| KEY FUTURE
ACTIONS
- Reaffirmation of ICPD POA and Bali
Declaration
- Policy and institutional framework
- Programme implementation
- National capacity building
- Resource mobilization
- Regional action
1. Reaffirmation of the Programme of Action
and the Bali Declaration
The Meeting stressed that the principles and recommendations
of the Programme of Action adopted in Cairo in 1994
and of the Bali Declaration of 1992 remained valid.
It further reaffirmed its adherence to the over-arching
agreement contained in the first paragraph of chapter
II of the Programme of Action that "The implementation
of the recommendations contained in the Programme
of Action is the sovereign right of each country,
consistent with national laws and development priorities,
with full respect for the various religious and ethical
values and cultural backgrounds of its people, and
in conformity with universally recognized international
human rights."
The Meeting also noted that the use of the term "reproductive
health" in the key future actions included all
those elements described in the Programme of Action,
specifically "reproductive health care is defined
as the constellation of methods, techniques and services
that contribute to reproductive health and well-being
by preventing and solving reproductive health problems.
It also includes sexual health..." (paragraph
7.2). Reproductive health in that definition included
family planning.
2. Policy and institutional
framework
(1) The process of globalization has contributed to
the emergence of a number of demographic, economic
and social issues that require attention. Governments
are urged to adjust policies to reflect increasing
levels of globalization. These actions should include
cooperation on a regional basis and with NGOs and
international agencies to seek policy solutions to
problems arising from increased flows of migrants
among countries in the region, and to protect the
rights of the migrants; and the promotion of activities
that will strengthen the family so that it can meet
the challenges of new values and roles of family members.
(2) Governments are urged to formulate, enact and
monitor legislation based on a holistic and realistic
framework for dealing with gender equality and equity.
Protective and enabling laws are inadequate in the
areas of the inheritance of property; protection for
women at work regardless of workplace; and relationships
between men and women, particularly within marriage.
(3) Governments should mainstream gender concerns
in the government bureaucracy by providing sensitization
and awareness training to key officials at different
levels.
(4) Governments are urged to adopt a more strategic
target-setting framework to promote gender equality
and equity directly by focusing on those groups with
the greatest needs, for example, those living in areas
of poverty and in areas where wide gender disparity
is known to exist.
(5) Governments should set explicit priorities within
reproductive health and ensure that standards of reproductive
health care are appropriate for the level of socio-economic
development.
(6) Governments are urged to ensure coordination between
various providers of reproductive health care, including
government, NGOs and private systems.
(7) Governments should undertake focused advocacy
to convince policy makers and programme managers that
a target-free, needs-based reproductive health approach
will result in sustained fertility decline in countries
with such a goal.
(8) Governments are urged to follow a holistic approach
to adolescent/youth development activities, incorporating
educational, vocational, recreational and other activities
where appropriate.
(9) Governments should promote research designed to
improve reproductive health policies and programmes,
covering inter alia adolescent/youth reproductive
health, gender relations, reproductive health problems
(such as reproductive tract infections, STDs, breast
cancer and cancer of the reproductive system), and
violence against women and children. Research is needed
to improve project formulation, implementation and
evaluation. More suitable research, especially qualitative
research, and needs assessment are required to determine
what is happening in the adolescent/youth population
in terms of knowledge, attitudes, values, beliefs
and practices related to reproductive health.
(10) Governments are strongly urged to facilitate
the accreditation of appropriate organizations in
civil society, including non-governmental organizations,
professional or ethnic group associations, religious
groups, academic institutions, labour unions, political
parties, community groups and the private sector.
(11) Governments are strongly urged to provide opportunities
for the active participation of civil society in all
stages of policy formulation, programme implementation,
resource mobilization, and monitoring and evaluation.
(12) Organizations of civil society are urged to exhibit
greater transparency in their use of resources and
demonstrate accountability in reporting.
(13) Parliamentarians are urged to continue to promote
the policies and programmes in support of the Programme
of Action and the Bali Declaration through the use
of national committees of parliamentarians on population
and development.
3. Programme implementation
(14) In view of the continuing high levels of maternal
and infant mortality in many countries of the region,
governments are strongly urged to integrate the elements
of safe motherhood, including antenatal, intrapartum
and postnatal care, with newborn care and other components
of reproductive health care.
(15) Governments, in cooperation with international
agencies when appropriate, should develop packages
of reproductive health care taking into account variations
in needs at different levels of service provision
and for different areas within countries. A range
of models, depending on the availability of resources,
manpower and needs, will have to be developed, as
no one package or model will be universally appropriate.
