ROLE OF NON-GOVERNMENTAL ORGANIZATIONS IN MEETING INDIVIDUALS' HEALTH NEEDS DISCUSSED BY COMMISSION ON POPULATION AND DEVELOPMENT

Press Release
POP/611

ROLE OF NON-GOVERNMENTAL ORGANIZATIONS IN MEETING INDIVIDUALS' HEALTH NEEDS DISCUSSED BY COMMISSION ON POPULATION AND DEVELOPMENT

The role played by non-governmental organizations in meeting the reproductive health needs of individuals was discussed this afternoon in the Commission on Population and Development, as it continued its consideration of follow-up to the recommendations of the International Conference on Population and Development (Cairo, 1994) concerning reproductive rights and reproductive health.

Introducing a report on the subject, Nicholas Dodd, Chief of the Reproductive Health Branch of the United Nations Population Fund (UNFPA) Technical Evaluation Division, said that non-governmental organizations continued to demonstrate their importance in meeting the reproductive health needs of women and men.

Responding to the contents of that report, the representative of the Netherlands said it indicated that non-governmental organizations were working with governments, but it was known that, in some cases, such organizations were working against governments, and it would be useful to solicit their views.

The Holy See's observer said the report's analysis of the work of non- governmental organizations for adolescents did not address the role of the family. In the future, such organizations should work within the family context by respecting and utilizing the role of parents.

The representative of the Philippines said her country had worked closely with non-governmental organizations, including in emerging areas of concern such as the role of men in reproductive health matters. Nigeria's representative said that non-governmental organizations should receive assistance in meeting the needs of such vulnerable groups as refugees and the poor.

Other statements were made by the representatives of France, Japan, Canada, Jamaica, Sudan, United States, Belgium, Norway, United Kingdom,

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Mexico, Germany, Indonesia and Iran. Representatives of the International Labour Organisation (ILO) and the United Nations Educational, Scientific and Cultural Organization (UNESCO) also spoke.

In addition, Sethuramiah Rao, Chief of the UNFPA Technical Evaluation Division, introduced a report on the flow of financial resources. Catherine Pierce, Deputy Chief of the UNFPA Technical Evaluation Division, and Birgitta Bucht, Assistant Director of the Population Division, responded to comments made previously by delegations.

The Commission on Population and Development will meet again at 10 a.m. tomorrow, 28 February, to take up programme questions.

Commission Work Programme

The Commission on Population and Development met this afternoon to continue its consideration of follow-up to the recommendations of the International Conference on Population and Development (Cairo, 1994) concerning reproductive rights and reproductive health. (For background, see Press Release POP/610, issued today.)

In addition, the Commission is expected to begin its consideration of the activities of non-governmental organizations and of the flow of financial resources.

The Secretary-General's report on the activities of intergovernmental and non-governmental organizations in the area of reproductive rights and reproductive health (document E/CN.9/1996/5) summarizes information gathered through a questionnaire filled out by 38 such organizations, or 40 per cent of all groups contacted. Only four out of the 22 intergovernmental organizations contacted responded, indicating that "it is clear that it is the non-governmental organizations, rather than the intergovernmental organizations, that have played a more significant role in the area of reproductive rights and reproductive health". (A list of participating organizations is annexed to the report.)

According to the report, the groups responding to the questionnaire are strong supporters of the Cairo Programme of Action. National and international non-governmental organizations are integrating family planning into the broader framework of reproductive health as called for in the Programme.

While many non-governmental organizations have incorporated new reproductive health components as a consequence of the Programme of Action, others stated that they had adopted the comprehensive approach to reproductive health many years prior to the Conference, the report states. "Undoubtedly, the Conference has reinforced their commitment to the reproductive health idea. However, the involvement of non-governmental organizations in reproductive health issues prior to the Conference also highlights the critical role that they played at the Conference, particularly in advancing the agenda of the Programme of Action."

Although most of the non-governmental organizations that responded to the questionnaire are achieving progress, it appears that a number of traditional family-planning organizations are still struggling with the concept of reproductive health, which at times is confused with the provision of family planning and maternal and child health services only or, at other times, with the provision of family planning and child health services exclusively. Those organizations still focus on the child rather than on the woman. "This gives the impression that, for some, the concept of reproductive health is still at a very early stage."

