XI. RESOURCE MOBILIZATION : CURRENT SITUATION AND FUTURE REQUIREMENTS

Technical and Policy Division, UNFPA

Introduction

Resource mobilization was an important part of the Programme of Action agenda and that of its regional predecessor, the Fourth Asian and Pacific Population Conference held in Bali, Indonesia, in August 1992. Adopting the Bali Declaration on Population and Sustainable Development, the Conference urged "all Governments, intergovernmental and non-governmental organizations, the private sector and external donors to make every effort possible to increase, on a regular basis, their financial commitment so as to attain their targets by the year 2000"(recommendation 65). It further called upon member States to intensify their support of population programmes and to strengthen technical cooperation among developing countries.

The Cairo Conference set out important population and development goals, including education, especially for girls; gender equity and equality; reduction in infant, child and maternal mortality; and the provision of universal access to reproductive health services, including family planning and sexual health. The Programme of Action adopted at the Conference called upon governments to commit themselves at the highest political level to achieving these goals, give the widest possible dissemination to and seek public support for the Programme of Action, and consider their current spending priorities with a view to requesting additional contributions for its implementation.

The Conference called upon the international community to "achieve an adequate level of resource mobilization and allocation, at the community, national and international levels, for population programmes and for other related programmes, all of which seek to promote and accelerate social and economic development, improve the quality of life for all, foster equity and full respect for individual rights and, by so doing, contribute to sustainable development" (paragraph 13.21).

The success of the Cairo Conference depends greatly upon the willingness of governments, local communities, the non-governmental sector, the international community and all concerned organizations and individuals to turn the recommendations of the Conference into action. A strong consensus emerged in Cairo for both a focused programme on population and reproductive health and an agreed schedule of resource mobilization.

The pre-Conference process and immediate post-Conference period saw an increasing flow of resources in the form of external assistance for population activities. Some members of the international donor community demonstrated their commitment to achieving the goals and objectives of the Programme of Action through increased donor funding. UNFPA recently estimated that domestic resource flows accounted for 80 per cent of the almost $10 billion in total global population-related expenditure and allocations in 1996, with the international donor community contributing the remaining 20 per cent, or $2 billion.1 The data on domestic resource flows are still undergoing critical review and should be regarded as preliminary.

A. Resource mobilization in the ESCAP region: current situation

1. External financial assistance for population activities

International assistance for population activities flows from primary donors, which include developed countries and private foundations, and intermediate donors such as multilateral organizations and agencies incorporated in the United Nations system, the development banks and international NGOs which channel most of the primary donors' funds for population assistance.

Three countries in the ESCAP region2 provide assistance to population activities in the form of primary funds that are channelled through bilateral, multilateral or private sources: Australia, Japan and New Zealand. Together, these three donors provided almost 9 per cent of the total primary funds of the developed countries and the European Union in 1995. During the period 1987-1996, external financial assistance for population originating in the ESCAP region followed a generally increasing trend, with a significant increase in funding recorded between 1993 and 1994 and again between 1994 and 1995 for Australia, and similar large increases for Japan and New Zealand between 1994 and 1995.

Both Australia and New Zealand further increased their commitments from 1995 to 1996; Japan has not yet reported its 1996 commitments. Informal indications are that the 1996 figure will be at least at the 1995 level, if not higher. Australia earmarked almost 3 per cent of its total official development assistance (ODA) for population activities, New Zealand contributed 1 per cent and Japan contributed just under 1 per cent of its ODA.

Japan is the major donor in the region, reporting $93.8 million in primary funds for population assistance in 1995. The majority of the funds, 60 per cent, flowed though multilateral channels, 23 per cent though the NGO channel and 17 per cent through the bilateral channel. Australia provided $32.6 million in primary funds for population assistance in 1996, with the majority of the funds, 42 per cent, flowing through the multilateral channel, 32 per cent through the NGO channel and 26 per cent through the bilateral channel. New Zealand reported providing $1.2 million for population assistance in 1996, of which 56 per cent flowed through the multilateral channel and 43 per cent through the NGO channel.

In addition, ADB made available $12 million for population assistance in 1995. This amount decreased sharply in 1996. It should be pointed out that the Bank's commitments reflect large blocks of loan agreements which are made in a single year but are intended to be expended over several years. Thus the commitment made and recorded in 1995 will be spread over several years.

According to the Global Population Assistance Report 1996, since 1990, with the exception of 1991, 1995 and 1996, more funds for population assistance were expended in Asia and the Pacific than in any other region. Final expenditure for population assistance in the region increased from $211.5 million in 1990 to $375.4 million in 1996 (table XI.1).

