Senate Appropriations Committee Increases 2010 Funding for Global Health Programmes

Last Thursday the U.S. Senate Appropriations Committee passed a $48.69 billion draft bill to fund the State Department and foreign affairs activities for this 2010 fiscal year. With a final vote of 29-1, Senator Leahy explains how "this bipartisan bill goes a long way to emphasize the importance of enhancing the capacity of the Department of State and U.S. Agency for International Development to carry out diplomacy and development programmes in areas of critical importance to the United States."

Of the $48.69 billion allotted, global health programs will receive $7.8 billion for their continued efforts. This amount is not only $434 million above the 2009 fiscal year request, but also $178 million above this years request, emphasizing a realization of the need for substantial funding in order to continue and improve efforts to address issues of global health. Within the $7.8 billion budget, $555 million will be allotted to child survival and maternal health, $628.5 million for family planning and reproductive health programmes, which includes an allocation of $50 Million for the UN Population Fund, $5.709 billion to combat HIV/AIDS, and an additional $700 million for the Global Fund to Fight AIDS, Tuberculosis and Malaria.

In addition to increased funding for family planning, the Senate Appropriations Committee went a step further and adopted an amendment proposed by Rep. Frank Lautenberg, D- New Jersey, which "would make permanent Obama's decision earlier this year to revoke a policy prohibiting U.S. aid to overseas organizations that promote or perform abortions." Under George Bush, U.S. taxpayer money, in the form of family planning funding, was banned from going to any international family planning groups that either performed abortions, or offered any sort of information, counseling or referrals which supported abortion. Also known as the "Mexico City Policy" or the "Global Gag Rule" this policy was introduced by the Reagan administration in 1984, overturned by President Clinton in 1993, restored by President Bush in 2001, and most recently overturned by President Obama earlier this year. By agreeing upon this new amendment, further administrations would be forced to accept the most recent stance adopted by President Obama, and must continue to allow funding for family planning organizations that promote abortions, regardless of any future leader's opinion on this issue.

To read more about the Senate Appropriations Committee's funding breakdown, you can access their FY 2010 Department of State Foreign Operations and Related Programs Appropriations summary at: http://appropriations.senate.gov/News/2009_07_09_Summary_of_FY_2010_State_and_Foreign_Operations_Appropriations.pdf?CFID=3878437&CFTOKEN=11326390

Online Forum: FP and HIV Service Integration: Experiences and Evidence

Online Forum: June 1-5, 2009

Register for free at http://my.ibpinitiative.org/public/fphivintegration

Please join us in a global discussion forum on family planning (FP) and HIV service integration. This forum will review the experiences of, and evidence for, integrating FP and HIV services. Share your experiences, challenges, and lessons learned, and pose questions and discuss with experts including:

*Rose Wilcher, Senior Technical Officer, Family Health International
*Betty Farrell, Senior Technical Advisor for Integration, EngenderHealth
*Heidi Reynolds, Senior Technical Specialist HIV/AIDS, MEASURE Evaluation

To register, go to http://my.ibpinitiative.org/public/fphivintegration and click on “register” in the upper left corner of the screen and fill in the required information. If you are already a member of the FP/HIV Integration Community in the Implementing Best Practices (IBP) Knowledge Gateway, click “login” in the upper left corner of the screen. Questions? Send an e-mail to info@ibpinitiative.org.

During the week long forum, you will receive no more than two emails per day; one email to introduce the day’s topic and questions and one daily digest, with all contributions screened and presented as a single, well-organized digest. You will be able to participate in the forum simply by responding to this daily digest via e-mail or by logging into the IBP Knowledge Gateway at http://my.ibpinitiative.org/public/fphivintegration.

This online discussion is sponsored by Family Health International (FHI), EngenderHealth, MEASURE Evaluation, and the Knowledge for Health (K4H) Project, based at the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs in collaboration with the Implementing Best Practices (IBP) in Reproductive Health Initiative and WHO.

International Conference on Family Planning Research and Best Practices

Kampala, Uganda, 15-19 November 2009

The Bill and Melinda Gates Institute for Population and Reproductive Health, Makerere University's School of Public Health, and other international and national partners are organizing a conference on “Family Planning Research and Best Practices.” The conference program will include an opening plenary, multiple concurrent oral sessions, an exhibit area, poster sessions, lunchtime roundtables, a policymaker forum, and special panel presentations. More information is available at: http://www.fpconference2009.org/

The dates for the conference are November 15 (evening opening) and November 16-17 (full days) with November 18 as an optional day for third-party sponsored meetings.

