or donor-driven funding. (RHI 2015; JSI 2014; Gribble 2010) Domestic private funds increasing for development overall; at very high levels for RH supplies. Domestic private funds may come from private companies, non-profits or individuals (ie, out of pocket) in-country. The presence of institutional investors in developing countries has reportedly been growing, and could potentially increase resources available for long-term investment in sustainable development, including emerging market pension funds, which currently manage $2.5 trillion in assets, and are expected to increase significantly, though a sizable portion of these portfolios is invested in domestic sovereign debt. The UNPFA/NIDI data show out-of-pocket spending by consumers as the main source of funding (64 percent) for the ICPD costed package. Funds raised and spent domestically by private non-governmental organizations account for only one percent of total global financing for the ICPD costed package. There is no global estimate of how domestic private sales and programme revenue may be contributing directly to RH supplies. Considering the very heavy load currently burdened by developing country consumers (See Figure 2), it is difficult to imagine increasing domestic private out-of- pocket financing for RH supplies, especially in LDCs and LICs. International public (donor government) funds increasing for development overall and for RH supplies. With occasional setbacks since the Monterrey Consensus set an Official Development Assistance (ODA) target for donors of 0.7 percent of Gross National Income (GNI) – see Key International FfD Accords Sidebar – ODA has steadily increased over time, reaching an all-time high of $134.8 billion in 2013. Alarmingly, the Intergovernmental Committee report found that overall development assistance for Least Developed Countries (LDCs) has fallen, and will continue to fall. As explained in Section 1, donor government funding for family planning and RH supplies appears to be increasing. Innovative Financing. Both the Intergovernmental Committee and the ICPD High Level Task Force16 identify innovative financing mechanisms (See Sidebar) as promising new sources of international public funds for development and for ICPD. Evidence is mixed regarding the effectiveness of these mechanisms for health (Atun et al 2012; Fryatt et al. 2010). 16 The High-Level Task Force for the International Conference on Population and Development is an autonomous group of distinguished representatives from all regions of the world, with records of service in government, parliament, civil society, the private sector and philanthropy. Sidebar 7: Innovative Financing The term “Innovative Financing” is used in many different ways. After reviewing more than 100 initiatives, the High Level Taskforce on Innovative International Financing for Health Systems identified airline tax, tobacco tax, immunization bonds, advance market commitments, and debt swaps as the most promising sources for new and additional financing for global health. Only GAVI (www.gavi.org), the Global Fund for AIDS, Tuberculosis and Malaria (www.theglobalfund.org) and UNITAID (www.unitaid.eu) use innovative approaches globally to mobilize, pool, channel, allocate, and disburse funding more effectively for medicines, vaccines, diagnostics, preventive interventions, and health systems in low-income and middle- income countries to address vaccine- preventable childhood diseases, maternal disorders, HIV/AIDS, tuberculosis, and malaria. (Adapted from Atun, et al 2012) FINANCING FOR DEVELOPMENT 20POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT International private funds increasing for development overall; also for RH supplies. International private funds come from companies, non-profit organizations or private philanthropic charities. The Leadership Council of the UN Sustainable Development Solutions Network initiative (SDSN 2015) envisions increased private sector (for-profit) financing of sustainable development through bank loans; bonds issued by governments or corporations; project financing by specialized financial institutions, including insurance companies, pension funds, sovereign wealth funds, and other asset managers; and direct equity investments, including portfolio flows and Foreign Direct Investment (FDI). Gross FDI17 financial flows to developing countries are massive –$778 billion in 2013 – and private cross-border transfers from individuals and households (remittances) have also grown substantially. The Intergovernmental Committee reports that FDI is the most stable and long term source of private sector foreign investment, though LDCs receive less than two percent of these flows. The UNFPA/NIDI data, which does not estimate corporate contributions to ICPD, indicate that private philanthropy and NGOs provide less than one percent of total financing for ICPD. In theory, the trend for increased international development financing strengthens the ability of the private sector domestically to support RH supplies, through increased out-of-pocket spending by households resulting from remittances or by private companies operating domestically but financed internationally. For-profit engagement in RH supplies in developing countries appears to be significant and growing, but it is not clear how much of this results from own-source financing, not subsidized by government. The private for-profit sector is involved in RH supplies in many ways, such as: › Manufacturers, which may finance their research from private capital or public research funds or some combination › Distributors, paid by public or private clients › Marketing and social marketing agencies › Consulting firms › Online markets – for buying and selling supplies › Pharmacies While the data presented in Section 1 indicate tremendous private, for-profit market growth for RH supplies in developing countries, it seems nearly impossible to determine whether or how much of this comes from international private for-profit capital, excluding government support for research and development. 17 FDI is cross-border investment by an entity residing in one economy that seeks to obtain a lasting interest in an enterprise residing in another economy (OECD). FINANCING FOR DEVELOPMENT 21POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Blended financial flows increasing for development overall; probably increasing for RH supplies. Blended financing mechanisms (See Sidebar) enable donors to use development aid to mobilize loans from financial institutions and influence how those projects are set up and managed. The European Union and World Bank are key supporters of blending financing. While the European Court of Auditors (2014) has found European Union blended financing to be reasonably well managed, there seems to be no reliable evidence that blending achieves development objectives. Only anecdotal evidence is available regarding blended financial instrument trends affecting RH supplies though RH supplies stakeholders have been hearing more about these types of instruments over the past decade or so. Certainly the The Implanon Access Initiative (Merck) which lowered the price of an important implant and the Jadelle Access Programme (Bayer) guaranteeing the supply of 27 million implants, training and a drastic price reduction, have been highly profiled in the field of RH supplies. In summary (Figure 5), based on available data and making informed guesses where data is unavailable, trends seem to indicate increases in all major categories of development financing overall and possibly for RH supplies, though the needs for financing development remain tremendous, especially in LDCs. FINANCING FOR DEVELOPMENT Sidebar 8: Blended Financing Blended finance is the complementary use of grant-like instruments and non-grant financing from private and/or public sources. In order of prevalence, they include: › Loans › Public Private Partnerships, such as donors providing technical assistance to government and private entities › Direct Market Interventions, such as equity, a transfer of resources in exchange for an ownership stake) › Risk-Based Instruments, such as credit guarantees or risk insurance › Performance Based Instruments, such as Advance Market Commitments Using ODA to leverage private capital reduces transparency while risking inefficiency and ineffectiveness (Bilal et al. 2013). Independent review of the effectiveness and impact of blended financing mechanisms would help determine if they are a suitable use of ODA. Financing Category Development overall RH supplies / FP / ICPD Domestic public ↑ ? ↑ ? Domestic private ↑ ? ↑ ? International public ↑ ↑ International private ↑ ? ↑ ? Blended public-private ↑ ? ↑ ? Figure 5: Financing Trends – Development Overall and RH Supplies 22POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Sidebar 9: Main FfD Policy Documents Hyperlinks to the main policy documents informing the FfD discourse can be found below. › March 2015 “Zero Draft” Outcome document › February 2015 “Elements” Background Paper for the Third FfD preparatory process › August 2014 Report of the Intergovernmental Committee of Experts on Sustainable Development Financing › December 2014 OECD DAC High-Level Communique › October 2014 OECD DAC Report: Measurement of Development Finance post-2015 A second Outcome draft is expected in April and a third in June, before final negotiations in Addis in July. KEY ISSUES – WHERE RH SUPPLY MEETS FFD A “Zero Draft” Financing for Development Outcome Document released in March this year contains the first indication of language that, after April and June revisions, will be negotiated and agreed by Heads of State and Government and High Representatives at the Third International Conference on Financing for Development (See Sidebar) in Addis Ababa in July. The agreed Outcome Document will guide government decision-making on financing for development for the foreseeable future. This Outcome Document builds on many months of research, meetings and analysis made available by the FfD Conference preparatory process (see Sidebar). In parallel, Development Ministries from all countries18 participating in the Development Assistance Committee (DAC) of the Organization for Economic Cooperation and Development (OECD) and others are changing how development assistance is defined and reported. Some of the proposed changes risk increasing competition for scarce Official Development Assistance (ODA) resources (Hoehn, et al 2015 in press). At the time of this writing, the Zero Draft provides the latest and best indication of the direction of the FfD discourse leading to the Outcome Document. After a preamble, the Zero Draft analysis is broken down into the following major categories: A. Domestic public finance B. Domestic and international private business and finance C. International public finance D. International trade E. Debt and debt sustainability F. Systemic Issues (eg, environment and international financial regulation) G. Technology, innovation and capacity-building H. Data, monitoring and follow-up In theory, any and all financial interactions can affect the availability of RH supplies, by affecting money flows from the macro level through to the level of the individual person needing access to RH supplies. In that sense, few of 18 OECD DAC Members: Australia, Austria, Belgium, Canada, Czech Republic, Denmark, European Union, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Japan, Luxembourg, Netherlands, New Zealand, Norway, Poland, Portugal, Slovakia, Slovenia, South Korea, Spain, Sweden, Switzerland, United Kingdom, United States. Other participants in the December meeting: Chile, Estonia, Hungary, Israel, Mexico and Turkey; the International Monetary Fund (IMF), the World Bank, the United Nations Development Programme (UNDP) and the Inter-American Development Bank (IADB). 3. Key Issues – Where RH Supply Meets FfD 23POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT the above topics are exempt. However, some of the issues – notably international trade, debt sustainability and international financial regulation – require a degree of research, data gathering and documentation that simply is not evident in the literature to date. The key issues described below identify major themes and language in the “Zero Draft” Outcome Document which available evidence suggests have significant implications for RH supplies. Messages that can be used for advocacy – highlighted in this section and in Annex – show both how financing for RH supplies can contribute to achieving the FfD goals and how proposed FfD approaches are likely to affect RH supplies financing. The RH supplies community stands to gain a lot by attempting to influence the language contained within these global outcome documents because they will continue to serve as a point of reference at the national level for the next decade and a half. In addition, the issues that are brought to the surface now will continue to be of use as country strategies are developed in response. 3.1 ODA Definition and Targets Analysis All key policy documents up to now have reaffirmed the agreement in Monterey in 2002 that donors should dedicate 0.7 percent of GNI to development assistance (See Sidebar), though only five donors have met this target19. The Zero Draft FfD Outcome Document starts with a clear call for all developed countries to substantially increase traditional development assistance and establish timetables for how and when they will allocate 0.7 percent of gross national income (GNI) to ODA20. It further calls on developed countries to allocate 0.15-0.20 of GNI to aid least developed countries. In parallel, the OECD DAC – which includes nearly all donors to development assistance – plans to clarify and expand the definition of ODA to include new “development enabling” sectors, such as those related to climate and security (OECD DAC 2014). An increase in ODA provides a very clear and direct opportunity to increase financial support for RH supplies in poor countries. Why should the RH supplies community intensify its advocacy toward donor countries for increases in ODA overall and for RH supplies specifically? › ODA grant support for RH supplies has a relatively direct, transparent and measurable impact on access to RH supplies. › Grant support is a particularly effective method of financing for annually recurring operational costs like RH supplies in low income countries and 19 Denmark, Luxembourg, Netherlands, Norway and Sweden (UN Millennium Project online 2015) 20 Zero Draft Outcome Document paragraph 2. KEY ISSUES – WHERE RH SUPPLY MEETS FFD Sidebar 10: Global Public Goods Global Public Goods are goods which the “free market” will not provide because their benefits are available to all and because consumption by one person does not prevent consumption by others. Health does not meet this definition of a public good, but health has external effects like global public goods, including prevention or containment of communicable disease and wider economic benefits (Shmit 2007). When it comes to RH supplies, the demographic effects of family planning can increase a country’s security and decrease pressure for migration, both of which are of broad public value (Ooms 2013). Because the free market will not provide the collectively optimal level of public goods, they should be prioritized by ODA (Sachs 2014). The GFF for EWEC focuses on supporting global public goods for health, which include knowledge, data, innovation and commodities. 24POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT least developed countries, where other resources are scarce and/or inappropriate. › The definition of ODA may expand to include sectors that are not currently included, which would make it more difficult for RH supplies to maintain visibility as a policy priority in competition with a greater range of sectors, eg, climate and security, and actors, eg, environmental and peace groups. Engaging in international cooperation and assistance is an international legal obligation for States Parties in the UN-ratified International Covenant on Economic, Social and Cultural Rights, which forms part to the corpus of the ICPD commitments. The advocacy targets for traditional ODA – donor governments – present a limited number of targets whose support for RH supplies and SRHR domestically in their own countries can be construed as a favorable policy bias. Civil society in donor countries is relatively well resourced and with reasonable capacity to influence their own governments’ decision-making. In this effort, RH supplies stakeholders can join forces with other, larger general relief and development organizations to push for increasing the size of the ODA pie. Opportunity According to the OECD DAC’s Creditor Reporting System, ODA grants provide 59 percent of international public finance for development cooperation overall and 97 percent for population assistance specifically (OECD DAC CRS, as cited in Hoehn et al 2015 in press). Donor grants are clearly very important to RH supplies access. This is especially true in LICs and LDCs, which do not have the resources and infrastructure to effectively self-finance health needs, nor RH supplies access. They require sustained financial support from donors in order to have functioning health systems (Ooms 2010). At least two credible institutions offer targets for domestic and international financing of global health. › The UN Sustainable Development Solutions Network asserts that universal health care should be “built on the foundation of human rights and equity”, (SDSN 2014); argues for all countries to work toward allocating at least 5 percent of national gross domestic product (GDP) as public financing for health; and urges high income countries to allocate at least 0.1 percent of GNI as international assistance to help low- and middle-income countries implement universal health care. › The Chatham House Centre on Global Health Security Working Group on Health Financing (Røttingen, et al 2014) recommends that all governments target spending at least 5 percent of their countries’ target GDP on health; that high income countries provide external financing for health “equivalent to at least 0.15 per cent of GDP”; and most upper middle income countries “should commit to progress towards the same contribution rate.” KEY ISSUES – WHERE RH SUPPLY MEETS FFD 25POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT In addition, international parliamentarians, through the International Parliamentarian’s Conference on Implementation of the ICPD Programme of Action (IPCI), have argued that donor governments should dedicate at least 10 percent of ODA to Population Assistance; a target met only by the United States during the past few years (DSW, et al 2013). Adoption of these recommendations would provide a helpful starting point for increasing development and domestic support for RH supplies and SRHR. Risk/Challenge There seems to be strong thread in the FfD discourse for decision-makers to focus their attention away from traditional aid in favor of developing new sources of financing for development. Development Ministries from all countries21 participating in the OECD DAC are discussing whether and how to clarify and expand the definition of ODA to include new “development enabling” sectors and public goods, such as those related to climate and security (Hoehn et al, 2015 in press). Expanding the definition of ODA, while the original Monterrey donor target for ODA of 0.7 percent of GNI remains the same, means more sectors and organizations competing for the same size pie and greater RH supplies competition with other sectors for scarce donor resources. This debate merits close monitoring and readiness for quick intervention. Recommendations To increase traditional development assistance in support of the ICPD costed package and RH supplies, SRHR stakeholders should join other development cooperation organizations in urging heads of government and finance ministries at the FfD in Addis Ababa to: 1. Reaffirm the Monterrey definition of ODA for monitoring donor country progress towards 0.7 percent of GNI. 2. Adopt the WHO recommendation that 0.1 percent of GNI should be reserved for global health financing 3. Adopt the SDSN recommendation that all countries work toward allocating at least 5 percent of national GDP as public financing for health. 21 OECD DAC Members: Australia, Austria, Belgium, Canada, Czech Republic, Denmark, European Union, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Japan, Luxembourg, Netherlands, New Zealand, Norway, Poland, Portugal, Slovakia, Slovenia, South Korea, Spain, Sweden, Switzerland, United Kingdom, United States. Other participants in the December meeting: Chile, Estonia, Hungary, Israel, Mexico and Turkey; the International Monetary Fund (IMF), the World Bank, the United Nations Development Programme (UNDP) and the Inter-American Development Bank (IADB). KEY ISSUES – WHERE RH SUPPLY MEETS FFD 26POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT 4. Adopt either the SDSN recommendation that high income countries allocate at least 0.1 percent of GNI as aid to help low- and middle- income countries implement universal health care or the Chatham house recommendation that high income countries provide at least 0.15 percent of GDP in aid for health in developing countries. 5. Adopt the International Parliamentarians’ Conference (IPCI) commitment to dedicate 10 percent of ODA to Population Assistance, increase funding for RH supplies specifically and close the $9.4 billion annual gap in funding to meet women’s needs for modern contraception in the developing world. 6. For all the above commitments, adopt time-bound implementation schedules and binding targets with clear deadlines and UN monitoring. 7. Ensure that financing for the climate be excluded from ODA and that new funds for the climate be additional to ODA. 3.2 Using ODA to Leverage Private Sector Investment Since the International Conference on Aid Effectiveness in Busan (See Sidebar), “global and innovative partnerships for development” have come to be seen by many as the inevitable solution to sustainable development financing. Using ODA to leverage new private capital in favor of sustainable development is a major thread throughout the FfD, the Zero Draft Outcome Document22 and the policy documents leading up to it. There is a significant emphasis on efforts by the World Bank and other IFIs to enhance support for infrastructure development and financing, mobilize private long-term finance for commercially-viable projects, and strengthen public and private partnerships (Development Committee 2015). By agreeing to the current Zero Draft language, decision-makers would agree to provide financial and technical support to preparing and prioritizing projects with the greatest potential for sustainable industrialization and support blended financing instruments (See Sidebar), including public private partnerships (See Sidebar). The GFF for EWEC calls for a greater role of the private sector in health financing strategies at the national level and aims to strengthen and improve the private sector’s efficiency. Analysis Many nonprofit champions of RH supplies worry about the possibility of increased involvement of companies in international financing for health in developing countries. There are at least two main reasons for this concern: the moral hazard of using public poverty eradication funds through 22 See especially Zero Draft Outcome Document paragraphs 8, 48, 52, 58. KEY ISSUES – WHERE RH SUPPLY MEETS FFD Sidebar 11: Public Private Partnerships (PPPs) As the WHO website explains, the term “PPP” can apply to ventures varying widely in size, participation, legal status, governance, management, policy-setting prerogative, contribution or operational role. Objectives typically include: › Developing a product › Distributing a donated or subsidized product › Strengthening health services › Educating the public › Improving product quality or regulation Some “PPPs” could be more accurately described as public sector programmes with private sector participation, such as Global Alliance for Vaccines and Immunization, which has its secretariat at UNICEF. There are also legally independent “public interest” (but actually private sector) entities such as the Global Fund to Fight HIV/AIDS, TB and Malaria. 27POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT mechanisms supporting private profit; and the problem of ensuring transparent, accountable, cost-effective results. Moral hazard When nonprofit organizations receive donor support for RH supplies, which they then sell in developing countries, net returns feed back into operations improving access. As a result, the moral hazard of public investment in nonprofit operations is relatively low. This relatively low moral hazard exists whether or not the nonprofit organization produces results efficiently and with relative cost-effectiveness compared with other possible implementing agencies, though public officials must be vigilant to avoid wasting resources through programme ineffectiveness or “market” inefficiency (eg, pushing products that consumers do not want). When a for-profit company receives a government subsidy to develop a RH product, which it then sells in developing countries, the moral risk is higher that public funds will be turned into private profit to the disadvantage of impoverished populations. Domestic government, domestic private organization or private consumer out-of-pocket funds may combine with the donor subsidy to return profit to investors that could have otherwise been used to improve RH supplies access. Market efficiencies normally attributed to for-profit market dynamics (eg, in meeting consumer demand innovatively) do not necessarily apply in a context where government defines and funds research, development, procurement and dissemination priorities, rather than consumers. Well-designed public-private “blended” financing mechanisms enable governments to use official funds to leverage private capital while sharing risks and returns with the private entities. Compared to “pure” loans, the EU claims that blending mechanisms enables donors to: › make transfers to heavily indebted countries without exacerbating debt problems; › bring companies’ financial rate of return closer to what they would get in developed economies for developing country projects with a high socio-economic and/or positive environmental impact; and › improve the quality of funded projects. Poorly designed public private partnerships and other blended structures can lead to high returns for the private partner, while the public partner retains all the risks (IOB 2013). In addition, Eurodad (2013) reports that there is no reliable evidence to show that blended financial mechanisms meet development objectives. (See Sidebar) Transparency and accountability For RH supplies, for-profit company innovation has produced many user- friendly products that have been helpful for increasing RH supplies availability and use. Whether this innovation produces net benefits on KEY ISSUES – WHERE RH SUPPLY MEETS FFD 28POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT aggregate seems obvious on the face of it. Unfortunately, the evidence is lacking regarding precisely where, when and how investments in development of new RH technologies by companies have generated net benefits compared with alternatives such as increasing understanding of existing contraception options, ensuring that existing RH supplies reach the populations needing them, investing in non-profit product development, and so on. There are several private sector mechanisms to govern (or build collective action), for social good and/or global health including GBCHealth23, but these are voluntary and self-regulating. (GBCHealth 2015). Disaggregated private for-profit data is not freely available, though some can be purchased from market research firms. There is no open international database where companies report RH supply financial flows24. Better availability and use of market research data in the international family planning and reproductive health community would help provide a more complete picture of financing-by-source for RH supplies. The proprietary nature of much of this information underscores the sensitivity of companies in openly sharing data about RH supplies costs and sales in their competitive markets. An open source approach to corporate reporting of RH supplies financial flows would have to make business sense for the companies providing data and benefit corporate profits from RH supplies. As Denise Harrison, Senior Market Development Advisor at USAID remarks “Many in our community question the validity of data (that can be purchased) from traditional market research, but it should be noted that companies make big investment decisions drawing on this data. We should ask if open access data works as well for government decision-making.” It would be very helpful to know more about the rapid growth of private markets for contraceptives in developing countries. For example, what is the economic profile of the purchasers in developing countries? If, as it seems reasonable to assume, they are middle- to upper-income people, do their out-of-pocket payments relieve the burden for public sector contributions to RH supplies, or do they reduce the opportunity for the sort of risk-pooling and resource re-allocation that enables governments to subsidize RH supplies for the very poor? How do their purchases influence which RH supplies are available? Does the growth of private out-of-pocket payments attract producers in ways that make it easier or more difficult for governments to negotiate RH supplies prices? How do socially marketed – subsidized but not free – RH supplies affect either the private markets or the public efforts to close the RH supplies gaps? How do donor purchases, at prices considerably below market, subsidize manufacturers? One could argue that consumer-driven purchasing has the potential to be more efficient in meeting needs than donor-driven RH supply than donor-driven purchase and 23 A coalition of companies bringing the voice of business to global health issues. See www.gbchealth.org 24 Many of the 59 companies listed as RHSC members do not make detailed financial reports available online. Among those that do, the information provided varies widely by description. KEY ISSUES – WHERE RH SUPPLY MEETS FFD 29POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT dissemination. However, determining whether this is true in developing countries requires more data than is likely to be available in the foreseeable future. The following passage by Dalberg (2014), nicely summarizes many of the risks and opportunities associated with increasing private sector engagement in RH supplies: “Given the complexity and trade-offs involved in market-shaping approaches for family planning, enhanced coordination and transparency are essential. In any market, interveners must consider complex trade-offs between individual products and approaches and between optimizing for the present versus delivering on the future. This is especially challenging in the family planning space, where providing women with choice is fundamental. While optimizing delivery for any one method is clearly not sufficient, there remains no objective metric for establishing the right balance to avoid biasing or distorting the market. Consequently, in the absence of global agreement on an optimal set of approaches, it is incumbent upon interveners to articulate the logic of their choices and the vision that they seek. To the extent that consensus can be reached around product priorities and the allocation of resources amongst them, prospects will be enhanced for building a common vision within the RH community.” At a minimum, it seems reasonable to expect that a very carefully researched market segmentation would help ensure that any ODA used to leverage increased private sector involvement will clarify their roles, cost-effectiveness and expected impact (Gribble 2010). The High Level Task Force on ICPD (2015) argues that public-private partnerships to finance SRHR, outsource service provision, or advance research and development “should be carried out only under strong regulation and stewardship by governments and within an existing context of tax-funded public health care, to ensure equitable access, quality of care and compliance with human rights and ethical standards.” It also recommends ex-ante criteria “to determine whether private sector partners have a demonstrated commitment to rights and gender equality-based approaches, have any prior involvement in human rights abuses or corruption, respect tax and other financial obligations, comply with labour and environmental standards, and have no conflicts of interest, for which proper disclosure should be required.” In order to ensure the greatest health impact in a time of uncertain donor and domestic resource allocation, Ministers of Health must ask not only for more funding, but also for policies that enable greater leverage of that funding. According to the Brookings Institute (Glassman 2008), approximately 28 percent of extra value (more supplies/lives saved for the same donor dollar) can be captured by adhering to efficient procurement and payment policies. KEY ISSUES – WHERE RH SUPPLY MEETS FFD 30POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT KEY ISSUES – WHERE RH SUPPLY MEETS FFD Opportunity Although somewhat haphazard, the evidence for the net benefits of PPPs for health and RH supplies financing does exist. For example, the USAID Strengthening Health Outcomes through the Private Sector (SHOPS) programme25 documents ways in which the private sector can be very helpful for improving health outcomes in developing countries. For those private sector entities that contribute meaningfully to improving access to RH supplies, increased support from government provides an opportunity to magnify that impact. Companies, non-profits, public-private partnerships and projects that innovate, manufacture and distribute RH supplies are among those with tremendous potential to aid sustainable development, sustainable industrialization and full employment of women. Increased funds leveraged from new sources that improve RH supplies access could be very helpful, particularly considering the very large volume of private capital available (see Section 2). Leveraging, or incentivizing, the private sector to increase resources is also a major focus of the GFF and FfD. Some but not all private sector entities have signed on to global “compacts” that provide governance frameworks for their involvement, such as GBC Health, an international coalition of businesses interested in improving global health. Public-private partnerships accompanied by a clear governance framework – including ex-ante assessment and criteria, transparent reporting, independent evaluation, and monitoring mechanisms – present an opportunity to leverage private capital that is transparent and accountable and can be assessed for cost- effectiveness. Some researchers have indicated that supply-chain management for the public sector, private training schools, low-cost clinic and pharmacy chains, and diagnostic laboratories present promising opportunities for private sector involvement (Fryatt 2010). As these are some key ways in which the private sector (nonprofit and for-profit) is involved in RH supplies access, they represent a very promising area for further research. Risk/Challenge The Intergovernmental Committee supports using ODA to leverage new private capital in favor of sustainable development mainly to exploit the potential to mobilize