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Despite the clear need to work towards integrating men into reproductive health programmes, there are very few initiatives that deal with this issue. Since this is a new area of work for many organizations, several of them are in the process of articulating the precise meaning of "men's involvement". Given the new nature of this effort, several non-governmental organizations are conducting research studies to assess the reproductive health-care needs of men. For some, this includes increasing male responsibility with respect to sexual practices, including greater participation in family planning, which is viewed as a key to improving reproductive health and curtailing the spread of sexually transmitted diseases. Other non-governmental organizations consider it important to increase male involvement in responsible parenthood.

Funding seems to be a major barrier for non-governmental organizations in the implementation of the Programme of Action. The issue of long-term sustainability should be carefully considered, the report states. Negotiations between governments that are privatizing services and non-governmental organizations will become an increasingly important factor in furthering the latter's goal of greater financial self-sufficiency.

Nearly all the non-governmental organizations that responded to the questionnaire reported an increase in activities concerning adolescent health. For most of them, it seems that the best solution in addressing the sexual and reproductive health needs of adolescents is to provide them with information through sex education classes, so that they could make sound decisions about their sexuality and, if they are sexually active, to give them access to contraceptive services, according to the report. There are many non-governmental organizations that are developing educational materials and teaching family-life education to adolescents with the aim of providing adolescents with decision-making skills and improving their self-esteem.

The report states that many of the activities developed by national non-governmental organizations are directed towards the school population. In many parts of the world, however, a significant number of girls are out of school, and it is difficult to reach out-of-school youth. There are some non-governmental organizations that are working towards enabling girls to expand their life options. Others are working on how to keep adolescent girls in school.

Responses to the questionnaire also reveal the existence of some obstacles concerning collaboration between governments and non-governmental organizations. These include initial suspicion of each other's agenda; lack of experience in collaborative working relations; competition for funds; changes in policy-making and of policy makers; difficulty in overcoming the established views of government officials and the medical establishment; the bureaucracy of government contracts; and skepticism on the part of governments about the proliferation of non-governmental organizations and doubts about their professionalism.

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According to the report of the Secretary-General on the flow of financial resources in international assistance for population (document E/CN.9/1996/6), the donor community has shown its commitment to achieving the goals of the Programme of Action adopted at the Cairo Conference. Several developing countries, despite unfavourable economic circumstances, have increased domestic resources for population activities.

Despite these encouraging developments, the report stresses that successful implementation of the Programme of Action is dependent on resource mobilization. "Additional resources are urgently required in order better to identify and satisfy unmet needs in issues related to population and development, such as reproductive health care, including family planning and sexual health information and services, and to keep pace with growing demands and improve the scope and quality of programmes." A larger share of international resources will be needed in sub-Saharan Africa and parts of Asia, as well as in least developed countries everywhere.

The report provides detailed data on the level of funding for population activities, including bilateral assistance, multilateral grants, multilateral loans, private assistance and expenditures by geographical region. It states that overall, official development assistance (ODA) amounted to 0.3 per cent of gross domestic product (GDP) of the major donor countries, ranging from about 1 per cent in Denmark, Norway and Sweden to less than 0.2 per cent for the United States. The total amount from bilateral sources for population assistance was $777 million, with the United States being by far the largest donor, having contributed $367 million.

Over the period 1990 to 1995, the annual income of the United Nations Population Fund (UNFPA) increased from $212 million to $306 million, the report continues. Private foundations, which provided $48 million for population assistance in 1990, contributed $124 million in 1993.

Among the bilateral initiatives mentioned in the report is Japan's $3 billion, seven-year Global Initiative on Population and AIDS. Germany has stated its intention to spend approximately $2.1 billion over the next six years, and the United Kingdom pledged to increase aid for population and reproductive health by approximately 65 per cent, for a total of about $160 million over two years. The European Commission of the European Union has announced plans to increase population assistance "more than tenfold by the year 2000", with a policy target of approximately $400 million annually until that date. The Government of Australia has announced a four-year initiative through 1998 of $130 million to assist population and family- planning programmes in developing countries.