NGOs constituted a major intermediate source of funds in the region, with 37 per cent of funds flowing through the NGO channel in 1996. The bilateral channel accounted for the remaining 27 per cent. A total of 42 countries and areas in the ESCAP region benefited from international population assistance in 1996. Bangladesh received the largest amount of assistance of any country in the region, $87 million, followed by the Philippines, $46 million, and India, $44 million. A total of $34.8 million was spent on regional programmes.

UNFPA reported a total of $74.5 million in project expenditure in the ESCAP region in 1996. The majority of funds went to reproductive health/family planning activities (see table XI.2) and just under 15 per cent to information, education and communication (IEC) activities. In addition, UNFPA reported expending a total of $1.7 million in the region in 1996 via the multi-bilateral modality whereby bilateral donors channelled assistance through UNFPA to specific projects. Project allocations in 1997 totalled $92.1 million, of which 55 per cent was allocated to reproductive health/family planning services and 14 per cent to IEC activities.

2. Domestic financial resources for population activities

Domestic financial resources for population activities originate from three major sources: governments, NGOs and the private sector. The number and complexity of sources make it much more difficult to monitor resource flows. Although it is possible to collect data from governments and NGOs, it is not yet possible to include the private sector (individuals and households) owing to insufficient data. Without considering private financing, all attempts to capture domestic flows will necessarily be estimations.

A total of 14 countries in Asia and the Pacific have provided data on domestic resource flows for population activities for 1996 via UNFPA questionnaires distributed to governmental and NGO bodies in the countries. Fifty-six questionnaires were sent to government departments and 120 went to NGOs in the ESCAP region. In some cases, questionnaires were duplicated and further distributed within the country. A total of 60 responses from the governments and 107 responses from NGOs were received.

The data represent the first systematic attempt by UNFPA to collect information on domestic resource flows. UNFPA is working closely with the Netherlands Interdisciplinary Demographic Institute to refine data collection procedures and to examine data quality.

Responses indicate that government expenditure accounted for 98 per cent of total domestic expenditure for population activities, and NGO expenditure accounted for the remaining 2 per cent. The reported expenditure of these countries suggests that NGOs are not yet in a position to raise significant national domestic resources. The largest percentage of government expenditure went to basic reproductive health services - 49 per cent, followed by family planning services - 42 per cent, basic research, data and population and development policy analysis - 5 per cent, and sexually transmitted diseases (STDs) and HIV/AIDS activities - 5 per cent. These figures should be considered tentative while they are still being subjected to careful scrutiny to ascertain the degree to which respondents were able to distinguish between different activities (for example, between basic reproductive health and family planning).

Thirteen countries in the region also provided data on national NGO expenditure by category of population activity. Well over half of the total expenditure went to family planning services - 61 per cent; the remaining 22 per cent went to basic reproductive health services, 11 per cent to STD/HIV/AIDS activities and 7 per cent to basic research, data and population and development policy analysis. Almost 72 per cent of the national NGO funding came from international assistance; just under 20 per cent came from self-generated funding, including service fees and cost recovery; and less than 9 per cent came from national sources.

Table XI.3 contains estimations of domestic financial flows from governments and NGOs. Almost half of the total expenditure for population activities from these two major sources went to basic reproductive health services, 42 per cent to family planning services, and an almost equal percentage to basic research, data and population and development analysis and STD/HIV/AIDS activities. The countries surveyed spend about 91 cents per capita on services related to the "costed population package" of the Programme of Action (paragraph 13.14).

Table XI.3 also provides data on total external assistance for each country surveyed. A number of countries reported relying heavily on donor contributions to fund their population activities (for example, Cambodia, the Democratic People's Republic of Korea, Mongolia, Nepal and the Philippines), while others reported that the majority of population expenditure was domestic (government and NGO) expenditure (for example, India, Indonesia, the Islamic Republic of Iran and Thailand). Further methodological work will be carried out to make sure that these figures are accurate and that no double counting has occurred.

3. Indonesia: a case study

An in-depth study of resource flows for population assistance was undertaken in Indonesia in August 1997 as part of the UNFPA collaborative project with the Netherlands Interdisciplinary Demographic Institute to collect data on international and domestic sources of funding for population activities. The case study was conducted to explore data quality, provide a "reality check" for the project's data collection methodology, investigate in greater detail other sources of financing (NGOs, private sector), and examine the influence of the Programme of Action on resource flows.