new resources. The motivation for increasing private sector involvement does not appear to be based on a thorough, nuanced or disaggregated sector-specific analysis of the effectiveness or cost- effectiveness of private sector interventions in achieving development aims. The RHSC (2014) identifies many “market inefficiencies” that impede effective private sector resolution of RH supply gaps, including: › Lack of private sector insight into user needs and design requirements; 25 See www.shopsproject.org 31POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT › Lack of incentives for the private sector to enter market Information and data gaps; › Sub-optimal global procurement practices; › Lack of demand predictability; › Lack of private sector incentive to meet stringent regulatory authority or WHO prequalification requirements; › Challenges for companies in gaining regulatory approval; › High cost of goods sold, distribution and delivery issues; › Lack of user / consumer awareness; and › Lack of coordination among actors. In light of market and institutional failures, the risks and challenges of encouraging the use of ODA to leverage private capital are many (IOB 2013), with limited evidence to assess effectiveness, much less cost-effectiveness. There are many different ways of working with the private sector and not all of them are risk-free. The RHSC report (2014) lists 22 RH supply “market shaping” initiatives – activities by donor governments, philanthropic foundations and multilaterals that seek to proactively influence the dynamics of a given market. Goodwill is high, but evidence generally anecdotal regarding whether and how private sector engagement generates overall net health benefits in LICs and LDCs. As the FfD “Elements” paper (See Sidebar) rightly points out: “When a commitment is made by a non-state entity, only the committing entity can be held accountable, not the class of organizations.” An increase in reliance on non-state entities will commensurately increase the monitoring and accountability burden, which for population assistance, is already insufficiently resourced.26 Recommendations At the international level, the Civil Society group advising FfD Outcome Document drafters express concern about the “omnipresent” role of private finance and attendant socialization of risks and costs and the privatization of profits and wealth. They consider the Zero Draft as detrimental to the interests of sustainable development and biased towards big corporations and private finance overall. Mindful that sustainable development is meaningless without regard for human rights, they urge States to commit to develop the necessary policies and binding regulations to ensure alignment of business practices with human rights obligations. They suggest the Outcome Document includes a commitment to “work towards a mandatory UN set of principles to formulate and adopt principles for a set of sustainable development criteria to be applied on all businesses, and especially in cases when to public funds used to leverage private sector investment, drawn on existing UN principles.” 26 The UNFPA/NIDI report makes it clear that Population Assistance investments in public policy research, administration and management have been flatlined for decades. KEY ISSUES – WHERE RH SUPPLY MEETS FFD 32POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT The fact that the broader finance and development-focused civil society is focused on monitoring, analyzing and addressing the inherent risks of shifting capital from poor individuals to wealthy individuals provides an opportunity for RH supplies stakeholders who also see to minimize risk of adverse capital transfers. SRHR and RH supplies stakeholders can learn from and build on the capacity of those civil society organizations; contribute to and strengthen their efforts to influence decision-makers; and focus their attention for the benefit of matters affecting RH supplies. To prevent a net drain of resources away from ICPD implementation and RH supplies access in developing countries, especially LICs and LDCs, SRHR stakeholders should join other development cooperation organizations in urging heads of government and finance ministries at the FfD in Addis Ababa to: 1. Agree that essential funding for PPPs should come from the private sector entities themselves, in order not to compromise the availability of public development aid for RH supplies among the world’s most poor populations. 2. Make any public development assistance that is used to “leverage” new private capital toward improving RH supplies uptake and SRHR outcomes contingent on a governance framework that includes assessment criteria, data transparency, independent evaluation and monitoring mechanisms, as well as a clear demonstration of relative overall cost-effectiveness in improving access. 3. Fund research to assess the ‘added value’ of the private sector and develop and disseminate evidence regarding best practices in public private partnerships for RH supplies and how domestic developing country governments can mitigate the risks of blending private and public resources. In addition, RH supplies champions must increase their literacy, knowledge and engagement on the commercial sector as an instrument for improving access to RH supplies. 3.3 Use of Loans The Zero Draft Outcome Document and policy documents leading up to it place a lot of emphasis on clarifying and most likely increasing loans to achieve the SDGs27. Most of it is focused on the problems associated with improving overall debt levels of poor countries and high-level macro- economic dynamics impeding sustainable development. But, there is more of concern in this issue than may seem immediately apparent to RH supplies interests. 27 See Zero Draft Outcome Document paragraphs 63, 64 and 82. KEY ISSUES – WHERE RH SUPPLY MEETS FFD Sidebar 12: Development Bank Loans (Part 1) As explained by NIDI (2015) development banks are an important source of multilateral population assistance. They focus on providing loans, which must be repaid, rather than grants. Most loans for population assistance come from the World Bank, which supports reproductive health and family planning service delivery, population policy development, HIV/AIDS prevention, and fertility survey and census work. The World Bank Group loaned $336 million for population and reproductive health activities in 2012. Three- quarters of this ($255 million) were loans from the International Bank for Reconstruction and Development (IBRD) loans at market rates. The rest were International Development Association (IDA) loans, made at highly concessional rates. “Concessional” rates are those whose associated costs and fees are lower than for loans available on the commercial market. 33POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Analysis Governance of the World Bank and other IFIs has been a long-standing if intermittent concern of SRHR advocates. Under the 2005-2008 leadership of its Chairman Frans Baneke – who worked for the Netherlands Development Finance Company for 20 years before joining the SRHR community – the EuroNGOs coalition28 conducted civil society training workshops and met with several World Bank board members regarding the need to increase World Bank funding for sexual and reproductive health and rights. Subsequently, the 2011-2012 EuroNGOs project “AHEAD for World Bank Advocacy” sought to build advocacy capacity of civil society in Kenya, Rwanda, Tanzania, Uganda, Mali, Senegal, Niger and Burkina Faso for influencing the World Bank at national level. Since 2010, IPPF’s “Scorecard” work monitoring progress on the World Bank’s Reproductive Health Action Plan has found it extraordinarily difficult to get clear, consistent and sufficiently detailed information regarding World Bank decision-making policies and procedures (IPPF 2014). The inability of SRHR stakeholders to obtain clear information and accountability from the World Bank mirrors that of the development community as a whole, including frustrations voiced by donor governments. The February FfD Elements document itself rued the slow progress to improve debt and loan practices of international financial institutions, and bemoaned the lack of developing country representation for accountability and governance, as follows: “Developing countries have yet to fully achieve greater voice and participation in the international financial institutions (IFIs)29 and in financial standard and norm-setting bodies….governance reforms at the IFIs, begun in the Monterrey context, have been slow and disappointing, despite the initiatives taken in the institutions themselves. Furthermore, despite some progress, representation (of developing countries) in international financial regulatory bodies…remains limited.” (Elements, p. 10) While this statement was subsequently nuanced in the Zero Draft FfD Outcome Document, the latter still deplores that ‘many countries remain vulnerable to debt crises’ and calls for higher representation of developing countries in IFIs’ governance structures. World Bank / International Development Association (IDA) loans reported in the OECD DAC Creditor Reporting System database under Population Assistance sector coding frequently indicate coverage of annually recurring, operating “current” costs, including: 28 See www.eurongos.org 29 IFIs are institutions that provide financial support (via grants and loans) for economic and social development activities in developing countries, such as the European Investment Bank, World Bank, International Bank for Reconstruction and Development, and International Development Association. KEY ISSUES – WHERE RH SUPPLY MEETS FFD Sidebar 13: Development Bank Loans (Part 2) NIDI and IPPF (2014) have found it extremely difficult to get clear, consistent, disaggregated and reliable data from the World Bank regarding its grants and loans for SRHR. It is also difficult to get information about the criteria and processes used for development bank loan decision- making. Many bank loans are used to finance basic social service programmes such as nutrition, integrated health and girls’ education projects. Often, ICPD components such as family planning, reproductive health and HIV/AIDS- prevention services are embedded in these projects. However, record- keeping systems do not disaggregate funds by ICPD categories. As a result, loans that finance basic social service programmes and which include family planning, reproductive health and HIV/ AIDS services go unrecorded. 34POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT › Information-education-communications activities › Control of communicable and non-communicable diseases › Health surveillance and promotion activities › Hospital/other health and nutrition services, support services › Health policy reform › Capacity building › Health care practitioner training › Strengthening of personnel recruitment and management Descriptions of these IDA loans as they appear on the OECD DAC Creditor Reporting System can be found in an Annex to this report. The descriptions do not indicate what proportion of loan financing was allocated to current costs, nor what requirements or qualifications may have been attached to them. This makes it very difficult for civil society to infer the principles and criteria being applied to IDA loans for population assistance or provide independent monitoring and assessment. According to the February draft Business Plan, the GFF plans to highly “incentivize” IDA and International Bank for Reconstruction and Development (IBRD) loans for financing of reproductive, maternal, newborn, child and adolescent health. The GFF Trust Fund will only commit grant resources to countries that allocate IDA/IBRD loans to RMNCAH. As a general rule, the minimum leverage ratio (the ratio of IDA/IBRD financing to grant resources) is one-to-one. This means the IDA/IBRD loan must match or exceed the grant resources, or the grant resources are reduced to the level of IDA/IBRD financing. Operationally, grant resources are inextricably linked to the corresponding IDA/IBRD loan. Grants will not operate as standalone projects but rather as complements to an IDA/IBRD loan. There is no separate management structure for the grants. In order to obtain GFF grant resources, developing countries will be required to accept four dollars of IDA/IBRD loan financing on average. Risk / Challenge There are many reasons to be concerned about IFI lending practices. The International Consortium of Investigative Journalists (ICIJ) recently reported highly destructive impacts documented for World Bank development investments, citing gross human rights violations and $50 billion in funding for projects graded the highest risk for “irreversible or unprecedented” social or environmental impacts (ICIJ 2015). More specifically, generally accepted public sector financial management practices recognize that loan/debt financing of annually recurring operating (“current”) costs increases the overall financial burden of those costs and risks undermining economic development unless certain factors are in place. Loan financing for sustainable development falls into two major categories: KEY ISSUES – WHERE RH SUPPLY MEETS FFD 35POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT concessional and non-concessional. Concessional loans are less expensive than could be accessed on the open market and can qualify for reporting as a contribution to traditional development aid. Non-concessional loans and market-like instruments are designed with the express aim of returning profits to capital providers. Because of their design and intent, non-concessional loans used to finance development increase the overall cost of the financing, which in turn increases the burden on developing countries. In order to assure that loan/ debt financing in developing countries does not undermine sustainable development, loan/debt instruments should be considered generally inappropriate for financing of recurring operating (current) costs, except in clearly specified circumstances, such as if the loan is planned to (a) serve as a bridge that fills a gap in financing due to known/planned donor disbursement delays; (b) with a donor guarantee / pledge backing; and (c) highly concessional in the case of LDCs. An additional concern regarding loans applies to the Global Financing Facility for EWEC. A great deal of the information that the GFF has released to public stakeholders raises many more questions than it answers. Critical underlying assumptions are left unexplained, and many are highly questionable.30 Opportunity The USAID Strengthening Health Outcomes Through the Private Sector (SHOPS) programme31 documents capital financing needs in developing countries that may be well served by loans. Bridge loans, like those espoused by the Pledge Guarantee for Health32, can fill RH supplies financing gaps that occur when there is a lag between a donor’s funding commitment and disbursement. Leveraging bridge lending, Ministers have the opportunity to procure essential medicines when they need them, and pay back when donor funding is available (PGH 2014). Recommendations The international Civil Society group advising the FfD Intergovernmental Committee drafters33, responding to input from this project, have urged that 30 The February draft GFF business plan presented scenarios with either 25 percent or 50 percent of government (presumably domestic) health expenditure being dedicated to RMNCAH resulting in a reduction of international (presumably donor government) dwindling to a tiny fraction of funding. The assumptions and calculations behind these projections were not detailed nor explained. 31 See www.shopsproject.org 32 See http://pledgeguarantee.org/pledge-guarantee-for-health-2-0/ 33 This group of more than 600 members serves as a communication platform among Civil Society Organizations dedicated to influencing the UN FfD process. Participants represent a wide range of finance and development-focussed international NGOs, such as the European Network on Debt and Development, the Society for International Develoment, CIVICUS, the Center for Human Rights and Climate Change, the Rethinking Bretton Woods Project. IPPF is a member, and the Women’s Working Group on Financing for Development participate. KEY ISSUES – WHERE RH SUPPLY MEETS FFD 36POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT the following language be added to the FfD Outcome Document: “We commit to providing sufficient development assistance in form of grants to ensure that the social compact is fulfilled and access to essential health information, services and supplies is ensured without loan/debt financing of annually recurring operating costs.” This helps strengthen the case for ensuring effective loan practices when it comes to RH supplies. To protect against the worst consequences of increased loan financing of RH supplies, SRHR stakeholders should join other development cooperation organizations in urging heads of government and finance ministries at the FfD in Addis Ababa to: 1. Require international lenders to make decision-making criteria and processes – especially for population assistance and RH supplies – open to public scrutiny and to refrain from lending practices that are contra-indicated with poverty eradication and sustainable development aims. 2. Make sufficient grant assistance available to ensure that access to essential reproductive health information, services and supplies is ensured without loan/debt financing of annually recurring operating costs. 