Funding for Sexual and Reproductive Rights and Health Adrienne Germain Alexandra Garita Repoliticizing Sexual and Reproductive Health and Rights Langkawi, Malaysia August 5, 2010 Plenary 5

Donor Funding for Health (1) Overseas Development Assistance (ODA) Fragmented and not enough (WB, 2010) $2.9 billion $14.1 billion Focus: vertical programs HIV/AIDS largest share RH decline as proportion but not in absolute amount

Donor Funding for Health (2)  Bilateral  Multilateral (UNFPA, UNICEF, WB)  Special funding mechanisms Global Fund to fight AIDS, TB, Malaria UNITAID GAVI and other public-private partnerships

Large Foundations Gates: New 5 year pledge $1.5 billion ($900m MNH; $400m FP; $200m Nutrition)- not new money MacArthur: Focus on maternal mortality and adolescent sexual and reproductive health Ford: SRHR per se not priority; fractured program Hewlett, Packard: Emphasis on FP/ Population

Health System Strengthening: An emerging focus Ideally: Harmonization of health sector investments Country by country- based on local epidemiology and demographics Principles: pro-poor, pro-women, based on human rights Prioritize comprehensive SRHR

Comprehensive SRHR Contraception Maternity care (ante and post-natal care, skilled attendance, emergency obstetric care) Safe abortion services STI/HIV prevention and treatment Protection of human rights − Sexual and Reproductive Rights Comprehensive sexuality education

Health Systems Strengthening Initiatives  International Health Partnership (IHP) 13 donors ( Austria, Belgium, Canada, Finland, France, Germany, Italy, Norway, Portugal, Spain, Sweden, the Netherlands, UK ) 47 countries Principles: country-led; one national health policy; pro- poor; RH and communicable diseases Emphasizes health systems strengthening Focus: harmonization of funding (Paris, Accra)  United States Global Health Initiative $63 billion, 6 years Harmonize AIDS investments (PEPFAR), malaria, TB, maternal and child health, FP/RH

Funding Health Systems Strengthening  Create mechanism or use existing? GAVI WB GFATM  World Bank: expected to triple to $4.1 billion (40% increase over FY 09) health system financing  Global Fund- experimenting with proposals based on National Strategic Plans for health system that include not only AIDS, TB, Malaria but also RH/MNH; RH window for regular proposals

Estimates of funding needed for SRRH  Estimated cost of RMNH range from $15.2 billion to $23.7 billion annually (PAI 2010) Includes: FP; MNCH; STI prevention; drugs; supplies and other materials; personnel Excludes: Safe abortion services HIV/AIDS resource requirements ($19 billion to $35 billion needed annually)  Task Force on Innovative Financing for Health Systems: $251b required for HSS by 2015 from all sources including governments ($10b per year on SRH)

Where are we against need? European donors: comprehensive SRRH policies (Netherlands, Norway, Denmark, Sweden, UK) but separate funding streams and staffing; HIV > RH US Government: never adopted SRRH but GHI can come close Few Southern Governments have SRH policies/programs or SRR strategies FALLING SHORT SG’s Joint Plan of Action: $14 −24 billion in 49 countries G8 Muskoka Initiative: pledge $7.3 − 8.3 billion

Challenges for Advocacy (1) Who is our target audience?  Donors: who drives funding decisions? Individuals?  Governments: Ministries of Finance? (Abuja)  Content/Positions SRRH encompasses HIV − or not? Vertical and horizontal approaches Human Right to health and pro-poor, pro-women, pro- marginalized groups Country ownership?

Challenges for Advocacy (2)  Need bigger pie for health but new money not likely European government budgets contracting US funding goes to US NGO contractors; no abortion Governments not meeting current commitments (Gleneagles- 0.7% GNP to ODA- 5 exceeding target ) (Abuja- 15% of GNP to health- 6 meeting targets)  While promoting funding increase, do more on using existing funds better

Challenges for Advocacy (3)  Building our Movement Donors question value of funding political movements Difficulties with measuring results of advocacy Need for new blood, training, mobilizing Perceived and actual competition for limited resources among our several constituencies