The findings from Indonesia indicate that external assistance played a significant role when the country's population programme was in its initial stages. Now that it has matured and grown, however, the importance of population assistance has decreased in significance to the point where government funding currently supports almost 90 per cent of the country's population programme. However, external assistance continues to be of vital importance because national NGOs, which are playing an increasing role in the provision of services, are highly dependent on external resources. Indeed, 90 per cent of the income of national NGOs comes from international sources, 7 per cent from self-generated funding and only 3 per cent from national sources.

Over the years, Indonesia's population programme has placed more emphasis on reproductive health, including improving the quality of family planning services. Other major concerns include the reduction of maternal mortality, curbing the spread of STDs/HIV/AIDS, and poverty alleviation. The Government plans to decrease funding for population activities and increase the role of the private sector so that by 2000, 50 per cent of the contraceptive services should be provided by the private sector. The Government anticipates that its involvement will eventually decline to 20 per cent.

Government expenditure on population activities in Indonesia totalled $239.3 million in 1996. Just over two thirds of this amount was spent on family planning services, 26 per cent on basic reproductive health services, 4 per cent on STD HIV/AIDS activities and 3 per cent on basic research, data and population and development policy analysis. NGOs reported expending $4.7 million on population activities for the following distribution of expenditure:family planning services - 50 per cent; STD/HIV/AIDS activities - 19 per cent; basic reproductive health services - 17 per cent; and basic research, data and population and development policy analysis - 14 per cent (see figure XI.1).

Figure XI.1 Final expenditure by category and source:Indonesia, 1996

Figure XI.2 External population assistance by category:Indonesia, 1996

External population assistance in Indonesia also focused on family planning services - 47 per cent; basic reproductive health services - 33 per cent; STDs/HIV/AIDS - 15 per cent; and basic research, data and population and development policy analysis - 5 per cent (see figure XI.2).

B. Resource requirements for the implementation of the Programme of Action

The Cairo Conference outlined a comprehensive population and development agenda, including public, private and civic activities in the areas of reproductive health, mortality reduction, women's empowerment, poverty eradication and educational advancement. The Programme of Action, which was adopted by acclamation, endorsed a new strategy that emphasized the integral linkages between population and development and focused on meeting the needs of individual women and men, rather than on achieving demographic targets. It urged the empowerment of women as both a highly important end in itself and a key to improving the quality of life for everyone.

The Programme of Action specified the financial resources, both domestic and donor funds, needed to implement the population and reproductive health package over the next 20 years. It estimated that in the developing countries and the economies in transition, the implementation of programmes in the area of reproductive health, including those related to family planning, maternal health and the prevention of STDs, as well as programmes that addressed the collection and analysis of population data, would cost $17 billion annually by the year 2000; $18.5 billion by 2005; $20.5 billion by 2010; and $21.7 billion by 2015 (paragraph 13.15). Approximately two thirds of the projected cost in developing countries is expected to come from domestic sources and one third will have to come from the international donor community.

Assuming that recipient countries will be able to generate sufficient domestic resources, the annual need for external assistance from donor countries would be $5.7 billion by 2000; $6.1 billion by 2005; $6.8 billion by 2010; and $7.2 billion by 2015 (paragraph 14.11). A large amount of variation exists among countries in their ability to allocate domestic resources for implementing the Programme of Action. In the least developed and other low-income countries, a relatively larger part of the total required resources will have to come from external sources on a concessional or grant basis.

The Cairo Conference contained global estimates of resource requirements for the implementation of population and reproductive health programmes. To determine national resource requirements, estimates were calculated of the financial requirements for population-related activities by country. According to these very rough estimates, approximately $11 billion will be needed to cover the costs of population activities in the ESCAP region in 2000.

The estimates were derived from projections of demand based on "unmet needs" with the goal of reaching "universal access" to reproductive health services by 2015. The estimate of the number of potential users is based on United Nations population projections (medium variant), as well as information obtained from censuses and surveys. The estimate for reproductive health is a comprehensive figure that includes family planning, reproductive health, safe motherhood, and the diagnosis and prevention of STDs/HIV/AIDS. The data analysis and research costs are based on estimates of the expanded requirements of each country for demographic and programme data to enable them to achieve the goal of providing universal access to reproductive health.3

In addition to the basic "costed population package", the Programme of Action also called for socio-economic development programmes designed to strengthen the primary health-care delivery system and child survival programmes, provide universal basic education, improve the status and empowerment of women, generate employment, address environmental concerns, provide social services and address poverty eradication through sustained economic growth. (paragraphs 13.17-19). Additional resources will be needed to support these and other programmes that address sectoral goals in the gender, social, health and economic areas.