3. Require international lenders to improve standardized reporting practices, eg, through OECD DAC reporting systems that will ensure monitoring and engagement in in International Financing Institution (IFI) practices by FfD decision-makers, governments and civil society. In addition, RMNCAH stakeholders must continue to closely monitor and intervene in the activities of the GFF for EWEC. While it is not clear how significant the GFF will become as a financing mechanism, considering only a few donors have expressed support so far, the alignment of the GFF approaches with the overall FfD debate and the institutional power of the World Bank group suggest that the GFF may continue to gain momentum. The RHSC and other SRHR stakeholders must remain vigilant to ensure that GFF practices produce results desired for RH supplies and SRHR as a whole. The GFF for EWEC should be expected to make detailed evidence in support of its business plan available for public scrutiny and be accountable to civil society concerns regarding criteria and processes that increase loan dependency in LDCs and LICs. KEY ISSUES – WHERE RH SUPPLY MEETS FFD 37POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT 3.4 Importance of ICPD Financing for Sustainable Development The Zero Draft Outcome Document makes explicit reference to the importance of implementing several strategies and programmes of action agreed previously by the United Nations34. It does not explicitly reaffirm the ICPD Programme of Action, though access to sexual and reproductive health information, services and supplies, including RH supplies, is an essential precondition for many aspects of sustainable development. Challenge Most of the economists and financial analysts who have thus far contributed to the FfD discourse remain unaware of the importance of the ICPD Programme of Action to sustainable development, and of course to RH supplies access. They do not see the importance of the consensus it reflected among 179 UN Member States nor the ways the ICPD PoA positioned population in relation to development, sustained economic growth, the environment, consumption patterns, governance, social equity and gender equality. At the ICPD, the international community agreed to fully finance four core programmes in an overall costed package: family planning; basic reproductive health; prevention of sexually transmitted diseases, including HIV/AIDS; and programmes that address the collection, analysis and dissemination of population data. Two-thirds of the required amount were to be mobilized by developing countries themselves and one-third was to come from the international community. These commitments have not been fulfilled on either side, which has undermined development progress in measurable ways (Beekink 2014; UN Secretary General 2014). Fully funding the ICPD Programme of Action would put in place many of the underlying factors required to ensure RH supplies access. Opportunity The reference to the New Partnership for Africa’s Development (Nepad) in the Zero Draft Outcome Document is helpful. In order to create a ‘mechanism’ for implementing the MDGs, the UN General Assembly adopted at its Fifty-sixth Session in September 2001 a Road Map towards the implementation of the United Nations Millennium Declaration. The Road Map contains both targets and indicators for each MDG and these will be partly used in developing NEPAD’s Implementation Plan. NEPAD can continue to play a leading role in the region with regard to financing of SDGs (AU 2006; NEPAD 2015. With NEPADs support of the ICPD PoA, there is an opportunity to advocate regionally for RH supplies domestic financing. 34 Zero Draft Outcome Document Paragraph 8. KEY ISSUES – WHERE RH SUPPLY MEETS FFD 38POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Fortunately, as a result of intervention enabled by this project, the global civil society group in March agreed to include ICPD as a recommended addition to the Zero Draft. This is a great breakthrough because the prior CS consolidated comments had no mention of ICPD, RH supplies or FP. They mentioned health only briefly. Receiving the support of leading finance and development organizations for inclusion of a recommendation to fully fund ICPD is a very helpful start for the advocacy campaigns. It is just a start, of course. Civil society vetting will come, and influencing the international decision-makers to ensure ICPD retains support presents a formidable series of challenges. Recommendation Thanks to input from this project, the civil society group advising the Intergovernmental Committee FfD Outcome Document drafters have urged inclusion of the following language in the next draft: “We agree that reproductive health and family planning supplies are essential to sustainable consumption and production patterns and we recommit to fully funding the ICPD Programme of Action.” Stakeholders concerned about access to RH supplies should urge Finance Ministers and Development Ministers to redouble their efforts to fully fund the ICPD Programme of Action. Doing so will not only increase measurable financial flows for RH supplies themselves but also strengthen the enabling environment required for people in developing countries to access them. 3.5 Guaranteed Social Protection, Essential Public Services and Universal Access The Zero Draft Outcome Document commits decision-makers to support something it calls “a new basic social compact to guarantee nationally appropriate minimum levels of social protection and essential public services for all.” It also promises to “guarantee access to essential health care and education for all persons.” The draft FfD Outcome Document would have Heads of State agree to increase public spending “to secure adequate investments to ensure universal access” and identifies domestic government spending as particularly important for this aim. Opportunity For Heads of State and Finance Ministers to guarantee access to essential health care, minimum levels of social protection and essential public services can only be good news for RH supplies access. In addition, the international civil society group advising FfD Outcome Document drafters have agreed to urge decision-makers to include explicit language on access to family planning, reproductive health supplies and the ICPD agenda. The support of KEY ISSUES – WHERE RH SUPPLY MEETS FFD Sidebar 14: Global Financing Facility for Every Woman Every Child In response to a call by the UN Secretary-General’s for expanded cooperation for action, the World Bank Group and the Governments of Canada, Norway, and the USA announced the creation of a Global Financing Facility (GFF) in support of Every Woman Every Child (EWEC) with up to $4 billion in financing support towards MDG acceleration and to improve reproductive, maternal, newborn, child and adolescent health (RMNCAH). GFF design has developed in parallel with the global FfD discourse. Many of its design features mirror those topics being discussed in preparation for the FfD Outcome Document. As the GFF is intended to serve as an implementation mechanism for financing RMNCAH, its business plan provides a helpful case study for how the abstract FfD discussion may play out in reality for RH supplies. 39POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT KEY ISSUES – WHERE RH SUPPLY MEETS FFD civil society internationally can be very helpful for giving additional weight to carrying forward SRHR and RH supplies messages to FfD decision-makers. Challenge The main challenge presented by this opportunity is to demonstrate at the national level that RH supplies constitute an essential public service and public good or at least should be part of a minimum essential package (Stenberg 2014; Hsu 2013). Experts may disagree about the application of the economic term “global public good” to family planning, but the benefits of investing in RH clearly accrue to the community at large. The challenge is to ensure that the FfD Outcome Document’s “nationally appropriate minimum levels of social protection and essential public services for all” guaranteed by Heads of State include FP and RH supplies. Ensuring this will require a much greater availability of transparent, detailed data for monitoring and advocacy intervention at the national and sub-national level in developing countries than has been available to date. Civil society groups advising the FfD Outcome Document drafters argue that asking States to commit to a “new basic social compact” obscures their existing obligation to fulfil the human right to social security enshrined in the Universal Declaration on Human Rights and International Covenant on Economic, Social and Cultural Rights (ICESCR).35 They observe that States have committed to “comprehensive systems of social protection that provide universal access to social services” in the past. They ask whether developing countries have the national resources to implement these provisions and demand explicit reference to international support for developing countries as part of the means of implementation and global partnership. When it comes to RH supplies specifically and the related costs that are necessary to ensure access, insufficient human resources has proven a major factor limiting access, as well as availability of needed equipment, functioning transport systems and many others. A declaration of commitment by decision-makers is welcome, but empty promises of the past demand ceaseless dedication to problem-solving at national and sub-national levels. Analysis The SRHR field has many arguments and overwhelming evidence to draw on when making its case that FP and RH supplies are a public good and a tremendous cost-effective public investment for sustainable development. While consumer out-of-pocket expenditures in developing countries represent 64 percent of all known financial flows for ICPD services, information and supplies (Figure 2), most Western European consumers 35 Collective in depth-analysis of the Zero Draft by the international group of Civil Society Organizations and Networks that follows the Financing for Development (FfD) process (draft 16 March 2015). Citations can be found therein. 40POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT KEY ISSUES – WHERE RH SUPPLY MEETS FFD contribute between 15 and 25 percent of total healthcare expenditures in their own countries (WHO Global Health Expenditures Database, accessed October 2014). On average across OECD countries, patients contribute about 20 percent of total healthcare expenditures (OECD.org 2013), though this may obscure how much consumers in wealthy countries pay for healthcare through taxes that support health systems. The disproportionate out-of- pocket burden by developing country citizens to the reproductive health, family planning and HIV/AIDs services, information and supplies in the ICPD programme of action demonstrates how essential these services are to private individuals. An accountable FfD system would respond not only to the demonstrable need for access to RH supplies, but also the clear demand being expressed for RH/FP by the poorest segments of society. Certain Middle Income Countries (MICs) display high levels of unmet need for family planning. Equally significant are the remaining inequities between geographic regions and populations groups within MIC countries with regard to access to social services. Catastrophic out-of-pocket spending rates were highest in some countries in transition, and in certain Latin American countries (Tobar 2013). An analysis of Demographic Health Survey data by Barros et al (2012) found that regardless of how poor a country is, the wealthy have the means to access needed interventions, while the poor lack access to key interventions such as skilled birth attendance. The High Level Task Force on ICPD’s February report, “Policy Considerations for Financing Sexual and Reproductive Health and Rights in the Post-2015 Era” (2015) concisely explains the challenges of inequality when it comes to accessibility and affordability of SRHR services. It suggests that countries would ideally provide universal free access to services and eliminate financial barriers at point-of-service delivery, which requires sufficient tax collection for general revenue for budget allocation. Sustainable consumption and production patterns start with a woman’s ability to control the number and timing of children she bears, and universal access to RH supplies is at the heart of this critical enabling factor. Reproductive health, and RH supplies, have a global public good value which is encouraging the ‘demographic transition’ through improved health care (WHO 2013; Ooms 2014; Stephenson 2010). If all unmet need were fulfilled in Sub-Saharan Africa alone, the number of unintended pregnancies in the region would drop by 78 percent, from 19 million to four million, resulting in eight million fewer unplanned births, five million fewer abortions and two million fewer miscarriages. Fulfilling unmet need in Sub-Saharan Africa would also prevent 555,000 infant deaths—255,000 newborn deaths and 300,000 deaths among older infants—which would result in a 22 percent decline in infant mortality. Enabling women to plan their pregnancies also leads to healthier outcomes for children. A recent study showed that if all births in developing countries were spaced at least two years apart, the number of deaths among children younger than five would decline by 13 percent. The number would decline by 41POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT 25 percent if there were a three-year gap between births (Guttmacher 2012). Expanding access to contraception will be a particularly cost-effective investment potentially accounting for half of all the deaths prevented in the accelerated investment scenario, due to its relative low cost (Stenberg 2014). Social protection and social insurance systems, while welcome, need to be approached cautiously. Risk pooling and prepayment to decrease risk and cost can in ideal circumstances decrease out-of-pocket expenditures by consumers. The GFF draft business plan also extensively emphasizes risk-pooling to “protect the poor and vulnerable” but goes on to acknowledge that these “are typically not completed in a single three to five year period” (GFF BP 2015). On the other hand, Oxfam provides ample evidence that risk-pooling in developing countries often excludes the poorest of the poor (Oxfam 2013). Putting social protection and social insurance schemes in place may require lengthy processes as necessary structures and systems are put in place. In the interim, simpler options to reduce out-of-pocket expenditures should be explored to mitigate their adverse effects. FfD Outcome Document decision- makers have a responsibility to direct increased financing toward ensuring that the poorest of the poor are reached. Recommendations To increase support for RH supplies, SRHR stakeholders should join other development cooperation organizations in urging heads of government and finance ministries at the FfD in Addis Ababa to: 1. Commit to include RH supplies in guaranteed minimum levels of social protection and essential public services in all national social compacts. 2. Provide additional international public funds for public policy research to determine the cost-effectiveness of mechanisms to assure universal access to essential services, and for third-party (ie, civil society) resource tracking and advocacy. 3. Provide international public funds to develop domestic government capacity to ensure measurable achievement of universal access to essential services, including RH supplies, and social protection. 