The report cites a few examples of action by the recipient States. Bangladesh has devised plans and policies that go beyond family-planning programmes by devoting serious attention to education, health and the empowerment of women. The Government of Pakistan announced that it had

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increased its national budget for population activities by 30 per cent. Iran has adjusted its national reproductive health and family-planning programme to reflect the recommendations of the Programme of Action. The Iranian Ministry of Health and Medical Education has already obtained an additional $2.35 million for the next fiscal year.

Statements on Work of Inter-Agency Task Force

MARIE CECILE JOAQUIN-YASAY (Philippines) said the document on the work of the Task Force was useful for all the countries involved in the implementation of the Programme of Action of the Cairo Conference. However, it was hoped that there was a mechanism to ensure that the developed countries also had the information available to developing countries.

She asked if there was a way to include the problem of the multiple burden of women -- taking care of children and the house and having to be a breadwinner all at the same time -- in an indicator that could be monitored to measure the improvement of the quality of life for women.

JACQUES VERON (France) said the report rightly stressed the link between reproductive health and health in general. One might systematically analyse the relationships between reproductive health, family planning and health in general. One might examine obstacles to those relationships and how those relationships occur. It might also be interesting to differentiate between different planning systems as there were different national models, all of which did not have the same results.

KEN OKANIWA (Japan) said the guidelines developed by the Inter-Agency Task Force would help the United Nations development system, under the leadership of the resident coordinators, by allowing for a more proactive stance towards assistance to developing countries in the field of population and development. The Cairo Programme of Action should be accorded the important priority which it deserved as a result of the work of the Inter- Agency Task Force.

RUTH ARCHIBALD (Canada) said there should be stronger collaboration between the UNFPA, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) in the area of maternal and child health, provided that such collaboration did not bring with it undue bureaucratic burden. She called for assurances that programmes for reproductive health care and family planning would continue.

EASTON WILLIAMS (Jamaica) commended the Organization for the speed with which it had established the Inter-Agency Task Force. It would be useful to produce a comparative analysis of the recommendations of the Cairo Conference, the Social Summit and the Women's Conference in the area of reproductive rights and reproductive health.

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AHMED TAHA MOHAMMED (Sudan) said a set of indicators was needed to properly analyse the interrelationships between population and development. Current population and development indicators showed similarities between countries such as the Sudan, Bangladesh and India, when in reality the differences in their levels of development were quite substantial.

CATHERINE PIERCE, Deputy Chief of the UNFPA Technical Evaluation Division, said the United Nations Statistical Office was working to develop an index on women's work inside and outside the home. In years past, there had been a lack of data on women's time-use, but that had improved to a certain degree. Efforts were under way to develop more precise indicators, as well as common data systems.

Statements on Activities of Intergovernmental Organizations and NGOs

NICHOLAS DODD, Chief of the Reproductive Health Branch of the UNFPA Technical Evaluation Division, introduced the report on the activities of intergovernmental and non-governmental organizations. He said that due to the limited response to the questionnaire on which the report had been based, it should not be viewed as a comprehensive survey. The responses indicated that non-governmental organizations continued to demonstrate their viability and importance in meeting the reproductive health needs of women and men.

Mr. MOHAMMED (Sudan) said the vision was still not clear for non- governmental organizations in the least developed countries regarding reproductive health and family planning. In countries like the Sudan, there was a need for research to identify the grass roots areas where services were required. In monitoring the effects of non-governmental organizations in the least developed countries, insufficiencies in the areas of assessment and evaluation were apparent. It would be helpful to have a training component to lessen those difficulties.

DICK CORNELIUS (United States) said it had been made clear that the report was preliminary and would benefit from further work. It had not been an easy report to compile, but its scope and style were disappointing. The Commission should request that the Secretariat continue to work on the report and analyse non-governmental activities that were supportive of implementing recommendations of the Cairo Conference. In addition, there should be more information on successful collaboration between non-governmental organizations and governments.

