The High Level Task Force for the International Conference on Population and Development (HLTF for ICPD) released a paper called “Policy Considerations for Financing Sexual and Reproductive Health and Rights in the Post-2015 Era”. The document makes the case about the importance of sexual and reproductive health and rights (SRHR) for achieving sustainable development and proposes nine recommendations to mobilize sufficient and predicable financing for SRHR services and policies.
The paper is a very good contribution because it suggests measures to overcome some of the historical problems and structural barriers for financing for sexual and reproductive health and rights. Additionally, the report is released with a very good timing, since governments are engaged in the negotiations on Financing for Development (FfD) and the Post-2015 Development Agenda, including its means of implementation. The outcomes of both negotiations will have major implications, since it will frame the space for governments to undertake the implementation of development policies for the next decades, as well as it will outline the role of United Nations Agencies, the private sector and civil society in the new development framework.
Two structural features explain to a certain extent the inadequacy and regressive nature of the financing for SRHR: i) developed countries have not fulfilled their promise in terms of international cooperation for implementing the ICPD Programme of Action (ICPD PoA) and ii) governments, especially in developing countries are transferring the costs of sexual and reproductive health and right services to citizens. In 1994, the ICPD PoA established that two third of the funding required would come from domestic resources, while one third from the international community. However this promise has not been fulfilled. The HLTF report recalls the UN figures: “as of 2011, the last year for which data is available, developing countries were covering three quarters of the ICPD package, a large share (62 percent) of which was financed out-of-pocket by private consumers – with alarming implications for equitable access to these preventative and life-saving services” (p.2).
The HLTF paper recommends that donors should fulfil the ODA target of 0.7% of gross national income and increase the proportion that goes to SRHR, with a focus on reaching those most in need (p.2). This proposal is very important and challenges alarming countries positions in the Post-2015 and FfD negotiations. In this sense, developed countries are promoting the need to “move beyond outdated dichotomies” between developed and developing countries. This is clearly an attempt to promote a new framework of “shared responsibilities” that dilutes their financial responsibility under the principle of international cooperation.
Secondly, the HLTF paper recommends removing financial barriers to accessing sexual and reproductive health services as well as to regulate private sector financing for the provision of sexual and reproductive health services. These references are very important. Under the FfD and Post-2015 processes, developed countries are promoting the involvement of the private sector in the provision of services as well as public-private partnerships (PPP) at national and global levels. The profit-driven nature of the private sector can threat the availability, accessibility and quality of sexual and reproductive health and services.
As it has been highly recognized in the ICPD+20 Review process and stated below, one of the structural problems in implementing the ICPD PoA has been the inequality gap in terms of accessibility and affordability of SRHR services. In this sense, the HLTF report states “ideally, countries would provide universal free access to services and eliminate financial barriers at point-of- service delivery. This requires a commitment to a tax-funded budget allocation to ensure the provision of at least a minimum service package on a universal and free basis, of which sexual and reproductive health services must form a core part” (p.8).
Additionally, it is proposed that: “public-private partnerships to finance sexual and reproductive health and rights, 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” (p.9). Ex-ante criteria are also recommended: “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” (p.9).
Third, in global negotiations the private sector engagement in financing the development agenda is being portrayed as “inevitable.” However, the HLTF paper proposes a pool of interesting policy recommendations to use the national policy space and to increase public resource mobilization to ensure predictable and sustainable financing in order to fulfil the SRHR agenda.
According to the report governments should maximize the fiscal space for health spending, including for SRHR. The recommendations ranges from exploring monetary and debt management policy scenarios that could free up resources for health, including SRHR; take full advantage of flexibilities in the TRIPS agreement to maximize access to less expensive generic medicines to progressive taxation, excise taxes, earmarking tax revenues (hypothecation) and budget reallocations (p.6 and 7). Finally, based on some of the proposals promoted under the Financing for Development agenda, a list of innovative source of finance is provided. Examples include financial transaction taxes, debt swaps, allocations of the IMF’s Special Drawing Rights, among others.
To conclude, the HLTF paper offers a series of policy recommendation to overcome the inadequacy and regressive nature of funding for sexual and reproductive health and rights agenda at national and global levels. These recommendations should be fully integrated in the Post-2015 and Financing for Development negotiations to ensure an equitable, predictable and sustainable financing framework for SRHR in the next decades.
Nicole Bidegain Ponte is a member of the Executive Committee of Development Alternatives with Women for a New Era -DAWN. Click here to read the full paper by the High Level Task Force.