The PPD ARO will be involved with this conference and is encouraging all PCCs to submit abstracts for oral sessions and poster sessions. The deadline for submission of abstracts is 1 June 2009. Information and guidelines on how to submit an abstract is at: http://www.fpconference2009.org/16701.html

Limited travel support from the conference organizers may be available to participants whose abstracts are selected for oral presentation. The conference organizers will provide you with travel support application forms with notification letters if you are selected for oral presentation.

As the PPD ARO does not currently have funding to support PCC travel to this conference, we are currently seeking funding from donors to help PCCs attend the conference. Thus, the PPD ARO would be willing to write letters of support to donors in your country (UNFPA country office, etc.) if you request. We will be happy to provide you with more information on the conference as the date nears, and would, of course, be happy to assist you with planning your logistics to the best of our abilities.

The PPD ARO contact for this conference is Mr. Abdelylah Lakssir, Programme Officer. You can reach him by email (E-mail: alakssir at ppdsec.org) or by phone (+256-772-779-714) or the general office contact: http://ppdafrica.org/contact.html

Conference website: http://www.fpconference2009.org/
Contact information: info@fpconference2009.org

Evaluation of World Bank Support for Health, Nutrition, and Population

Between 1997 and mid-2008 the World Bank Group's support for health, nutrition, and population (HNP) provided $17 billion for government-run projects in the fields of nutrition, health, and family planning. An additional $873 million was invested in private health and pharmaceutical investments. Although these numbers may seem high, a report issued last week by the bank's Independent Evaluation Group revealed that one third of the 220 projects undertaken by the World Bank HNP had failed to achieve their goals. Furthermore, the emphasis on HIV/AIDS related projects has resulted in unsatisfactory outcomes, and progress in the nutrition and family planning sectors have greatly been inhibited by such unequivocal funding measures.

According to the evaluation, 7 out of 10 AIDS projects financed by the bank had failed to achieve satisfactory outcomes. In Africa, the epicenter of the AIDS pandemic, 8 out of 10 AIDS projects had unsatisfactory outcomes, one of the bank's worst records worldwide. The report insinuated that the failure is not a result of incompetent or ineffective programmes, but rather the inability of inexperienced or weak bureaucracies to carry out such complex projects (ironically, which were encouraged by the donor). Julian Schweitzer, the World Bank’s director of health, nutrition and population, admitted that inexperience and weakness was not just at the country level, but also "sometimes our own".

To improve the effectiveness of such programmes, the report suggested a simplification of projects, a reduction in the number of government ministries involved, and a focus on more modest objectives. Also addressed, was the need to improve programmes in developing nations, with a specific focus on Africa. Middle income countries ranked adequately in their ability to carry out such initiatives, but in Africa, more than three-quarters of the projects were deemed ineffective. The World Bank Group's support for health, nutrition and population needs to make an immediate effort to concentrate resources where they are most crucially needed, and more importantly to ensure that programmes are being carried out appropriately within these regions.

Aside from the issue of programme efficiency, the report detailed another important trend in global health, namely, the disproportionate attention and funding allotted to AIDS programmes in the last decade. Since 1997, foreign assistance for global health has increased, with a specific focus on HIV and AIDS. Although it is incredibly important to deal with such a deadly disease, the focus on family planning has greatly declined as a result of this relatively new emphasis on AIDS funding. In reaction to the report, Professor William Easterly of New York University stated that the evaluation of the World Bank confirmed "a fear that many of us have had for some time: that hugely disproportionate attention to AIDS has had a negative effect on aid efforts for all other health problems."

Since 1997, nearly 60% of World Bank HNP projects have focused on AIDS, while efforts aimed at tuberculosis, malaria and leprosy were granted significantly fewer resources (malaria made up only 3% of the projects, and tuberculosis only 2%). Family planning has also been negatively affected by the disproportionality of funds, and leaders of the evaluation group have realized the implications of this. Martha Ainsworth, lead author of the report, reaffirmed the groups commitment to increase funding for family planning by stating, "helping women control the number of children they bear is essential to reducing the high rates at which they die in childbirth in the poorest nations, the fact that no one’s been paying attention to reducing high fertility is critical for Africa."