4. Approach risk-pooling strategies with care and skepticism, with alternative social security mechanisms put in place to ensure that the poorest and most vulnerable increase their access to RH supplies. KEY ISSUES – WHERE RH SUPPLY MEETS FFD 42POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT 3.6 Global Funds The trend for global FfD and aid effectiveness commitments has been a continuous push for greater national ownership and control by developing country governments of all processes affecting their sustainable development and growth. At the same time, the Zero Draft Outcome Document36 emphasizes the use of global funds as a possible modality to fund the new social compact for access to basic services. Analysis There are two main components of this issue that have immediate relevance for RH supplies financing: the overall value of global funds as mechanism for financing development assistance for health overall, including RH supplies; and the specific value of global funds for cost-effective management of RH supplies procurement. Global Fund for Health The UN’s Sustainable Development Solutions Network (2015) recommends creation of a Global Fund for Health (GFH) – combining GAVI, the GFATM, the Global Finance Facility for EWEC and other existing mechanisms – to comprise a financing window to strengthen health systems and support horizontal approaches to health. The proposed GFH would disburse a minimum of $15 billion per year as of 2020 compared with a combined total of $5.2 billion today for GAVI and the GFATM. In theory, consolidating vertical funds has a wide range of possible benefits, including reducing the administrative burden for developing country governments that current manage numerous vertical financing arrangements for health, and improving health system management across disease groups and target populations (Ooms and Hammonds 2014). However, considering donors’ incentives and the political and institutional momentum of these distinct institutions, combined with the extraordinary complexity of harmonizing procedures among them, it seems unlikely that this year’s FfD decision-making would take major steps in that direction. The discussion merits close monitoring, however, because none of the existing global funds for health focus specifically on RH supplies. RH supplies procurement Looking more closely at the benefits of global funds for procurement of RH supplies highlights the challenges of managing national and international processes for best development effects. A recent study of the contraceptive supply purchases in Mexico confirmed that consolidated, international purchases made by UNFPA on behalf of countries such as Mexico can reduce national health procurement costs and increase the transparency of these processes. Additional advantages include higher predictability and reliability 36 Zero Draft Outcome Document Paragraph 11 KEY ISSUES – WHERE RH SUPPLY MEETS FFD 43POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT of contraceptive supply and delivery, as well as lower administrative and financial burdens due to reduced procurement-related staff time. Procurement experts have highlighted that when countries take on the task of procuring commodities, making sure the system works effectively takes time. The community needs to pay close attention to possible adverse effects: government procurement may take longer, at higher prices due to lower volumes, or switch brands with consequences for client acceptance (Dowling 2007). Recent studies have shown that when countries pick their suppliers, these suppliers sometimes select lower quality supplies (Bate 2014) which poses major concerns for RH supplies. National regulation must enable the use of international purchase systems by national governments or decentralized administrations, and a detailed review process is required to anticipate and prevent problems. (Vernon et al 2015) Opportunity Countries increasingly have the opportunity to either manage their own procurement systems or rely on international procuring agents like UNFPA (Gribble 2010; Dowling 2007). Governments in countries that receive donated contraceptives do not themselves need the capacity to manage complex and lengthy procurement systems and processes. International procurement agents often are able to negotiate lower prices through bulk volumes. Usually, UNFPA supplies can enter a country free of taxes. International public private partnerships have also proven helpful by negotiating minimum volume guarantees that enabled lower prices for specific RH supplies (FP2020 2013). Experience with RH supplies procurement has shown that stimulating national procurement is a long term effort requiring capacity investments by donors to improve Ministries of Health, national medical stores, regulatory and other systems. As developing countries develop their capacity to procure quality RH supplies directly, a continued role for global and multilateral Funds enables pooling of domestic funding from various countries for joint procurement and can help ensure an efficient use of scarce domestic resources. The RHSC (2014) reports that in January 2013, a consortium of international donors and Bayer HealthCare signed a deal to supply and purchase 27 million doses of the Jadelle® implant for the coming six years, in exchange for a 53 percent price reduction. Price reductions for ARV drugs generated through market interventions by UNITAID, the UK Department for International Development (DFID), and the Clinton Health Access Initiative (CHAI) generated an estimated global savings of at least $600 million from 2008 to 2011. (RHSC 2014) Challenge The international FfD Civil Society group, at the time of this writing, have rejected a suggestion to strengthen the Zero Draft FfD Outcome Document language regarding the value of global funds and multilaterals in negotiating KEY ISSUES – WHERE RH SUPPLY MEETS FFD 44POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT cost-effective procurements. Furthermore, they are highly critical of the disproportionate and “distorting” influence of private philanthropies over approaches to sustainable development. They express concern that private philanthropic foundations, whose legitimacy is questionable and priority- setting processes are non-transparent, have too much influence over how governments, intergovernmental and UN fora approach sustainable development. They are concerned with the ways in which global funds can drive sustainable development priorities through a centralized, top-down approach, and see them as using their international power, influence and resources to impose unhelpful requirements on developing country governments while increasing overhead costs for sustainable development. The overall concern is that global / international funds have power and influence that undermines the ability of developing country governments to effectively manage their own sustainable development and economic growth. If the SRHR sector seeks to get buy-in from the larger world of civil society organizations influencing FfD, the role of global funds in relation to procurement will require further discussion. Recommendation To increase support for RH supplies, SRHR stakeholders should urge heads of government and finance ministries at the FfD in Addis Ababa to continue to support international procurement agencies as developing countries develop their own internal capacity to cost-effectively manage RH supplies procurement. 3.7 Domestic Public Finance and Tax Revenues The Zero Draft Outcome Document emphasizes the importance of increasing domestic revenue generation in developing countries in order to strengthen sustainable development. It speaks to the need to improve fairness and effectiveness of tax systems for improving countries’ economic and social situations37. Challenge In reviewing Demographic Health Survey data, Barros, et al (2012) found highly unfair and avoidably inequitable access to skilled birth attendance and other interventions, when access is compared by income quintile. The authors do not know who accounts for the very high estimated out-of-pocket investment by consumers in developing countries, but it seems unlikely that consumer purchase of RH supplies is limited to the wealthy in those countries. As developing countries improve their systems of tax collection, it is important to ensure that efforts to increase public spending and domestic 37 Paragraphs 19 and 20. KEY ISSUES – WHERE RH SUPPLY MEETS FFD 45POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT resource mobilization do not undermine RH supply access. It seems reasonable to suggest that the necessity of high out-of-pocket spending for RH supplies and other essential services in developing countries demands tax-exemption or tax deductibility for those services and supplies. Increases in domestic government revenue should come from sources that do not further compromise access. The challenge for RH supplies stakeholders is to ensure that policymaker efforts to increase general revenues are progressive and reduce the barrier to meeting needs that is presented by out-of-pocket costs among poor populations. Opportunity Increased domestic government allocations to RH supplies would be very useful in closing the RH supplies funding gap in ways targeting the specific needs of each country. The Chatham House and Sustainable Development Solutions Network’s recommendation that all countries allocate at least 5 percent of GDP as public financing for health provides a helpful starting point. For Sub Saharan Africa, the Abuja Declaration commitment to spend 15 percent of national budget on health will remain a hollow promise if the national budget is insufficient due to failure to raise tax revenue (SDSN 2014, Røttingen 2013). The international Civil Society group advising FfD Outcome Document drafters, at the time of this writing, have collectively urged decision-makers to ensure progressivity of tax systems and include the following language: › “We also agree to incorporate sustainable development, the elimination of extreme inequality, and ensure equity, including gender equality, as key objectives in all tax and revenue policies, including in the mandatory reporting and incentives provided to domestic and foreign investors, and tax treaties and agreements.” › “(…) efforts should be made to increase transparency, enhance information sharing, and improve reporting-of international assistance for tax and fiscal management, since impacts of such ODA are currently difficult to monitor and evaluate.” › “Strong action- oriented measures on guaranteeing universal social services including care services that reduce and redistribute unpaid care work, labour market regulation, and the elimination of discriminatory gender norms that underpin the vertical and horizontal gender-based segregation of the workforce should must should be included. Progressive taxation and fiscal systems should be recognized as a tool to achieve gender equality.” › “We agree that universal access to reproductive health supplies and modern methods of family planning are essential to enabling women’s full participation in the economy and in the labour force and we agree to fully funding the ICPD Programme of Action.” The support of civil society internationally can be a tremendous help for carrying forward these messages to FfD decision-makers. KEY ISSUES – WHERE RH SUPPLY MEETS FFD 46POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT The support of civil society internationally on these issues provides an opportunity for increased gravitas and momentum for influencing FfD decision-makers. Recommendations To ensure that efforts to increase domestic resource mobilization do not undermine RH supply access currently funded out-of-pocket by consumers in developing countries, SRHR stakeholders should join other development cooperation organizations in urging heads of government and finance ministries at the FfD in Addis Ababa to: 1. Agree that consumer out-of-pocket spending for RH supplies and other essential services should be tax-exempt / tax deductible for very poor populations. 2. Adopt all the above recommendations of the global FfD civil society advisory group regarding domestic revenue generation and taxation. In addition, SRHR stakeholders can urge policymakers to support promising approaches found by Barros et al (2012) to improve equity – including deployment of services and health workers in the areas most in need, task shifting, reductions in financial barriers to access to services, and conditional cash transfers. 3.8 Women’s Labour and Human Capital The Zero Draft Outcome Document talks about the importance of women’s full and equal participation in the formal labour market to increase sustainable development. The potential of women’s human capital cannot be tapped without universal access to RH supplies. In order for women to have full and equal labour market participation, they must be able to control the timing and number of their pregnancies, which requires universal access to reproductive health and modern methods of family planning. The international Civil Society group advising FfD Outcome Document drafters, at the time of this writing, have agreed to collectively urge decision- makers to agree that “universal access to reproductive health supplies and modern methods of family planning are essential to enabling women’s full participation in the economy and in the labour force” and “to fully funding the ICPD Programme of Action.” The Women’s Working Group on Financing for Development (WWG on FfD) an alliance of organizations and networks advocating for the advancement of gender equality, women’s empowerment and human rights, is closely monitoring the FfD process and working with the international civil society group advising FfD decision-makers. The support of civil society internationally on these issues provides an opportunity for increased gravitas and momentum for influencing FfD decision-makers. Sidebar 15: Country Ownership Since the Paris Declaration in 2005, the field of development cooperation has continuously increased emphasis on developing country ownership and control over development investments. Many donors have increased the amount of bilateral aid provided through mechanisms such as general budget support, which delegate authority for resource allocation to the national developing country government. Unfortunately, developing countries are often less prepared to prioritize funding for family planning, RH supplies and sexual and reproductive health and rights in their budgets than are donor governments. In addition, the challenge of increasing funding for SRHR in developing countries is exponentially more burdensome than influencing donor countries, for many reasons, not least of which is insufficient and non- transparent spending data. FfD decision-making this year will extend this challenge for the foreseeable future. KEY ISSUES – WHERE RH SUPPLY MEETS FFD 47POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Recommendation To increase FfD decision-making in support of RH supply access, SRHR stakeholders should continue to work with the international civil society FfD group to maintain the link between RH supplies and women’s labour market participation in Outcome Declaration language to be adopted by heads of government and finance ministries at the FfD in Addis Ababa. 3.9 Devolved Decision-Making The Zero Draft Outcome Document recognizes that around the world, national governments are increasingly devolving responsibilities to the sub-national level, which often lack technical capacity and resources to manage them effectively. It commits Outcome Document signers to develop mechanisms to help strengthen sub-national government capacity to manage its responsibilities while also ensuring appropriate local community participation in decision-making.38 Opportunity The SRHR field and those concerned about RH supplies access have been struggling for several years to address the many challenges associated with devolution of decision-making and financial management to sub-national levels. Building technical capacity of sub-national governments in financial and administrative management of supply chains for essential goods and services is essential to sustainable development. Improved sub-national technical capacity on financial and administrative management of supply chains for reproductive health supplies could be very helpful for improving access and uptake, monitoring resource flows and strengthening accountability. Ensuring that local communities are able to participate in decisions affecting their access to RH supplies is an essential component of improving local accountability. Understanding financial resources available for RH supplies at national and sub national levels is also essential for ensuring access (Pradhan et al 2010). A commitment from FfD decision-makers to build sub-national and municipal technical capacity-building in sectorial finance and management may be of tremendous assistance for those seeking to improve sub-national financial flows tracking and management. Challenge The post-2015 discussions will provide a set of SRHR-related indicators. These indicators are expected to guide the elaboration of tailored, national indicators, to be integrated into national monitoring systems. National governments must ensure that decentralization processes are accompanied 38 Zero Draft Outcome Document Paragraph 36 Sidebar 16: Sub-national Decision-making for RH Supplies Developing countries’ increasing tendency to decentralize responsibilities from national to subnational government has shifted attention to curative and emergency care rather than prevention; reduced awareness of the need to increase FP funding; increased corruption in procurement; reduced capacity to plan and manage the RH supplies pipeline and related data. In some cases decentralization has increased instability, increased the cost of RH supply procurement and compounded stock-outs and shortages in supplies. Civil society can help maintain focus on SRHR and RH supplies; however, civil society is not systematically included in local processes. Local civil society organizations typically lack access to and understanding of key documents, processes and opportunities and are unable to participate meaningfully. ( JSI 2010; Schmidt 2011; JSI 2012; Vernon et al 2015). KEY ISSUES – WHERE RH SUPPLY MEETS FFD 48POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT by efforts to establish effective monitoring systems at subnational level that allow for tracking SRHR spending among other issues. Vigilance and continued advocacy, especially at national and subnational levels will be required to ensure that international commitments to increase subnational financial and managerial capacity produce measurable improvements in RH supplies access. A very recent case study on the re-centralization of contraceptive supply purchases in Mexico (Vernon, et al 2015) provides evidence that in certain contexts, such as in Mexico, centralized RH supplies procurement may be more cost-effective and efficient than decentralized purchase systems, due to bulk discounts and a single tendering process. Perceived problems with the decentralization of RH supplies procurement were related to weak administrative and logistical systems at the subnational level of the states. The report concludes that in the particular case of RH supplies procurement, it is recommendable to consider, in the medium term, keeping structures at least partially centralized while simultaneously strengthening respective administrative structures and logistics at sub- national levels. Recommendations To increase support for RH supplies in a context of devolved decision- making, SRHR stakeholders should join other development cooperation organizations in urging heads of government and finance ministries at the FfD in Addis Ababa to: 1. Increase international donor funding to improve national and sub- national technical capacity on financial and administrative management of supply chains for reproductive health supplies for increased FP and RH supply access and uptake, monitoring resource flows and strengthening accountability. 2. Direct funding to civil society in developing countries to ensure that local communities are able to participate in decisions affecting their access to RH supplies. 