1. A “Simple” Guide for Travelers in the ICPD and the MDG Galaxy +SEX Meeting Copenhagen, Denmakr 6 June 2007 Stan Bernstein Senior Policy Adviser, Office of the Director Technical Support Division June 2007 bernstein@unfpa.org

2. The Original MDGs: Where is SRHR? The IPCD Goal of Universal Access to Reproductive Health by 2015 disappeared from the proto-MDGs after June 2000 and stayed out The components of the ICPD definition of Reproductive Health were distributed among various other goals: maternal health (esp. mortality reduction), HIV/AIDS (family planning?) The contribution to multiple MDGs was lost A long series of regional meetings, Commission on Population and Development resolutions and donor country representations redressed this gap

3. Entering the MDGs As committed to by the world’s leaders at the World Summit in September 2005 As recommended by the Secretary General in his Report on the Work of the Organization in August 2006 As noted by the General Assembly in October 2006 As affirmed by the Interagency and Expert Group on MDG Indicators A new target has been added to MDG Goal 5 “Improve maternal health”: “Universal access to reproductive health by 2015”. Key indicators have been proposed by the IAEG on MDG Indicators. The process needs support in its final stages. It must now be in national and international monitoring reports on MDG progress and integrated in development plans, action strategies and budgets.

4. Where are we now? Significant numbers of women and couples lack access to key RH information and services Poorer countries and poorer people within countries suffer the greatest deficits Rural and poor peri-urban population lack access Young people lack access Successful models exists but they must be scaled up to reach everybody We are almost at the mid-point between the Millennium Summit and the target date.

5. Source: UN Statistics Division, MDG Indicators database 2 Proportion of births attended by skilled health personnel 020406080100 Northern Africa Sub-Saharan Africa Latin America and the Caribbean Eastern Asia Southern Asia South-Eastern Asia Western Asia World 2004 1990 There has been progress on MDG5: but not in outcomes

6. Skilled attendance among the Poorest and Richest Women Source: World Bank, 2004, Round II Country Reports on Health, Nutrition, and Population Conditions Among the Poor and the Better-Off in 56 Countries Percent of women ages 15-49

7. Contraceptive use is increasing

8. Proportion of desires for family planning met (by wealth quintile)

9. Maternal Mortality Ratio by levelUnmet Need for Family Planning, Total, Per Cent Low MMR: <100 Modearte MMR: 100-299 High MMR: 300-549 Very high MMR: >550 9.89 11.26 23.19 25.87 Source: Calculations generated from data from SWOP (MMR) and DHS/MICS (UNM) 4 MMR and Unmet Need

10. Guttmacher Institute % of married women 15-49 with unmet need Young women are the most likely to have an unmet need

11. % of married women 15-49 with unmet need Unmet need among married women is usually higher in rural areas Guttmacher Institute

12. The World Summit Outcome Added recommendations & responses The leaders of the world recommended at the World Summit (paragraph 22) that all countries undertake MDG-oriented development strategies. These are to follow the Paris Principles. The G8 Summit at Gleneagles included commitments for resource increases commensurate with the levels needed to ensure rapid progress on the MDGs Regional processes are adapting SRHR supportive policy and operational strategies: the AU Comprehensive framework and the Maputo Plan of Action

13. Scaling up: principles Definition: The process of expanding the scale of activities with the ultimate objective of increasing the number of people and increasing the impact of the intervention with a specific objective of regularizing it into routine public sector health services for interventions that have been well evaluated with demonstrated evidence Universal access to RH means ensuring that each person who wants a service can get it – it is available, accessible, acceptable, affordable and of quality Promoting UARH requires comprehensive integrated approach with stress on expanding rights and promoting women’s empowerment (beyond the MDG measures) and participation and promoting men’s involvement.

14. Scaling up: routes to coverage Expanding coverage: alternate modalities – pooling risk, mobilizing demand and action Social insurance schemes Social protection funds Vouchers and private incentives General resource availability; e.g., micro-credit Civil society involvement Expanding the range of actors – beyond the health system Full integration in the health system

15. National development strategies National strategies include expanding service delivery points, integrating services in basic service packages and integrating components with each other (e.g., HIV/AIDS and SRH). The national development plans have increasingly become and will become the action plan to achieve the MDGs. Plan ahead: Developing human resources and institutional capacity takes time and investment. Incentives (not only financial) need to be sufficient to retain staff.

16. Engaging in all stages of national planning Poverty analysis—provides the rationale for intervention, or the ‘why’, ‘what’ and ‘where’; Strategy—outlines the ‘how’ to reduce poverty; Costing—evaluates ‘how much’ it costs for the policies as outlined; Budgeting—articulates the distribution of funds among competing priorities; Policy matrix—clarifies ‘who’ does ‘what’ in the implementation; Monitoring indicators—track progress towards poverty reduction based on the outlined targets/objectives

17. Needs assessments and situational evaluation Identifying a range of necessary interventions; For each intervention define targets; Compare lists of interventions to avoid overlaps; Cost the needs by adding coverage targets and unit costs in costing models; Develop a financing strategy.

18. Aligning initiatives: the challenge for donors, policy makers and implementers Other initiatives need an RH vision (e.g., Global Fund on HIV/AIDS – RH integration – effective linkage, priority to prevention; Road Maps for Maternal Health and Child Survival; Scaling Up for Health in Africa) Logistics and commodity security – including RH security (Global Programme for RH Commodity Security) Strengthening health systems as a whole (not just disease-specific programmes); but going beyond health Influencing and investing in regional initiatives: E.g. the African Union and the Maputo Plan of Action

19. Sector wide approaches SWAps: a method of coordinating donor support in a particular sector, so that all significant government and donor funds support a single policy and expenditure program led by the government. Goals of SWAps: –reducing earmarked money –eliminating geographic and programmatic fragmentation associated with individual donor priorities –coordinated missions and reviews –a comprehensive budget that consolidates sources of financing (government, donor and other) to the sector The national development plan should reflect the commitments to policies and programs developed through SWAps and SWAps should become more aligned with the poverty-reduction orientation of the national development plan The budgeting should be incorporated in Medium Term Expenditure Frameworks.

20. Monitoring and evaluation: principles Improving data and performance monitoring is a must. Coverage, contents and quality. Using marginalized groups as signals of generalized access (rural, poor and the young). Mobilizing resources from multiple sources for impact. Creating constituencies – organizing community reporting and action, participatory approaches Monitoring budgets and resource flows (reproductive health accounts) Results-based monitoring of aid effectiveness needs to include key SRHR indicators

21. Monitoring and evaluation: methods Aligning reports and actors – making efforts accountable major administrative units (states, provinces, districts) political units (parliamentary constituencies) Selecting units that can influence policy, legislation and budgets and increase accountability. Mapping service coverage and outcomes can identify gaps and strategies. If progress on SRHR is monitored, it will count!

22. How can Denmark stay engaged Support the ICPD/MDG principles in regional discussions and in aid priority setting and monitoring Form donor coalitions (and support UNFPA) to raise the issue in national policy dialogues Support the call for 10% of ODA going to SRHR, with special attention to gender equality concerns Preserve, protect and expand the European Consensus Vigorously implement the Africa Strategy with a fully integrated approach to SRHR Promote and support NGO engagement