(16) In order to improve measurement and monitoring
of population and reproductive health programmes at
all levels, governments, with assistance from international
agencies when appropriate, are urged to (i) adapt
and strengthen management information and statistical
systems; and (ii) improve skills in monitoring, evaluation
and analysis. These actions are crucial for effective
management and decision-making at all levels of population
and reproductive health-care programmes.
(17) Governments and other organizations should invest
more in operations research and utilize the findings
to improve the effective implementation of integrated
reproductive health care.
(18) Governments should rationalize logistic systems
so that essential reproductive health drugs, including
contraceptives and other supplies, are continuously
available where they are needed and unnecessary duplication
is reduced. This should facilitate the cost-effective
provision of reproductive health care.
(19) Governments should consider allowing duty-free
import of contraceptives and other health-related
commodities and ensure effective distribution to all
target groups, especially vulnerable groups.
(20) Governments are urged to adapt existing training
programmes with the aim of improving training in quality-of-care
elements, with special emphasis in interpersonal communication
skills and client satisfaction.
(21) Governments are strongly urged to adjust existing
service structures to make them more client-centred
and provide referral and follow-up care that is responsive
to client needs.
(22) As the existing quality-of-care framework was
developed in the context of family planning services,
governments, with the assistance of international
agencies when appropriate, are urged to develop and
test the framework on a broader set of reproductive
health-care services.
(23) UNFPA, in cooperation with other international
agencies and governments, is strongly urged to continue
to undertake and support the documentation and dissemination
of research findings related to quality of care in
order to develop greater awareness among policy makers
of the quality-of-care principles.
(24) Faced with the issue of providing access to information
and services relating to reproductive health to adolescents
and youth, and constrained by sensitivities associated
with socio-cultural and religious considerations,
governments, in partnership with civil society, should
develop a mechanism to bridge or narrow the gap between
provision of reproductive health information and services
to adolescents and youth within a friendly and enabling
environment. Advocacy and awareness campaigns should
be conducted for adult opinion leaders, including
parents, teachers, religious leaders, traditional
leaders, officials and legislators to create understanding
of adolescent and youth issues among them.
(25) Governments are strongly urged to involve, through
relevant participatory approaches, adolescents and
youth in the project design, planning, management,
implementation and monitoring of adolescent/youth
programmes. Adolescents and youth should also be used
as trainers and counsellors for their peer groups.
(26) Governments should differentiate groups of adolescents
and youth in designing appropriate programmes. Such
groups would include in-school, out-of-school and
employed adolescents and youth, for example. Governments
should provide adequate training and skill development
to adolescents and youth to enable them to become
productive members of their societies.
(27) In operating adolescent and youth programmes,
governments should encourage the joint participation
of females and males in discussions, planning, training
and other activities, where appropriate in the cultural
context.
(28) Governments, with cooperation from international
agencies and civil society when appropriate, should
undertake research into the most effective methods
of obtaining the participation of adolescents and
youth in programmes serving their needs.
(29) Governments are urged to increase male participation
in reproductive health programmes and promote greater
family health responsibility among males.
(30) Governments are urged to promote male responsibility
and socialization from an early age, rather than delaying
until males are of reproductive age, in view of the
socialization effects of the global culture.
(31) Despite legislation banning prenatal sex- selection
and sex-selective abortion in some countries, the
high sex ratios at birth observed for these countries
may indicate that discrimination against the girl
child starts even before birth. The poor nutritional
status and relatively high mortality of girl children
in many countries also show that gender-based discrimination
has major health consequences. Governments are urged
to establish or strengthen programmes to monitor these
basic indicators of gender discrimination.
(32) UNFPA, in collaboration with other international
agencies and governments, should increase efforts
to identify, test and agree upon a core set of indicators
that are valid and reliable for all countries in the
region, and that could be used by all countries for
comparative monitoring of progress in achieving the
goals of the Programme of Action and the Bali Declaration;
and an additional set of indicators that would be
useful for monitoring progress in countries at different
levels of development and facing different population
and reproductive health issues.
(33) Civil society organizations should play a more
active role in planning, implementing and evaluating
programmes at the community level, especially programmes
dealing with complex and sensitive issues, such as
gender relations, adolescent/youth reproductive health
and male participation in reproductive health.
(34) Non-governmental organizations should establish
NGO "umbrellas" or coordinating organizations
to maximize their effectiveness. Governments should
encourage and facilitate such action.
(35) UNFPA, in collaboration with WHO, other international
agencies and governments, should continue to (i) coordinate
the elaboration of conceptual and practical issues
related to the technical content, standards of care,
information, education and communication messages,
monitoring and evaluation of reproductive health programmes;
and (ii) provide the necessary technical support to
countries.
(36) UNFPA, in collaboration with other international
agencies and governments, should increase their efforts
to analyze, document and disseminate information about
successes and constraints in the implementation of
a variety of models of integrated reproductive health
care, including quality-of-care components, to assist
countries to accelerate and strengthen implementation
of reproductive health services.