3. Direct additional resources toward data collection, analysis and monitoring of financial resources available for RH supplies at national and sub national levels is essential for determining obstacles to access. RH supplies and SRHR stakeholders will be required to continue ramping up their advocacy efforts at the national and sub-national level in developing countries for the foreseeable future. KEY ISSUES – WHERE RH SUPPLY MEETS FFD 49POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT 3.10 Transparent Data Collection, Monitoring and Follow-up The Zero Draft Outcome Document dedicates its entire final section to data collection, monitoring and follow-up. It talks about the importance of strengthening the capacity of national statistical systems and improving the timely availability of transparent financing data disaggregated by gender. One of the clearest findings of this analysis is that there is simply insufficient transparent data collection and monitoring to know, with a high degree of certainty, specific ways that the changes anticipated by the global FfD discourse will affect RH supplies. Financing data in every category except donor assistance – domestic public, domestic private, international private – for SRHR is highly insufficient. The support of FfD decision-makers, governments and civil society can be a tremendous help for ensuring that funds are directed toward collecting, monitoring, analyzing and reporting data on RH supplies funding, especially from international private, domestic public and domestic private sources. Recommendations To improve access and outcomes disaggregated RH supplies financing data is essential. SRHR stakeholder should urge decision-makers to: 1. Establish an international panel to develop and fund concrete ways to overcome the dearth of data on international health and SRHR funding by IFIs, non-DAC Government donors, private foundations and funding that is channeled through and spent by NGOs. (See also Pradham 2014). 2. Increase international public support for: a. tracking international and domestic financial flows for RH supplies. b. helping national developing countries develop and improve systems for tracking and reporting domestic and international financial flows – budgets and disbursements – dedicated to sexual and reproductive health and rights. c. tracking national-level out-of-pocket expenditures for sexual and reproductive health and rights disaggregated by sex, socioeconomic status and other demographic and geographic variables to capture the financial burden and use of services among disadvantaged population groups (ICPD 2015). 3. Commit all countries to reporting total health expenditure and total sexual and reproductive health expenditure by financing source, per capita, and establish country compacts / agreements between governments and all major development partners that require reporting KEY ISSUES – WHERE RH SUPPLY MEETS FFD 50POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT on externally funded commitments and expenditures, based on an agreed common format. 4. Agree that States should work towards developing standardized accounting and reporting frameworks for sexual and reproductive health, with data disaggregated by ‘government-as source’ (domestic public resources, i.e. taxes) and ‘government-as-agent’ (all financing disbursed by the government, including external revenue, such as ODA). Considering the overwhelming information burden and dearth of financing data that can enable government decision-makers and civil society to know how changes in financing for development are affecting funding for RH supplies, the above list serves mainly as a starting point, in hopes of instigating further discussion and action. 3.11 Additional Issues There are many additional issues raised by the global FfD discourse and Zero Draft Outcome Document that merit consideration or present an advocacy opportunity. Where money moves, it has the potential adversely or beneficially, to affect access to RH supplies. The following issues are relevant and instrumental. They merit additional study and action, but may be lower priorities for advocates than the issues detailed above. › Inserting references to health and RH supply chain infrastructure into Outcome Document calls for strengthening developing country infrastructures and ensuring that RH supplies experts are included in any related global initiatives (Zero Draft paragraph 53). › Ensuring that RH supplies are explicitly addressed in commitments to implement environmental, social and governance (ESG) reporting frameworks for the private sector to contribute to transparency and accountability” (Zero Draft paragraph 15). › Ensuring that commitments to strengthen investment in research and development of new technologies (Zero Draft section G) include RH supplies. › Supporting commitments to develop a broader metric of well-being, which recognizes the multi-dimensional nature of poverty and the social, economic, and environmental dimensions of domestic output, than GDP as a sustainable development indicator (Zero Draft paragraph 119). KEY ISSUES – WHERE RH SUPPLY MEETS FFD 51POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT This overview of financing for development trends and their possible implications provides a starting point for RH supplies advocacy toward major decisions to be made at the Third International Conference on Financing for Development in Addis Ababa in July. It was prepared to help RH supplies champions better understand and intervene on topics being debated internationally, to position RH supplies for increased funding in the future. One of the most striking findings of this analysis is just how little coherent and reliable information is available regarding major sources of RH supplies financing. A great deal of research is needed for RH supplies stakeholders to intervene effectively in the macro-economic and systemic financing discussions being debated internationally. In theory, any development financing issue may have implications for RH supplies financing, such as: › whether donor governments increase ODA and how they prioritize the use of public funds › whether domestic government increase spending for SRHR and RH supplies and how they prioritize that spending; › whether private financing domestically or internationally increases access to RH supplies; and › whether financing decisions agreed internationally and nationally affect the ability of consumers in developing countries to purchase or otherwise obtain their needed supplies. The Key Issues described in Section 3 may very well represent a subset of the development financing issues that RH supplies champions should be concerned with. Even for those issues, however, much more research is needed. Given the urgency of effective RH supplies and SRHR advocacy between now and the Third International Conference on Financing for Development in Addis Ababa in July, it is important to remember that many of the trends described in this analysis began years ago. Their implementation will be rolled out incrementally in country after country over the coming years. The SRHR and RH supplies champions have been working over many years to improve their financial and economic policy-making literacy and engagement, to ensure more and better financial support where needed. The advocacy mapping provided in Annex can help RH supplies champions engage strategically between now and December. After the July decision- making in Addis, advocacy must continue and with a greater emphasis than ever before on monitoring financial flows by international financing institutions and by national and subnational governments in developing countries. 4. Concluding Remarks CONCLUDING REMARKS 52POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT ANNEX 1: ADVOCACY MAPPING Key development financing events, stakeholders and entry points for RHS advocacy In order to ensure the best possible use of the report’s messages and recommendations, it is accompanied by a mapping highlighting key development financing events, stakeholders and entry points for RHS advocacy in the run-up to the Addis Ababa conference and Post-2015 UNGA high-level event. The mapping will ensure that the report results can be effectively used to influence FfD decision-making. The mapping, structured chronologically according to events and opportunities occurring between January and December 2015, is intended to support nuanced advocacy interventions, by providing an ‘actionable framework’ on how to best take the report’s messages forward in order to influence relevant players at key moments in the FfD decision-making process. Both the report and the mapping must therefore be seen as complementary parts of a comprehensive ‘advocacy package’. Mapping explained Under the column “Tactics and tools for Influencing” 4 key aspects are addressed for each event/ advocacy opportunity: Registration process, key sessions to attend, the expected outcome of the event and key actions to take for RH Supplies/ SRHR advocacy in preparation, during and in the follow-up to the event. A selected number of past opportunities are mentioned to put upcoming opportunities into a logical context by focusing on the most important FfD-related outcomes since the beginning of the year. The colour border on the left of each row is currently used to indicate key dates relating to the 3 major development processes marking this year for development, namely: The FfD (red) Post-2015 SDG indicators (green) GFF (purple) processes Blue important events for RH supplies advocacy which are not part of the above 3 main processes. Annex 1: Advocacy Mapping 53POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Timeline Entry point/opportunity Key stakeholders Tactics and tools for influencing Past key events & advocacy references 9 January, Riga, Latvia EU launch of the European Year for Development (EYD) European Commission President Jean-Claude Juncker and European Commissioner for International Cooperation and Development Neven Mimica REGISTRATION: N/A. past event. KEY SESSIONS TO ATTEND: N/A OUTCOME (key advocacy points): DECISION No 472/2014/EU OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL: EYD Focus on youth and development – which should include RH of young girls: › The European Year should raise awareness of all forms of gender discrimination faced by women and girls in various regions, particularly in terms of access to education, jobs and health systems, as well as of forced marriage, sexual exploitation, genital mutilation and other malpractices ACTIONS: › Attend EYD-related events in 2015 –especially those targeting youth / young girls in development › list available at: link – April has been declared EU month of health. › Use Decision wording as tool for advocacy 21 January, New York FfD Elements Paper published in the context of first drafting session for preparation of the outcome document to the Financing for Development (FfD) preparatory process, to be presented during the 3rd international FfD conference in Addis Ababa, in June. Hosted by the Office of the President of the UN General Assembly, with support from the Financing for Development Office (FFDO) and the UN Non-Governmental Liaison Service (UN-NGLS) Susan Alzner phone: 212-963-3125 e-mail: For any questions regarding civil society participation in the FfD3 process, contact: ffd3@un-ngls.org REGISTRATION: N/A. KEY SESSIONS TO ATTEND: N/A OUTCOME: Elements paper: For subsequent drafting sessions, reflection is encouraged on the following questions: › Do the elements presented cover the most critical dimensions of the agenda? › Are the key challenges covered in each of the building blocks? › See top RH supplies priority financing issues under international public finance building block. › What are concrete policy proposals that can be most transformative to address these challenges? See recommendations from RHS work. › How can the elements presented be made most relevant to and synergistic with the post- › 2015 agenda and implementation of the SDGs? › What should be the key deliverables in Addis Ababa? See recommendations from analysis of systemic FfD issues in Elements paper implications for RH supplies ACTIONS: › Use element paper as a basis further input to FfD outcome doc/ advocacy 54POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Timeline Entry point/opportunity Key stakeholders Tactics and tools for influencing 5 February, Brussels Publication of the European Commission Communication ‘A global partnership for poverty eradication and sustainable development after 2015’. EU positions in preparation for the Financing for Development conference in Addis Ababa and the UN post-2105 summit in New York later in 2015. European Commission REGISTRATION: N/A. KEY SESSIONS TO ATTEND: N/A OUTCOME: Key points in list of possible actions annexed to Communication, related to FfD: › 4) Mobilisation and effective use of international public finance. Actions for all: All countries should provide their fair share to support poorer countries in reaching internationally agreed objectives: › i. The EU and all high-income countries should provide 0.7% of their GNI as Official Development Assistance (ODA). › ii. Upper middle-income countries and emerging economies should commit to increasing their contribution to international public financing and to specific targets and timelines for doing so. ACTIONS: › Quote communication in events with participation of the European Commission. 6 Feb., New York Post-2015 SDG Framework Elements paper published. REGISTRATION: N/A. past event. KEY SESSIONS TO ATTEND: N/A OUTCOME: › Elements paper – Rough outline– refer to latest drafts available. ACTIONS: › Use element paper as basis for further input to FfD outcome doc/ advocacy 55POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Timeline Entry point/opportunity Key stakeholders Tactics and tools for influencing 5 March, Brussels Friends of Europe Conference, Brussels: Financing for development: The challenge of implementing SDGs. Neven Mimica, European Commissioner for International Cooperation & Development REGISTRATION: N/A. past event. KEY SESSIONS TO ATTEND: N/A OUTCOME: › Example of useful quotes from Comm. Mimica’s key note speech: ‘Let me be clear: The European Union should play its full part when it comes to ODA – the stance we have taken in the [Post-2015] communication is very clear: The EU along with all high income countries should meet the 0.7% UN target for ODA’ […]’The last Eurobarometer published in January shows that 67% of EU citizens say that the EU should increase aid to developing countries. […] The EU development assistance costs us just 4 cents per day for each EU citizen but it provides an invaluable contribution to those in need. Of course, we need to continue to support the poorest members of society in the poorest countries in the areas of health, education and jobs – but we may also need to rethink how we spend these resources. […] ODA alone is not enough to implement a broad development agenda’. ACTIONS: › Use European Commissioner Mimica’s quotes on FfD during the event for advocacy in the lead-up to FfD. 12-13 March, Santiago, Chile LAC Regional Consultation on FfD Organizer CEPAL, Ministerio de Relaciones Exteriores de Chile Daniel Titelman, Director, División de Desarrollo Económico, email: daniel. titelman@cepal.org REGISTRATION: N/A. past event. KEY SESSIONS TO ATTEND: N/A OUTCOME: › Contact organizers. ACTIONS: › Contact organizer + coordination team in charge to receive information about outcome of + follow-up to the consultation. › Ensure follow-up and key messages feed into the global community discourse through the RHSC/LAC forum March- April GFF SRHR consultations: CSO and Private sector World Bank RHSC MSI IPPF REGISTRATION: N/A. KEY SESSIONS TO ATTEND: N/A OUTCOME: › GFF roundtable consultations for specific constituencies: MSI and IPPF prepared key messages on SRHR: RHSC GFF consultations report › RHSC coalition GFF Position Paper ACTIONS: › Use position papers for influencing GFF advocacy on RH supplies. 56POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Timeline Entry point/opportunity Key stakeholders Tactics and tools for influencing 16 March 3rd Zero draft of FfD outcome document published. Launch of process for collective CSO response to draft established through FfD listserv. FfD preparatory process hosted by the Office of the President of the UN General Assembly, with support from the Financing for Development Office (FFDO) and the UN Non- Governmental Liaison Service (UN-NGLS) Susan Alzner phone: 212-963-3125 e-mail: For any questions regarding civil society participation in the FfD3 process, contact: ffd3@un-ngls.org CSO FfD listserv Contact persons: Matt Simonds: Matt.Simonds@ituc- csi.org Stefano Prato:Managing Director Society for International Development (SID) Website: http://www.sidint.net REGISTRATION: N/A KEY SESSIONS TO ATTEND: N/A OUTCOME: Key SRHR asks (in green) incorporated into consolidated CSO response, thanks to input from RHSC study researchers: › Language addition, Para 8 zero draft: “…In this regards, we agree to strengthen support for the implementation of relevant strategies and programmes of action, including [ADD] the International Conference on Population and Development Programme of Action, the Istanbul Declaration and Programme of Action, the Samoa Pathway, the Vienna Programme of Action for Landlocked Developing Countries, and the New Partnership for Africa’s Development.” › Language addition, para 15 zero draft: Language addition: “We agree that reproductive health and family planning supplies are essential to sustainable consumption and production patterns and we re-commit to fully funding the ICPD Programme of Action.” › Addition para 22: “We agree that universal access to reproductive health supplies and modern methods of family planning are essential to enabling women’s full participation in the economy and in the labour force and we agree to fully funding the ICPD Programme of Action.” › Para 64, addition: We urge providers to take into account the recipient country’s level of development, vulnerability by population groups, unmet needs (e.g. for family planning), debt level, ability to mobilize domestic resources, access to other sources of finance, […] › Addition Para 119: “We further call on the United Nations and the IFIs to develop a broader metric of well-being than GDP as a sustainable development indicator, which recognizes the multi-dimensional nature of poverty and the social, economic, and environmental dimensions of domestic output, [ADD] by taking into account inequities, vulnerabilities and unmet needs within countries and between population groups.” ACTIONS: › Contact FfD listserv coordinator to obtain consolidated full CSO response and use SRHR-related messages for RH supplies advocacy and input to further drafts. 