Mr. OKANIWA (Japan) said his Government was working closely with non- governmental organizations in Japan. Regarding the report, he said that while there had been time constraints and other difficulties, he had been disappointed by the scope of the coverage of the report. In Japan, a very active and important non-governmental organization that played an important role in the formulation of project missions and projects in the field had had not even received a questionnaire to which to respond. The report should be

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developed further so that the Commission would have a more comprehensive paper.

Ms. JOAQUIN-YASAY (Philippines) said her country had worked closely with non-governmental organizations, including in emerging areas of concern such as the role of men in reproductive health matters.

ROBERT LOUIS CLIQUET (Belgium) said the reports indicated a shift from fertility control to the enhancement of reproductive health goals. However, posing those two goals as being in opposition to one another was not in keeping with the spirit of the Cairo Programme of Action.

AASJE PAPINEAU SALM (Netherlands) said the report indicated that non- governmental organizations were working with governments, but it was known that, in some cases, such organizations were working against governments, and it would be useful to solicit their views. "I have the feeling that governments use non-governmental organizations to do things that they do not want to do in sensitive areas." That matter also warranted attention.

HELGE BRUNBORG (Norway) said the report indicated that there was a lack of models for implementing reproductive health programmes; however, that did not take into account the experience of developed countries, which were not solicited for the questionnaire on which the report was based.

JOHN HOBCRAFT (United Kingdom) said it was extremely important for the Commission to keep track of the critical work of non-governmental organizations.

CHRIS UGOKWE (Nigeria) said there should be a way of enabling non- governmental organizations to provide relevant and timely information on their activities to the Commission. He wondered whether there was a way for such organizations to lobby governments to include family-life education in the school curricula of their respective countries. Non-governmental organizations should receive assistance in meeting the needs of such vulnerable groups as refugees and the poor.

Bishop JAMES McHUGH, observer for the Holy See, said the report's analysis of the work of non-governmental organizations for adolescents did not address the role of the family. In the future, such organizations should work within the family context by respecting and utilizing the role of parents.

Mr. VERON (France) said the report provided some perspective on the work of non-governmental organizations, but it was limited because the sample of such organizations solicited for the questionnaire had been so limited. The sample should accordingly be reviewed. In addition, more intergovernmental organizations should be solicited in future questionnaires. It was hoped that multilingualism would be respected in the process.

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Ms. ARCHIBALD (Canada) said there was a clear need for a survey like the one on follow-up actions of non-governmental organizations, and while she commended those who had put the report together, she cautioned participants about drawing too many conclusions from the present report because of the limited representation in the survey. If the scope of questionnaire was broadened, the conclusions drawn would be different. The concerns about integrating women in the policy fields would not be as great an issue to those non-governmental organizations concerned with delivering service.

Mr. DODD, Chief of the Reproductive Health Branch, UNFPA Technical Evaluation Division, responding to comments on the report, said he agreed with the concern expressed that it was not representative of the activities that were undertaken by non-governmental organizations in the world, including some that might not have such positive attitudes towards the issues of reproductive health and family planning. Perhaps, reporting on specific case studies might provide examples which other countries could learn from and build on. Work being done by non-governmental organizations in developed countries should be explained to see if it could be adapted for developing countries.

He said the role of non-governmental organizations had to be determined on a case-by-case basis. They were meeting the needs of marginalized populations, adolescents, refugees and the urban poor in many countries where governments were unable or unwilling to provide services to those groups. He expressed concern that certain non-governmental organizations had not received the questionnaire.

Within the context of family planning and reproductive health services, there was a change from trying to meet targets or quotas to an attitude of providing services to those who needed them, he continued. There was a vast need for family health and planning. It was necessary to meet the needs of individuals first, and perhaps demographic concerns would take care of themselves as people were enabled to engage in better family planning and spacing of children.

Statements on Financial Resource Flow

SETHURAMIAH RAO, Chief of the UNFPA Techncial Evaluation Division, introduced the report on the flow of financial resources. Updating the figures in the report, he said that bilateral assistance to population programmes had increased from $777 million in 1993 to $934 million in 1994, an increase by about 20 per cent over the previous year. However, the 1994 statistics were still provisional. "The UNFPA is examining whether this represents an increase in levels, a shift in modalities or a change in reporting or accounting procedures."