Mr. Schweitzer, of the World Bank, strongly agreed with the evaluators call for greater efforts in family planning and nutrition, and reaffirmed the necessity of donors and recipient countries working together to coordinate projects and achieve targeted results. In recent years, PPD has advocated against global decrease in population and family planning funding, and it is our hope that such an internal evaluation will be a call to action for the World Bank Group's support for health, nutrition, and population to change their efforts. And as PPD has long recognized, an emphasis on the African region and family planning efforts are crucial to achieving progress worldwide.

To view an executive summary of the report, visit:

http://siteresources.worldbank.org/EXTWBASSHEANUTPOP/Resources/exec_summary.pdf

Or you can access the entire evaluation at: http://go.worldbank.org/EI6ARNQKX0

Interested in reading more about specific countries project performance assessment reports? Then check out: http://go.worldbank.org/3764K5QNI0

Experts Call on Obama to Recommit U.S. Funds to Family Planning and Reproductive Health Programmes

From 1978 through 2006, Joseph Speidel, Steven Sinding, Duff Gillespie, Elizabeth Macquire and Margaret Neuse successively directed the U.S. Agency for International Development's (USAID) Population and Reproductive Health program. These five development experts recently issued a report entitled Making the Case for U.S. International Family Planning Assistance, urging President Obama to double U.S. Investments in USAID programmes.

USAID was established in 1961 by President John F. Kennedy, and since then has implemented reproductive health programmes in 50 countries. The programme’s funding peaked in 1995, and has continuously declined thereafter. The five said that this may have resulted from the (mistaken) belief that rapid global population growth has halted; from diversion of resources to other needs. . . and from lack of understanding that family planning is not only essential for women's health, but also a critical part of any successful development strategy." In actuality, donor funds for family planning programmes are more crucial now than ever before as countries around the world work to achieve major progress in the arena of sexual and reproductive health in order to meet approaching international deadlines.

The five development experts suggested that President Obama should move quickly to meet the growing demand for planning services worldwide if the goals of the ICPD and Millennium Development Goals are to be reached. U.S. investment in contraceptive supply and reproductive health programmes run by USAID should be doubled, and the United States should recommit itself as a world leader in family planning. With a new administration and Congress in session, the experts urged a reversal in former funding policies that did not meet the demand for women's reproductive health services, and suggested an increase to $1.2 billion for USAID's population budget by 2010. A future increase to $1.5 billion in 2014 was also predicted, taking into account their imminent plans to expand their work into 17 additional countries with unmet family planning needs. The continuous decline in family planning and reproductive health funding has forced many successful programs to remain stagnant or close. The global fertility decline has slowed and the number of women dying from pregnancy-related complications is unacceptable. The U.S. should take the lead in re-establishing appropriate funding to programmes such as USAID, setting the example for countries worldwide to realize the importance of family planning, and commit themselves to effective programmes.

The report discusses the global unmet need for family planning, family planning as a global success story, family planning as a declining priority, USAID as an effective and capable agency, and the request for more funds. Examples of countries excelling in the fields of family planning and reproductive health are also examined throughout the report, and should be looked to as a resource for South-South cooperation.

The entire report can be found online at http://www.prb.org/pdf09/makingthecase.pdf

An audio clip of the press conference for USAID can be heard at http://www.ccmcfiles.org/population/making_the_case/making_the_case_audio_call_4_21_09.mp3

To read more about what President Obama has accomplished in his first 100 days, regarding women's health, check out http://www.planetwire.org/details/7969

Bongaarts and Sinding on International Family Planning Programs: Myths v. Facts

Bongaarts and Sinding (a "founding father" of PPD) published "A response to critics of family planning programs" in the recent issue of International Perspectives on Sexual and Reproductive Health.

In this article, the authors argue that funding for international family planning programs in developing countries has declined by 30% since the mid-1990s. Decisions by policymakers and donors to reduce investments in contraceptive services and supplies were based on plausible-sounding—but misguided—arguments. “Donor fatigue” and persistent opposition from conservative governments and institutions, in particular the Bush administration and the Vatican, contributed to this decline. Family planning programs were placed on the back burner as other pressing problems, such as the AIDS epidemic, rose in prominence.