20 March Publication of first draft declaration documents for Post-2015 SDGs’ framework: Post-2015 targets; REGISTRATION: N/A. KEY SESSIONS TO ATTEND: N/A OUTCOME: › Post-2015 targets draft ACTIONS: › Use Post-2015 targets related to health (e.g. Goal 3. Ensure healthy lives and promote well-being for all at all ages) but also those on “sustainable consumption” to advocate for RH supplies financing within the FfD framework.in order to ensure FfD/ SDG coherence. 57POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Timeline Entry point/opportunity Key stakeholders Tactics and tools for influencing 23-24 March, Addis Ababa Africa Regional Consultation towards the Third International Conference on Financing for Development Focal person: Gamal Ibrahim: Geibrahim@uneca.org REGISTRATION: N/A. KEY SESSIONS TO ATTEND: N/A OUTCOME: › A full summary of all in-country consultations can now be obtained through the FfD virtual group or by contacting focal person. 23 March, Geneva European regional FfD Consultation Registration deadline: 9 March. Organizer: UNECE Mr. Wu Hongbo, United Nations Under-Secretary-General for Economic and Social Affairs Secretary-General Mr. Christian Friis Bach, Executive Secretary of the United Nations Economic Commission for Europe Ms. Cihan Sultanoglu, Chair of the Regional UNDG Team for Europe and Central AsiaUNDP Regional Director forEurope and CIS Ms. AminaJ Mohammed Secretary-General’sSpecialAdviseron Post-2015DevelopmentPlanning Mr.Henryde Cazotte, Secretariat of the Leading Group on Innovative Financing for Development Ms.JeanSaldanha, Chair of Financing For DevelopmentTaskforce, Concord REGISTRATION: N/A. KEY SESSIONS TO ATTEND: N/A OUTCOME: › A full summary of all in-country consultations can now be obtained through the FfD virtual group or by contacting focal person. ACTIONS: › Use geographic analysis to influence global debate. › Key messages from Chair’s summary of meeting to be taken forward for advocacy: 13. The promotion of gender equality and the empowerment of women and girls is a necessary condition to achieve sustainable development, which is not only a human rights issue but also an important contribution to economic prosperity. The Addis Ababa Outcome document should give high attention to achieving and financing for gender equality, which constitutes an important goal and means of implementation of the Post-2015 Development Agenda. Proposals included gender sensitive budgeting and tax policies; ensuring equal access to financial resources, land and other productive assets, and integrating gender considerations in ODA investment decisions.[…] 22. Public-private partnerships (PPP) hold great promise for tackling infrastructure needs and the provision of some social services, but they require a conducive economic environment, effective legislation and, more broadly, the development of domestic capital markets. Risk mitigation instruments, if properly designed, may encourage the involvement of private investors in particular sectors. Standards, such as those promoted by the UNECE International PPP Centre of Excellence, can facilitate the development of PPP, promote transparency and accountability and put people first.[…] 29. Some participants highlighted that tax policy should be concerned not only with raising revenues but also with the impact on equality of different tax structures. The burden of indirect taxes falls disproportionally on the poor, therefore a shift towards direct taxes would be advisable to support inclusiveness. The effect of taxes as incentives for behavioral changes that support sustainable development also needs to be taken into account.[…] 40.Several countries reiterated the need to reaffirm the ODA commitment of 0.7 percent ODA/GNI. Some delegations called for timetables by those countries that did not yet achieve this level. 58POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Timeline Entry point/opportunity Key stakeholders Tactics and tools for influencing Mar 23 – 27, New York Post-2015 intergovernmental negotiations on SDGs and targets: 25 March: Interactive Dialogue with Major Groups and other Stakeholders, March 2015 18-member Stakeholder Steering Committee to collaborate on the engagement of the Major Groups and other stakeholders in the third post-2015 negotiating session (23- 27 March 2015). REGISTRATION: N/A. Past event. KEY SESSIONS TO ATTEND: N/A OUTCOME: not yet published. ACTIONS: › Ally with like-minded Steering Committee members (e.g. Asian-Pacific Resource and Research Centre for Women – ARROW; Women Environmental Programme) to advocate together for increased funding for RH supplies in the new financing architecture. 31 March, Brussels European Parliament Development Committee discussing financing for development, budget support, migration, EU-Africa relations, tax. EU Commissioner for Development Mimica Rapporteur: Pedro Silva Pereira (S&D) REGISTRATION: N/A. Past event. KEY SESSIONS TO ATTEND: N/A OUTCOME: › EP DEVE Committee- report on FfD – under finalisation. ACTIONS: › Draw upon language from report where it strengthens RH supplies argumentation: Urges the EU and its Member States to re-commit without delay or negotiation to the 0.7 % of GNI target, with at least 0.2 % of GNI reserved for LDCs, and to present multiannual budget timetables for the scale-up to these levels by 2020; Stresses that the EU and other developed countries must honour their commitment to provide scaled-up, new and additional climate finance to developing countries reaching USD 100 billion per year by 2020; […] Emphasises that ODA should remain the standard measure of financial efforts made; supports the inclusion of concessional loans based on calculation of their grant equivalents, despite due consideration of total official support for development 59POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Timeline Entry point/opportunity Key stakeholders Tactics and tools for influencing 31 March – 1 April, Paris OECD 2015 Global Forum on Development: Post-2015 Financing for Sustainable Development Forum. Rintaro Tamaki, Deputy Secretary- General, OECD José CorreiaNunes, Head of Unit, Budget Support, Public Finance and Macro-economic Analysis at EuropeAid Martine Durand, Chief Statistician, Director, OECD Statistics Directorate Wu Hongbo, Under-Secretary- General for Economic and Social Affairs, United Nations Annette Detken, Head of Competence Centre Sustainable Economic Development, Education and Health, KfW Ricardo Fuentes-Nieva, Head of research, Oxfam REGISTRATION: N/A. Past event. KEY SESSIONS TO ATTEND: N/A OUTCOME: › The Global Forum on Development offers a timely opportunity to explore these unknowns of the new FfD framework with a broad set of experts, practitioners, non-state actors and policy makers ahead of the third UN Financing for Development Conference in Addis Ababa (July 2015) ACTIONS: › Ask Raj Kumar (Devex), who acted as moderator at event, about outcome from his (media) point of view. › Ask for Devex interest in publication of an article / Op-Ed on the impact of new financing structures for social sector funding including SRHR/ RH commodities/supplies. 60POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Timeline Entry point/opportunity Key stakeholders Tactics and tools for influencing APRIL 2015 1 -2 April, Kinhasa, DRC GFF DRC consultation In the DRC, the GFF will build and expand on an already strong joint approach toward MDGs 4 and 5 and provide the significant support needed for the development of a health financing strategy. There is already strong partnership alignment in the DRC, with the Global Fund, GAVI, UNICEF, and UNFPA DRC, for the GFF to build on. GFF working group -AFP is the key contact for francophone GFF related issues REGISTRATION: N/A. Past event. KEY SESSIONS TO ATTEND: N/A OUTCOME: › not yet published. ACTIONS: › For advocacy background, refer to GFF concept note: In DRC an innovative partnership will finance and support the scale up of the results-based financing (RBF) program. The Global Fund, UNICEF, World Bank and the RMNCH Trust Fund are coming together to work with the government to design a program that aims to rapidly increase access to essential maternal and child health services.It is expected that by the end of 2015 all the health zones in two provinces (Equateur and Bandundu) will be covered by a comprehensive package of services implemented through an RBF program.The GFATM and UNICEF have committed financial, technical and human resources and will work with the WB to scale-up RBF in DRC. The GFATM is expected to provide HIV/TB Commodities to health facilities participating in the program. › Advocacy tools: Use USAID advocacy guidance tool “Enhancing Contraceptive Security through Better Financial Tracking” for preparing a RHS country analysis on DRC and present it to meeting participants / speakers. › Key advocacy messages that DRC is focusing on are: a separate commodity fund, and systems support. Focus on the demographic dividend. 2 April, Tanzania GFF consultation Tanzania The recently-developed One Plan II and Big Results Now will be the basis of Tanzania’s RMNCAH Investment Case. A health financing strategy is nearly finalized. REGISTRATION: N/A. KEY SESSIONS TO ATTEND: N/A OUTCOME: › GFF roundtable consultations for specific constituencies: MSI and IPPF prepared key messages on SRHR: RHSC GFF consultations report › RHSC coalition GFF Position Paper ACTIONS: › Use position papers for influencing GFF advocacy on RH supplies. 61POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Timeline Entry point/opportunity Key stakeholders Tactics and tools for influencing 2 April Every Women Every Child - Launch of Synthesis report of Consultations on updating the Global Strategy for Women’s, Children’s and Adolescents’ Health: Round 1-Priorities for the Global Strategy – Report Consultation coordination: AfriYan, Cambodia Reproductive and Child Health Alliance, CHESTRAD, Citizen Hearing partners, Maty Dia, Evidence for Action, Girls’ Globe, GHC, Vanita Gowda, Hriday, IPPF Africa Regional Office, NCD Alliance, Philippine NGO Council on Population, Health and Welfare, Safe Motherhood Network Federation Nepal, Fumie Saito, Uganda Youth and Adolescents Health Forum, White Ribbon Alliance Nigeria and Tanzania, Women Deliver, World Vision Uganda and Indonesia, and YWCA. PMNCH Secretariat: Robin Gorna (Executive Director); Andres de Francisco (Deputy Executive Director); Geir Lie; Lori McDougall; Nebojsa Novcic; Breshna Orya; Kadi Touré; and Veronic Verlyck; with support from Nicholas Green; Tammy Farrell; Nacer Tarif; and Caroline Nakandi REGISTRATION: N/A. KEY SESSIONS TO ATTEND: N/A OUTCOME: › This report has been developed to contribute to the process of updating the Global Strategy for Women’s, Children’s and Adolescents’ Health, in advance of its launch in September 2015 alongside the new Sustainable Development Goals (SDGs). › This report aims to synthesise the views of more than 4,550 organisations and individuals who discussed and provided input through a wide - ranging consultation process, coordinated by the Partnership for Maternal, Newborn & Child Health (PMNCH) at the request of the office of the United Nations Secretary General. › › This report has been developed to provide a timely › input into the first draft of the Global Strategy, expected for release in early May 2015. PMNCH will take a further round of › consultations on the first draft of the Global Strategy during the month of May 2015 through the consultation web- hub: › (www.WomenChildrenPost2015.org ) ACTIONS: › Get involved in continued strategy consultation process (May) to challenge some of the views reflected in the report which may represent a risk to RH supplies funding, e.g.: › There was some trepidation that hard won attention to neglected challenges (newborn lives, stillbirths, sexual and reproductive health and rights) might be put at risk depending on where both the Global Strategy and the larger global policy process around the SDGs land later in 2015; › There were mixed views about the extent to which the Strategy should focus on Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH)‘ core business as opposed to embracing whole-of-life issues. There was wide acknowledgement that the health challenges facing women and children were complex and increasingly extend beyond the RMNCAH core agenda. › Ally with PMNCH secretariat to take forward some of the financing-relevant report recommendations within the FfD process, e.g.: Financing, UHC and the Global Strategy – The costs of saving the lives of family members creates huge financial burdens for households driving many millions into poverty every year and the numbers could increase as chronic disease burdens grow. Domestic and global financing systems, soundly and sustainably linked to universal health coverage (UHC), are vital elements to addressing and curbing this slow-motion emergency. The Global Strategy is well placed to demonstrate and promote the links between the needs of the poorest and most vulnerable people - often women and children-to the UHC agenda, drawing attention to promotive and preventative services that will have impact on well-being throughout the life course. 62POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Timeline Entry point/opportunity Key stakeholders Tactics and tools for influencing 7-8 April, Amman, Jordan. Western Asia regional consultation on Financing for Development No further information available on agenda/ participants. REGISTRATION: N/A – past event. Reach out to APA http://www.asiapacificalliance.org/ KEY SESSIONS TO ATTEND: N/A OUTCOME: › Regional messages to become part of the geographic analysis. ACTIONS: › A full summary of in-country consultations held until present can now be obtained through the FfD virtual group. › Use geographic analysis to influence global debate. › Reach out to APA to make sure they are aware and have the necessary messages and share preliminary findings 8-9 April 2015, New York 3rd International Conference on Financing for Development Preparatory Process: Informal Interactive Hearings with Civil Society and the Business Sector. Co-Facilitators: H.E. George Talhot, Permanent Representative of Guyana; H.E. Mr. Geir O. Pederson, Permanent Representative of Norway. CSO FfD listserv Contact persons: Matt.Simonds@ituc-csi.org Civil Society Steering Committee members, selected on 10 March: Aldo Caliari - Center of Concern Andrew Hanauer - Jubilee USA Network Au’Birthly (“PEFI”) Kingi - Vagahau Niue Trust Chibeze Sunday Ezekiel - Strategic Youth Network for Development (SYND) Daniel LeBlanc OMI - VIVAT International / OMI Gérald Volcy - Action Communautaire de Solidarité et d’Intervention Sociale (ACSIS) Jean Saldanha - CIDSE/ Addis Ababa NGO Coordination Group Jennifer Narcisa Del Rosario Malonzo - IBON International REGISTRATION: N/A past event KEY SESSIONS TO ATTEND: N/A OUTCOME: › Provide civil society organizations and business sector entities with an opportunity to share their views and recommendations on the draft outcome document of the Conference. ACTIONS: › Reach out to CSO Steering Committee / listserv, to obtain information on conclusions/ follow-up to the meeting. 63POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Timeline Entry point/opportunity Key stakeholders Tactics and tools for influencing Jesse Liam Griffiths - Eurodad Kate Lappin - Asia Pacific Forum on Women, Law and Development Martin Tsounkeu - ADIN - Africa Development Interchange Network Matthew Simonds - International Trade Union Confederation Mcleo Mapfumo - Zimbabwe United Nations Association Mohammad Muntasim Tanvir - Global Campaign for Education / ActionAid International Nathan Charles Coplin - New Rules for Global Finance Nerea Craviotto Ortega - AWID / Women’s Working Group on FfD Nicole ALIX - The Mont-Blanc Meetings - International Forum of the Social and Solidarity Economy Entrepreneurs Prakash Tyagi - GRAVIS Rachele Tardi - International Disability and Development Consortium (IDDC) and International Disability Alliance (IDA) Ravi M. Ram - Amref Health Africa Yvon Poirier - RIPESS-Intercontinental Network for the Promoton of Social Solidarity Economy 64POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Timeline Entry point/opportunity Key stakeholders Tactics and tools for influencing 8-10 April, Incheon, Republic of Korea “Development cooperation for people and planet: What will it take?” DCF High-level Symposium Aim is to distil key policy recommendations for the purpose of applying these in FfD-III and post-2015 negotiations; and to assist countries and other stakeholders with their preparations for implementation of a unified and universal post-2015 development agenda. CO-CHAIRS: Wu Hongbo, Under-Secretary-General for Economic and Social Affairs, UNDESA, and Secretary-General for the Third International Conference on Financing for Development & Yun Byung-se, Minister of Foreign Affairs, Republic of Korea Key speakers: George Talbot, Co- Chair, Third International Conference on Financing for Development, Permanent Representative of Guyana to the United Nations (tbc) Martin Sajdik, President of the Economic and Social Council, United Nations REGISTRATION: N/A – past event KEY SESSIONS TO ATTEND: FfD discussions structured around following key Focus questions, very relevant to RH supplies: › What should be the place of ODA post-2015, building on its distinctive characteristics and strengths? › How can ODA be better targeted to wherever poverty is deepest in developing countries, i.e. in politically and environmentally vulnerable countries? › What is needed to ensure that ODA effectively responds to the vulnerabilities of the poorest people? What could this mean for ODA allocation considerations post-2015? OUTCOME: › Set of recommendations in the run-up to the Third International Conference on Financing for Development in Addis Ababa on 13-16 July 2015 and the post-2015 Summit at the United Nations in New York in September 2015. NOT yet published. ACTIONS: › Insist on Link between RHS and environment / women’s freedom to take informed family planning decisions and sustainable development (see related messages in the report). 