Mr. MOHAMMED (Sudan) said international assistance needed to give higher priority to incorporate population education in basic education. Since 20 per cent of the population was in grades 1 to 8, two cycles of such education

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would result in 40 per cent of the population benefiting from that information.

He said the international assistance needed to be linked to the national endeavours of his Government. International assistance was directly linked to reproductive health and family planning in certain areas. The component regarding the question of income generation in vulnerable groups should be activated by governments.

Mr. OKANIWA (Japan) said the definition of population activities should not be too restrictive, as population issues were directly or indirectly related to various economic and social factors. Japan provided assistance to developing countries in accordance with their requests. In some cases, they were directly related to population as in family planning. Other assistance was more indirect as in primary health care, education of women and literacy. Sometimes the developing countries asked for primary health-care cooperation rather than maternal health-care cooperation.

He asked for clarification on information in the report regarding allocation of resources under Japan's Global Issue Initiative. He stated that his Government had not designated an amount for HIV/AIDS.

Referring to the claim in the report that contribution from corporations to non-governmental organizations had increased, he asked for clarification as to the sources. He noted that many of the resources of those organizations came from governments. It would be useful to use a country-by-country format for the report, which should also include an element of domestic resource mobilization.

Mr. CORNELIUS (United States) said the report did not adequately address the financing of health and education programmes. In addition, it did not sufficiently cover the issue of resource requirements. Adequate resources were critical to the successful implementation of the Programme of Action. Any monitoring system must track resources from all sources, including both developing and donor countries. Up to two thirds of the resources for implementation of the Programme were expected to come from the developing countries themselves. In addition to examining the flow of resources from donor countries, it would be useful to assess flows from the private sector.

Ms. ARCHIBALD (Canada) said there was an urgent need to monitor expanding population programming in a systematic manner. Therefore, reporting procedures should be developed so that data on resource flows and other matters could be standardized.

NORBERTO TERRAZAS (Mexico) said that the report did not accurately assess the needs of Latin American and Caribbean countries which, now more than ever, required assistance. He called for the designation of priority regions which required assistance.

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Mr. HOBCRAFT (United Kingdom) said there was some difficulty in the way the figures in the report were interpreted. A more careful analysis was required. It was unfortunate that the contribution of the European Commission had not been included in the table on total ODA.

He said the brief of an expanded report would be extremely wide, but the priority area was to develop consistent criteria that concentrated on the costed elements of the Programme of Action. There was also a need to look at domestic flows, as well as donor flows. Those issues needed urgent attention.

Mr. WILLIAMS (Jamaica) said the flow of international funding should be coordinated and monitored.

CHARLOTTE HOHN (Germany) said a country-by-country profile of financial flows was required. Much needed to be done on definitions and classification of flows. The studies under way seemed to still follow the family-planning approach. She had hoped that methodological research in that area would be utilized.

She said that contrary to statements in the report, Germany did not give first priority to family-planning services and second priority to health education, HIV/AIDS and women's empowerment activities. She would like to have that expunged from the document.

Ms. JOAQUIN-YASAY (Philippines) said that in her country's experience, there was a lot of duplication of areas of funding. For example, now much of the funding was allocated to capacity-building. It would be useful to develop a framework for how the funds should be spent.

Ms. PAPINEAU SALM (Netherlands) said much confusion would be resolved if a classification system for funding could be developed. The policy of the Netherlands had, until recently, been to allocate population assistance through multilateral channels. Some $50 million had been spent through multilateral channels, but no exact figure was available for the Netherlands' bilateral flows.

PRAYONO ATIYAMTO (Indonesia) said the report was useful and should be updated with more recent data. There was a trend towards increased commitment on the part of developed and developing countries with respect to the implementation of the Programme of Action. The Commission should make a proposal as to how to monitor the flow of resources from the private sector.

E. HOSSEIN DEHGHANI (Iran) said the reports before the Commission had used wording that was controversial and had been the subject of many reservations placed on the Programme of Action at the Cairo Conference. "In our view, marriage is only between men and women, and cohabitation cannot be an alternative to marriage." All reproductive health services for adolescents should be provided under the supervision of their parents.