The immediate post-Cairo period produced a sense of optimism regarding the successful implementation of the goals and objectives of the Conference. Indeed, international assistance for population activities increased from a total of $1.3 billion in 1993 to $2.0 billion in 1995. However, the momentum of Cairo appears to have been short-lived. International assistance in 1996 remains at $2.0 billion.

Financial constraints remain one of the chief obstacles to the realization of the objectives of the Conference. The current level of donor spending, $2 billion, falls far short of the $5.7 billion international assistance needed by 2000 to finance the Programme of Action. The international community must guard against "donor fatigue" and continue to allocate sufficient resources to meet the goals of the Conference. At the national level, governments should focus on increasing the mobilization of domestic resources, which provide the largest portion of funds for attaining development objectives, as one of the highest priority areas to ensure the implementation of the objectives of the Programme of Action.

C. Monitoring of resource flows

UNFPA has monitored international assistance for population activities regularly and published its findings in the annual Global Population Assistance Report. In 1997, it expanded its data collection system by embarking on a collaborative effort with the Netherlands Interdisciplinary Demographic Institute to gather data systematically not only on external resources, but also on domestic resource flows. The UNFPA/NIDI project has served to enhance the quality, timeliness and coverage of reporting on international and domestic resource flows.

In order to reflect the Conference perspective, the data collection strategy for this project uses a classification of population activities that closely follows the "costed population package" of the Programme of Action, using the following four categories: family planning services; basic reproductive health services; STD/HIV/AIDS activities; and basic research, data and population and development policy analysis. In the post-Conference transitional years, modifications were made to the categories of population activities to reflect the Conference's "costed population package", to simplify reporting procedures, and to accommodate the actual recording systems of agencies supplying the data. UNFPA is working closely with the Netherlands Institute and others in the field to resolve the difficulty of accurately attributing expenditure to the specific "costed population package" from broad reproductive health programmes.

D. Consequences of resource shortfalls

Stagnating donor contributions to population activities in 1996 and, possibly, in 1997 have become an increasing concern as the five-year review and appraisal of the implementation of the Programme of Action draws near. To alert the international community to the negative effects of resource shortfalls, UNFPA undertook a study to illustrate specific population and reproductive health consequences that are likely to occur as a result of insufficient resource mobilization. It presented the findings in a conference room paper to its Executive Board in May 1997. At the request of the Board, a more detailed report, with an annex explaining the data, methodology and assumptions, was presented to the Board in September 1997.4

If resource mobilization falls short of the targets agreed to at Cairo, it would necessarily mean that the Conference agenda would not be fully implemented, thus slowing progress towards achieving its goals and worsening various reproductive and social sector outcomes. Projecting readily quantifiable results based on three plausible scenarios of future resource mobilization through the year 2000, UNFPA examined the likely consequences of not meeting the goals of the Programme of Action owing to resource shortfalls (table XI.4). The three scenarios are:

The constant growth scenario assumes that developing countries meet the Cairo targets while donor resources continue their current below-target rate of growth
The intermediate growth scenario assumes that international assistance will grow 20 per cent more slowly than in the first scenario
The low growth scenario assumes that developing countries fall short of the Conference target while donors continue their current below-target rate of growth

Both the constant and intermediate growth scenarios assume that developing countries will meet their targets, while the donor resources are below the target. The low growth scenario is the worst-case scenario, assuming that both domestic and donor resources will fail to meet target levels.

The original analyses of the consequences of resource shortfalls were conducted on a global level. Assuming that the consequences of not meeting the targets agreed to in Cairo will not vary greatly by region, the likely consequences for the ESCAP region can be estimated.5 Some of these consequences include the following:

An additional 70 to 130 million unintended or unwanted pregnancies in the period 1995- 2000. Millions of unintended pregnancies will occur because couples lacked access to family planning services or used traditional methods that failed.
An aditional 29 to 52 million induced abortions in the period 1995-2000. A major consequence of the lack of access to family planning services is an increase in the number of induced abortions of unwanted pregnancies. Besides the fact that abortion is a tragedy in its own right, the costs of abortions to the women undergoing the procedure and to the country's health system are enormous. Unsafe abortion is a major public health problem and a major cause of maternal deaths.
An additional 34 to 61 million unintended births between 1995 and 2000. Extra births resulting from unintended pregnancies imply additional economic burdens for both families and societies.
An additional 140,000 to 250,000 maternal deaths during the period 1995-2000. Resource shortfalls will result in additional deaths of women from causes related to pregnancy and childbirth. Moreover, the incidence of maternal morbidity, which is more difficult to measure, is expected to increase significantly.
An additional 1.9 to 3.4 million infant and child deaths during the period 1995-2000. Resource shortfalls will result in the deaths of more infants and children, a direct consequence of the large number of unintended births.
Resource shortfalls will also have a direct impact on the spread of HIV/AIDS, which will result in additional AIDS-related morbidity and mortality. The resulting social and economic impact on families, communities and entire countries will be enormous.