10 April, New York 10am- 1:00pm in Conference room 8 at UN HQ Mobilizing local finance to implement the post-2015 development agenda The purpose of the side event is to highlight the importance of local development finance within the context of the Financing for Development agenda, and to explore concrete policy measures and actions that can help mobilize subnational financing for development in a sustained and sustainable fashion. Preliminary agenda and list of speakers available in event concept note Key stakeholders invited: - H.E. Mr. François Delattre, Ambassador, Permanent Representative of France to the UN -H.E. Mr. GeirO. Pedersen, Ambassador, Permanent Representative of Norway to the UN, Co-chairs of the 3rdInternational Conference of Financing for Development –tbc - H.E. Mr. George Talbot, Ambassador, Permanent Representative of Guyana to the UN, Co-Chair of the 3rdInternational Conference of Financing for Development - tbc REGISTRATION: To apply for a special event ticket, please visit: http://bit.ly/SETs-10April-Mobilizing-local-finance Deadline: 7 April KEY SESSIONS TO ATTEND: The debates will focus on three main areas: › Strengthening the mobilization of domestic resources; › Local taxation remains underdeveloped, and conditions to capture a portion of the capital gains in land value and the added value of economic activities are often not met. › Some countries allow local authorities to benefit from part of national economic growth through the taxation of economic activities, income or local sales (VAT). › The debates will focus on opportunities for reforming local taxation and transfers (fiscal decentralization),to foster the diversification and increase of local budgets and investments Local governments’ access to long-term financing; › Access to loans and financial markets has been the backbone of most infrastructure investments in Western cities over the past two centuries. Cities have led this process, supported by central governments. However, in developing countries, national governments are keen to maintain macroeconomic equilibrium and restrict local governments’ autonomy to access loans (often in an excessively constraining manner). › The debates will highlight the necessary conditions for fostering local governments’ access to financing (loans, financial market, bonds, etc) in order to enable them to invest in sustainable urban development. 65POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Timeline Entry point/opportunity Key stakeholders Tactics and tools for influencing - Lenni Montiel, Assistant Secretary General for Economic Development, UNDESA -tbc -Jérémie Daussin- Charpantier,Lead Specialist on Local Finances and Decentralization, AFD - Gulelat Kebede, Head Urban Economy and Financeat UN-Habitat - Barbara Samuels, Executive Director, Global Clearinghouse for Development Finance - Aniket Shah, Program leader –Financing for Sustainable Development Initiative, UNSDSN - Christèle Alvergne, UNCDF Various representatives of local authorities or local government associations in developing countries. The role of development partners in supporting local authorities › International and regional development banks already play a vital role in financing urban basic services and infrastructure in different regions. However, these banks tend to lend to national governments and the private sector, rarely granting credit directly to local governments. › ODA will continue to play a significant role in financing basic infrastructure and social service investments, particularly in low-income countries. However, it must focus more effectively on those countries that are most vulnerable tosocial and environmental challenges. Climate-finance mechanisms should be made accessible to the local level for enabling local governments to invest in resilient infrastructures. ACTIONS: › Use open debates to intervene and present participants with evidence about the risks of financing recurrent costs (e.g. for basic services) through loans › Regarding VAT, highlight need to consider that RH supplies and public goods are exempt. › Instead of ODA focus on most vulnerable countries, suggest focus on most vulnerable populations within a country. › Ally with LAs to seek agreement on message that Climate-financing should also enable local governments to invest in RH supplies. 66POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Timeline Entry point/opportunity Key stakeholders Tactics and tools for influencing 13-17 April, New York Forty-Eighth Session of the Commission on Population and Development The Priority Theme of the session is “Realizing the future we want: integrating population issues into sustainable development, including in the post-2015 development agenda.” IPPF Asian Forum of Parliamentarians on Population and Development Women Deliver Women’s Global Network for Reproductive Rights REGISTRATION: › Online Pre-registration using CSO Net is NOW CLOSED. › If you wish to organize a side event, please contact the Population Division ahead of the meeting. Registration for side events will close on 6 April 2015. OUTCOME: › Recommendations on how to integrate population issues/ ICPD programme of Action with Post-2015 SDG + FfD framework. KEY SESSIONS TO ATTEND: Key agenda points: › During the session, the 2015 Report of the Secretary-General on the flow of financial resources for assisting in the further implementation of the ICPD Programme of Action will be discussed. › General debate on national experience in population matters: realizing the future we want —integrating population issues into sustainable development, including in the post-2015 development agenda. Under this item, Governments would report on national experiences in meeting the goals and objectives set out in the Programme of Action of the International Conference on Population and Development as they relate to the integration of population issues into sustainable development, including in the post -2015 development agenda. ACTIONS: › Use this opportunity to demonstrate potential threats of the new financing architecture for ICPD PoA financing, by using the CSO zero draft input. › While most stakeholder statements are thematic (linked to Post-2015 indicators), statement of Asian Forum of Parliamentarians on Population and Development mentions financial commitment – explore possibility of joint advocacy for RHS funding. 13-17 April 2015, New York. 3rd International Conference on Financing for Development Preparatory Process: Outcome Document 2nddrafting session The objective of the conference is to discuss new and enduring questions in development finance for Low-Income Developing Countries. No agenda/ participants list available. Co-chairs -H.E. Mr. GeirO. Pedersen, H.E. Mr. George Talbot will presumably lead the session, as during 1st drafting session. Professor Jeffrey Sachs (The Earth Institute, Columbia University). REGISTRATION: To apply for a Special Event Ticket for the 13-17 April drafting session, please visit: http://bit.ly/FfD3-SETs-Drafting-Sessions Deadline: 8 April KEY SESSIONS TO ATTEND: No agenda published. Zero draft is expected to be discussed. The conference will include paper presentations, a policy panel, and a keynote address by Prof. Jeffrey Sachs. OUTCOME: › 1st Draft of FfD outcome document. ACTIONS: › Use RH supplies/ SRHR relevant messages included in FfD CSO consolidated input to zero draft (see messages above) to influence drafting of 1st draft outcome document. 67POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Timeline Entry point/opportunity Key stakeholders Tactics and tools for influencing 14-16 April, Geneva, Switzerland 66th Session of the UN Economic Commission for Europe: Committing to Action on Sustainable Development in Times of Change The 66th session of the UN Economic Commission for Europe (ECE) will serve as the Regional Forum for Sustainable Development and give input to the 2015 high-level political forum on sustainable development (HLPF). The high-level dialogue of this meeting will discuss, inter alia: how to transform the proposed Sustainable Development Goals (SDGs) into guidelines, standards, regulations and policies so as to help countries to achieve the goals and take action at the regional level; and how to develop a framework for accountability and monitoring of sustainable development. High-level thematic discussions will also be held and focus on actions and commitments. No details available yet. REGISTRATION: Online at: link KEY SESSIONS TO ATTEND: Provisional agenda: link › High-level thematic discussions will › take the form of moderated multi-stakeholder › debates on change and cooperation, and will address key questions on five thematic issues, focused on actions and commitments. Relevant sessions to advocate for funding SRHR/ RH supplies as a fundamental strategy for sustainable development: (b)Sustainable management of ecosystems and natural resources; (e)Partnering for sustainable development 4. Discussion and adoption of the outcome doc. OUTCOME: › The outcome of the session would form the regional contribution to the 2015 High-Level Political Forum on Sustainable Development. ACTIONS: Use RHS messages from this analysis to answer the following questions guiding the High-Level ECE dialogue: › How can we, through regional cooperation, transform the proposed Sustainable Development Goals into guidelines, standards, regulations and policies that will help countries to achieve the goals and take action? › How can we create and facilitate new partnerships between governments, the private sector and civil society that lead to action towards sustainable development? › How can we develop a framework for accountability and monitoring of sustainable development? › Highlight cost-effectiveness of investing in RH supplies funding for ensuring sustainable use of resources in the long-run. › Advocate for SRHR/ RH supplies to become an integrated part of climate/ sustainable development strategies/ policies. 68POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Timeline Entry point/opportunity Key stakeholders Tactics and tools for influencing 16-17 April 2015, Berlin, Germany International conference of G7 parliamentarians “She Matters” Hosted by the German Federal Ministry for Economic Cooperation and Development (BMZ), organised by the German All Party Parliamentarians Group on Population and Development, in collaboration with DSW (Deutsche Stiftung Weltbevoelkerung) and the European Parliamentary Forum on Population and Development (EPF). Speakers: - BMZ (German Ministry Development & Cooperation) - DSW; EPF - MPs from EU and developing countries - UN Women - UNFPA - WHO - Guttmacher Institute - IPPF - Save the Children - World Vision REGISTRATION: Event is only for invited Parliamentarians and a limited number of conference observers. For further information, please contact: EPF: secretariat@epfweb. org KEY SESSIONS TO ATTEND: All. Schedule: link OUTCOME: › Part of set of stakeholder consultations organized by the German government in the run-up to G7- conclusions are expected to feed into high-level summit discussions. ACTIONS: › Ahead of meeting: Ally with DSW for joint messaging on SRHR/ RH supplies. › Use following evidence for advocacy message to be transmitted through DSW and other like-minded organisations: According to a recent survey carried out by DSW to assess whether the newly elected members of the European Parliament are committed to health and SRHR in development, “83 per cent of MEPs agreed that supporting SRHR in EU development cooperation is either very important or important”. In general, health and women’s and girls’ rights were high on the development priority list of MEPs. › Use this evidence and strong Pop. & Devt group within the German parliament to influence G7 decision-makers on the need for continued funding to SRHR and RH supplies as a key step towards ensuring sustainability of development funding. April 17- 19, 2015, Washington D.C. World Bank Group International Monetary Fund Spring Meetings Key speakers: Christine Lagarde, Managing Director, IMF Dr. Jim Yong Kim, President, World Bank Group Ban Ki-moon, Secretary-General, United Nations Ms. Ruth Messinger, President, American Jewish World Service Dr. Ashmawey, President, Islamic Relief Worldwide REGISTRATION: Now closed (30 March DDL). KEY SESSIONS TO ATTEND: › Thursday, 16 April: Accountability for Better Development Outcomes: A Conversation with Government, Industry and Civil Society › Thursd, 16 April: Trust, Voice, and Incentives: Learning from Local Successes in Service Delivery in the Middle East and North Africa › Frid, 17 April: Flagship: Ebola: The Road to Recovery › Frid, 17 April: Tax Evasion and Development Finance: Strengthening Global Enforcement › Frid, 17 April: Flagship: Universal Financial Access 2020 › Friday, 17 April: Flagship: Financing for Development: The Way Forward › Friday, 17 April: Action 2015 Advocacy › Sunday, 19 April: Flagship: Fiscal Forum: “The Political Economy of Rising Public Debt” ACTIONS: › Before the event: Seek possible alliances with WHO and NGO speakers (Save the Children, Oxfam America, ONE) – especially those represented in GFF working groups – e.g. Save the Children (contact: Michael Klosson, Vice-President, Policy & Humanitarian Response) to jointly advocate for SRHR dimension within the WB discussions. 69POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Timeline Entry point/opportunity Key stakeholders Tactics and tools for influencing Dr. Carolyn Woo, President and Chief Executive Officer, Catholic Relief Services Hafez Ghanem, Vice President of the World Bank for the Middle East and North Africa H.E. Muhammed Sulaiman Al-Jasser, Minister of National Economy and Planning, Kingdom of Saudi Arabia H.E. Adel El-Adaway, Minister of Health, Egypt, Makhtar Diop, Vice President, Africa Donald Kaberuka, President, African Development Bank His Excellency Benny Engelbrecht, Minister of Taxation, Denmark His Excellency Luis Miguel Castilla, Ambassador to the United States & Former Minister of Economy and Finance, Peru His Excellency Mogens Jensen, Minister for Trade and Development Cooperation, Denmark Mr. Ray Offenheiser, President, Oxfam America His Excellency Børge Brende, Minister of Foreign Affairs, Norway (TBC) Honorable Amara Mohamed Konneh, Minister of Finance and Development Planning, Liberia (TBC) Min Zhu, Deputy Managing Director, IMF › No session on GFF (!) foreseen - ally with GFF working group to send a strong message. › During session on Ebola crisis as opportunity for advocating for more funding for HSS, including stable RHS procurement systems. › Challenge WB and IMF leaders represented on impact and risks of loans if used for recurrent operational costs (e.g. on SRHR) for developing countries national budgets and deficits. › Approach Christine Lagarde to advocate for mainstreaming gender and SRHR issues within new financing frameworks to allow for economic advancement of women. Remind Lagarde about her strong commitment towards women’s economic empowerment, as expressed in many recent media statements/ press briefings. 70POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Timeline Entry point/opportunity Key stakeholders Tactics and tools for influencing Jeffrey Sachs, Director, Earth Institute, Columbia University Bertrand Badre, CFO, World Bank Michael Elliott, CEO of ONE Justin Forsyth, CEO of Save the Children Joaquim Levy, Finance Minister, Brazil Helen Clark, Administrator, UNDP and former Prime Minister of New Zealand Arun Jaitley, Finance Minister, India 71POST-2015 FINANCING FOR REPRODUCTIVE HEALTH SUPPLIES DRAFT Timeline Entry point/opportunity Key stakeholders Tactics and tools for influencing 20-21 April, Berlin Germany Inclusive dialogue with civil society in the context of Germany’s G7 Presidency. CSO preparatory dialogue in the run-up of the G7 Summit 2015 in Schloss Elmau, which will focus on the global economy as well as on key issues regarding foreign, security and development policy. Additionally the UN conferences to be held in 2015 as well as the post-2015 agenda will be discussed. The umbrella organisation of development policy non- governmental organisations (VENRO) and the Forum Environment and Development will be organising this dialogue together with the Federal Chancellery. As part of an outreach process Angela Merkel will meet representatives of the scientific community, business and trade unions, as well as non-governmental organisations and young people from the G7 countries. Detailed list of speakers not

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