Myth: Family planning programs have little or no effect on fertility.

Fact: Decades of research show that comprehensive family planning and reproductive health services lead to sharp rises in contraceptive use that help women avoid unwanted pregnancies. Over a thirty-year period (1960–1990), fertility declined in the developing world from more than six to fewer than four births per woman, and almost half of that decline—43%—is attributable to family planning programs.

Myth: Fertility declines are under way everywhere, so the population problem has largely been solved and family planning programs are no longer needed.

Fact: Population will keep growing even if fertility could immediately be reduced to the replacement level of 2.1 births per woman, because:

• Current birthrates still leave fertility above the level needed to bring about population stabilization.
• People live longer as higher standards of living, better nutrition, expanded health services, and greater investments in public health measures have reduced death rates, and further improvements are likely.
• The large number of young people entering their childbearing years will result in population growth for decades to come. For example, in sub-Saharan Africa, 43% of the total female population was younger than 15 years in 2005.

Myth: The death toll of the AIDS epidemic makes family planning undesirable and unnecessary.

Fact: Despite the substantial mortality from AIDS, UN projections for all developing regions predict further large population increases. Despite a severe epidemic in sub-Saharan Africa, the region’s population is expected to grow by at least one billion between 2005 and 2050. This is because the annual number of AIDS deaths (two million) is equivalent to just 10 days’ growth in the population of the developing world.

Myth: Family planning programs are not cost-effective.

Fact: The World Bank estimates the cost of family planning at $100 per life-year saved. This is of the same order of magnitude as other health interventions, such as basic sanitation for diarrheal disease, a short course of chemotherapy for tuberculosis, and condom distribution for HIV prevention. All these interventions, including those for family planning, are much more cost-effective than antiretroviral treatment of AIDS, which currently receives a large proportion of health-related development aid.

Myth: Family planning programs at best have made women the instruments of population control policies and, at worst, have been coercive.

Fact: Today, nearly all programs around the world respect the right of couples to make informed reproductive choices, free from undue persuasion or coercion. An important exception is China, however, where the one-child policy continues to violate reproductive rights standards.

Population growth and what to do about it has been the subject of controversy since the 1700s. Perhaps because at its most fundamental level the subject deals with sex, it has been a peculiarly incendiary topic of public policy debate. Yet much of today’s discussion about family planning programs, a principal instrument through which population policies have been implemented over the past 50 years, is based on faulty perceptions and misinformation. Large-scale national family planning programs have, for the most part, been remarkably successful.

Why does this matter? Because women and children continue to suffer and die as a consequence of unwanted and unintended childbearing. Beyond that are renewed concerns about a variety of environmental issues and about the security of nations and the stability of governments, as well as deepening worries about food security and pervasive poverty.

“In the face of declining political and financial commitment to family planning programs, we must address head-on the faulty criticisms that have held back efforts to satisfy the unmet demand for family planning services,” say Bongaarts and Sinding. “High fertility and rapid population growth remain real problems that merit our attention and action.”

Read the entire article online at: http://www.popcouncil.org/pdfs/JournalArticles/IPSRH_35_1.pdf

The journal International Perspectives on Sexual and Reproductive Health can be read online for free at: http://www.guttmacher.org/journals/toc/ipsrh3501toc.html

Achieving the Millennium Development Goals: The Contribution of Family Planning

The Millennium Development Goals are quickly approaching their target date of 2015, and in order to ensure that progression is being made in a positive direction, the USAID Health Policy Initiative has specifically focused on the considerable and noteworthy contributions that family planning has thus far made to achieving the goals. Updated analysis for more than 30 countries demonstrates how family planning can help accomplish MDG's by reducing costs for meeting the goals and improving health outcomes.

MDG Briefs for Bangladesh, Bolivia, Burkina Faso, Cameroon, Chad, Democratic Republic of Congo, Dominican Republic, El Salvador, Ethiopia, Ghana, Guatemala, Guinea, Honduras, India, Indonesia, Kenya, Madagascar, Malawi, Mali, Nepal, Nicaragua, Niger, Nigeria, Pakistan, Peru, Rwanda, Senegal, Tanzania, Uganda, Yemen and Zambia can be accessed in English (and often French or Spanish) at: http://www.healthpolicyinitiative.com/index.cfm?id=publications&get=Type&documentTypeID=15