4. National capacity-building
(37) Governments are urged to ensure that both basic
and continuing training deal with reproductive health
care in an integrated fashion in order to facilitate
the integration of various components of reproductive
health.
(38) Governments should strengthen and support a primary
health-care system of community-based programmes involving
families and communities. The programme should include
gender-responsive comprehensive health service centres
to deal with all aspects of health care, including
infertility, for all members of the family. Health
workers and volunteers should include females and
males working together.
(39) Governments, in cooperation with international
agencies when appropriate, should develop or expand
a methodology for data analysis that can be used to
determine the gender-responsiveness of public policies
and programmes. This effort should include the development
of indicators and tools for monitoring gender equality
and equity at all levels of society.
(40) Governments and organizations in civil society
should promote awareness, particularly among women,
about legal rights, and the legal, medical and social
services that are available in cases of need.
(41) Governments are strongly urged to design and
support programmes of advocacy of gender equality,
equity and the empowerment of women. Governments should
proactively develop a critical and strategic partnership
with women NGOs in identifying areas of wide gender
disparity, and should also actively enjoin, encourage
and support women NGOs to assist the government in
advocacy and information campaigns for gender awareness,
especially at the local level.
(42) In order to increase understanding of many of
the social and cultural processes that are impeding
implementation of the recommendations of the Programme
of Action and the Bali Declaration, governments and
international agencies are urged to undertake and
support innovative qualitative and quantitative research
into the relationships between socio-cultural and
population processes.
(43) Governments, with the assistance of international
agencies when appropriate, and non-governmental and
inter-governmental agencies, are urged to: (i) capitalize
on the experience contained within the region by organizing
collaborative South-South activities in research,
training and exchange of information; (ii) provide
support for groups of countries in similar cultural
or economic contexts to meet and discuss issues of
shared concern; and (iii) explore the feasibility
of utilizing the considerable capacity of some countries
in the region for the manufacture of contraceptives.
(44) International agencies are urged to support and
fund the exchange of experience among government and
civil society organizations, especially NGOs.
(45) In view of the expanded training requirements
arising out of the Programme of Action and the Bali
Declaration, and given the active decentralization
of population programmes and the lack of trained planners
and managers at the local level, governments, in cooperation
with civil society organizations and with the support
of international agencies when appropriate, are strongly
urged to improve the training of population programme
workers, especially at the local level.
5. Resource mobilization
(46) UNFPA, in collaboration with international agencies,
is strongly urged to continue and increase advocacy
efforts to encourage the international community to
strive to achieve the agreed target of 0.7 per cent
of the gross national product (GNP) for official development
assistance (ODA) and consider meeting the generally
accepted goal of devoting at least 4 per cent of ODA
to population programmes.
(47) Governments are urged, to the extent possible,
to increase the mobilization and improve the utilization
of domestic resources as one of the high priority
areas to ensure the implementation of the objectives
of the Programme of Action and the Bali Declaration.
These efforts could include (i) advocacy designed
to increase political commitments; (ii) the use of
operations research to identify the most cost-effective
methods of service delivery; and (iii) encouraging
greater community participation in programmes.
(48) Governments are strongly urged to consider new
ways of mobilizing resources through the selective
introduction of user fees, social marketing, cost-sharing
and other forms of cost recovery without impeding
the access of vulnerable and disadvantaged groups
to social services, including reproductive health
care.
(49) Governments, in partnership with other organizations,
especially NGOs, should explore innovative ways of
mobilizing private contributions.
(50) Governments should explore the strong potential
for resource mobilization via multi-bilateral funding.
(51) Governments, in cooperation with international
agencies, particularly UNFPA, are encouraged to utilize
the modality of South-South partnership to develop
strategies of advocacy for additional resources.
(52) Organizations of civil society should develop
income-generation projects and cost-recovery mechanisms
in mobilizing resources for core costs and for implementing
the Programme of Action.
(53) Governments and organizations in civil society
are urged "to do more with less" by better
utilization and efficient management of scarce resources.
6. Regional action
(54) ESCAP and other international organizations should
take into account these key future actions in designing
and carrying out Asian and Pacific regional population
programmes for the next planning cycle.
(55) In order to review the progress made towards
implementing the recommenda- tions of the Programme
of Action, the Bali Declaration and the present High-level
Meeting, and to adjust policies and programmes in
the light of new challenges that have emerged in the
region, ESCAP and UNFPA should organize a ministerial
conference on population in the Asian and Pacific
region in 2002, in accordance with resolution 74 (XXIII)
of 17 April 1967 of the Economic and Social Commission
for Asia and the Pacific.
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