In addition, failure to implement the Programme of Action fully because of financial constraints would hinder population and development policy formulation, programme implementation, data collection and research activities, and advocacy and education efforts.

Besides consequences that deal directly with the Conference's "costed population package", which focuses on reproductive health, family planning, STDs and population policy, there are wider developmental consequences associated with resource shortfalls. These include negative consequences for the environment, poverty, human development and women's empowerment. The consequence of a resource shortfall will be felt far beyond the population field. Continued rapid population growth will wipe out gains already made in other important areas, such as improving primary health-care facilities, extending school systems, providing affordable housing, expanding public transport and road infrastructure, and managing critical natural resources.

E. Conclusion

The successful implementation of the goals and objectives of the Conference requires not only the incorporation of population concerns in all relevant national development strategies, plans, policies and programmes, but the continued commitment of the international community, governments, NGOs, the private sector and local communities to the mobilization of adequate financial resources for population and development programmes that promote social and economic development and improve the quality of life for all.

If the goals of the Conference through the year 2000 are to be met, both domestic and international allocations of resources to population activities must increase from the present levels. The Programme of Action highlights priority areas at the national level in which action is needed:

Governments should identify how best to allocate resources among various sectors, depending on the country's social, economic, cultural and political realities as well as its policy and programme priorities
Countries should strive to intensify efforts to generate higher levels of domestic resources from both the public and private sectors, and to ensure their effective utilization in both service-delivery programmes and information, education and communication activities
Countries should improve the national capacity, cost-effectiveness, quality and impact of population and development policies and programmes, while at the same time ensuring their accountability to all persons served, especially the most vulnerable and disadvantaged groups in society (paragraphs 13.11-13).
Many least developed and other poor countries will be unable to mobilize adequate financial resources to implement their population and development programmes. They will need external assistance to supplement domestic resources to satisfy unmet needs in reproductive health care, including family planning services, STD/HIV/AIDS activities, and basic research, data and population and development policy analysis to improve the scope and quality of service and to respond to future increases in demand.

The international community should strive to achieve the agreed target of 0.7 per cent of their gross national product for ODA. The international community should also consider meeting the generally accepted target of devoting 4 per cent of ODA to population funding. All three channels of donor funding, bilateral, multilateral and NGO, should increase in size and capacity. The strong potential for growth via the multi-bilateral modality in particular needs to be explored.

In devising the appropriate balance between funding sources, more attention should be given to South-South cooperation as well as to innovative ways of mobilizing private contributions, especially in partnership with NGOs. Governments should also examine new ways of mobilizing resources, such as the selective use of user fees, social marketing, cost-sharing and other forms of cost recovery, provided that such modalities do not impede the access of disadvantaged groups to social services.

The consequence of resource shortfalls in the future would be daunting: increases in the number of unintended pregnancies, and additional numbers of induced abortions, increases in the number of unintended births, additional maternal morbidity and mortality, and increased infant and child mortality. Larger outlays of social sector investment would also have to be made to address the needs of growing populations. An additional concern is an increase in AIDS-related morbidity and mortality and the resulting social and economic impact on individuals, families, communities and countries.

The international community can, and must, meet the challenge of mobilizing sufficient financial resources to implement the goals of the Programme of Action. Mobilization of resources for population and development must be placed high on the global development agenda.

End Notes

1 "Flows of financial resources for population activities", report of the Secretary-General (E/CN.9/1998/6).

2 All references to the ESCAP region exclude non-Asian contries that are members of ESCAP (France, the Netherlands, the Russian Federation, the United Kingdom of Great Britain and Northern Ireland and the United States of America).

3 United Nations Population Fund, Resource Requirements for Population and Reproductive Health Programmes.

4 United Nations Population Fund, Meeting the Goals of the ICPD: Consequences of Resource Shortfalls up to the Year 2000:Report of the Executive Director (DP/FPA/1997/12 and annex)

5 UNFPA estimates based on the scenarios of future resource mobilization explained in Meeting the Goals of the ICPD...