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Mr. BRUNBORG (Norway) asked about the capacity of the UNFPA to handle the changing financial flow of resources for population programmes.

Mr. RAO, Chief of the UNFPA Technical Evaluation Division, said States had made critical points concerning the need for a strong commitment to resource allocations. Unfortunately, at the time that the report had been written, not all of the necessary information had been received, but in the near future an updated report would be issued. The updated report would provide information on a country-by-country basis. Work had begun on analysing the individual requirements of various countries, and next year's reports before the Commission would reflect new developments in that field. The classification issue was of utmost importance. If classification could be clarified, it would be easier to monitor the implementation of the Programme of Action at the national and international level.

Responding to the statement by Iran, BIRGITTA BUCHT, Assistant Director of the Population Division, said, clearly, there was a need to adhere to agreed language concerning unions. Defined by the United Nations, unions existed between persons of opposite sexes which involve rights and obligations fixed by customs and traditions.

E. KENNETH ANDOH, Coordinator, Population Activities, International Labour Organisation (ILO), Geneva, said the ILO supported and endorsed the assertion that the population issue must no longer be seen and treated in isolation, but rather in conjunction with overall development strategies, especially with efforts to eradicate poverty, create job opportunities and promote employment, achieve sustained economic growth in the context of sustainable development, develop human resources by investing in the people, and empower women and raise their status and ability to participate fully in the development of their societies.

The ILO had not only continued to pursue its traditional objective, but had also responded to the recommendation of the Cairo Programme of Action by adopting a more holistic approach to development. It had been very active in post-Cairo activities at the international level, participating fully in the work of the Inter-Agency Task Force on the implementation of the Programme of Action. In that respect, the ILO had contributed effectively to the work of the various working groups, including taking the leadership of the working group on international migration. The organization had continued to address specific population and development problems facing developing countries with direct technical support, technical advisory services, policy research and analysis, advocacy in social and economic development and training programmes and workshops.

He said the ILO's active role in promoting and advocating the importance of population issues within the context of social and economic development, and sensitizing policy-makers, as well as leaders of workers' and employers' organizations, had contributed to increased understanding of the importance of

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and support for: population activities; the establishment of national population policy and planning units; the formulation and implementation of national population policies; and the integration of family welfare education into educational programmes of workers. The population planning units and commissions continued to facilitate government efforts in the integration of population and related factors into development plans and strategies, especially in Africa.

GUSTAVO LOBEZ, of the United Nations Educational, Scientific and Cultural Organization (UNESCO), said the agency was fully committed to implementing the Cairo Programme of Action. Within the Inter-Agency Task Force, UNESCO was the lead agency for the working group on basic education which developed guidelines for the United Nations resident coordinator system. In collaboration with the UNFPA, UNESCO continued to promote population information, education and communication projects, most of which had a component of reproductive rights and reproductive health. Activities included the preparation of radio programmes about health education, AIDS and other related topics addressed to youth and adolescents.

He said, through the emergence and application of new communication technologies, efforts should focus more on enabling youth and other sensitive target groups to receive information on reproductive health and to gain access to scientific literature on those subjects. The UNESCO had a critical role to play in implementing the new international action plans with respect to education and information for development. Investment in education was an investment for the future. "In this regard, it is important to mention that the nine high-population countries have, at the highest level, decided to double their investment in education by the end of the century." The UNESCO was working on a new international programme called "learning without frontiers" which aimed to offer the entire population greater opportunities for education.

Mr. ATIYAMTO (Indonesia) said the report lacked information on the reproductive health of adolescents and older men and women. Could that omission be corrected? he asked. He would also like clarification about alternative to marriage in developed countries. Regarding cohabitation as an alternative, he wanted to know whether the references in the report reflected the situation in a particular region. Cohabitation was not considered an alternative to marriage in many countries. To avoid misinterpretation, there should be a clearer statement on the question.

He also wanted clarification on the statement that one strategy to overcome obstacles to achieve reproductive rights and health would be to strengthen and make greater use of international treaty-enforcement and monitoring mechanisms. Such treaty enforcement would be counter to the spirit of the Cairo Conference.

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