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In 1994, the International Conference on Population
and Development (ICPD) issued a 20-year Programme of Action that
reflects the international consensus on a comprehensive set of recommendations
aimed at fostering sustainable development, poverty reduction and
women's empowerment; improving health (including reproductive health)
and the quality of life of the world's people, and creating a better
balance between population dynamics and social and economic development.
In 1999, a United National General Assembly Special Session noted
the fifth anniversary of the ICPD agreement, reaffirmed international
support, identified Key Future Actions needed for successful implementation
of the action plan and proposed additional benchmark indicators to
monitor progress.
In 2000, representatives of 189 nations, including
147 heads of state and government, gathered at the United Nations
for a historic Millennium Summit. They adopted an ambitious set of
Millennium Development Goals (MDGs). Achieving them by the target
date of 2015 would transform the lives of the world's people, including
reducing by half the number of people living in extreme poverty.
The consensus of 179 nations expressed at the ICPD not only helped
lay the foundation for the Millennium Development Goals, but also
meshes seamlessly with them.
In 1995, UNFPA published Resource Requirements
for Population and Reproductive Health Programmes: Programme Country
Profiles for Population Assistance. The current publication is an
updated version of that volume, with a greater emphasis on policy
and institutional commitments and a broader range of socio-economic,
gender, demographic and health indicators. The expanded range of
indicators reflects the priorities identified in the five-year review
of the Programme of Action and the perspectives from the other international
conferences of the 1990s that culminated in the Millennium Summit.
Attention is also given to differences within countries. Indicators
for ICPD and MDGs are identified by special symbols.
Country Profiles for Population and Reproductive
Health will be published every two years with updated policy
descriptions and indicators. The information is also available
on the UNFPA web site (http://www.unfpa.org/profile),
where it will be updated annually. Internet technology allows users
to display comparisons between countries as well. A CD-ROM is also
available with search and comparison capabilities. (see ordering
information)
The profiles contain, in a concise form, basic
information on population, social, economic and health indicators
derived from international sources (see below). Social and political
contexts and policy priorities have been obtained from standard United
Nations sources. Information on disparities within countries is derived
from reports of demographic and health surveys, special tabulations
of the World Bank and related sources. Estimates of resource requirements
for population and reproductive health programming for the period
2000 to 2015 include costs related to family planning, reproductive
health, sexual health, prevention of sexually transmitted infections
and related reproductive health services, as well as cost estimates
for collecting and analysing population data and other programme-relevant
research.
This section outlines the objectives of the country's
formal population policy (if any), or of population-related components
of its general development policies. Actions and other measures currently
taken to implement these policies are also highlighted to illustrate
the Government's political will and priorities. These descriptions
are based on various sources, including the biennial Population Policy
Inquiries of the United Nations Population Division and the regular
reports on country programme progress submitted to UNFPA.
Each of the major subregions is introduced with
an overview of common key issues.
These tables summarize the major indicators of
the country's demographic and social situation based on the most
recent information available. They are organized to present blocks
of indicators related to population, estimated programme resource
requirements, socio-economic and health conditions, adolescent reproductive
health, gender equality and reproductive health commodity security
needs. A graph of key population and reproductive health indicators
related to the MDGs is presented for each country.
Basic population indicators are obtained from United
Nations medium-variant population projections (the 2000 revision1).
Other indicators are presented as obtained from the relevant sources
provided in the Technical Notes. Maternal mortality ratios refer
to what was known in 2000 about levels in 1995 with individual country
sources relating to the most recent data accessible.2 Additional
details are provided in the Technical Notes.
The database is collated and maintained by the
Population Reference Bureau.
The ICPD Programme of Action contained global estimates
of resource requirements for the implementation of national population
and reproductive health programmes through the year 2015. These estimates
are described in paragraphs 13.15, 13.16 and 14.11 as follows:
It has been estimated that, in the developing countries
and countries with economies in transition, the implementation of
programmes in the area of reproductive health, including those related
to family planning, maternal health and the prevention of sexually
transmitted diseases, as well as other basic actions for collecting
and analysing population data, will cost $17.0 billion in 2000, $18.5
billion in 2005, $20.5 billion in 2010 and $21.7 billion in 2015.
It is tentatively estimated that up to two thirds
of the costs will continue to be met by the countries themselves
and in the order of one third from external sources. However, the
least developed countries and other low-income developing countries
will require a greater share of external resources on a concessional
and grant basis. Thus, there will be considerable variation in needs
for external resources for population programmes between and within
regions.
Given the magnitude of the financial resource needs
for national population and development programmes (as identified
in chapter XIII), and assuming that recipient countries will be able
to generate sufficient increases in domestically generated resources,
the need for complementary resource flows from donor countries would
be in the order of (in 1993 US dollars) $5.7 billion in 2000, $6.1
billion in 2005, $6.8 billion in 2010 and $7.2 billion in 2015.
In 1995, the contributions of developing countries
accounted for about 76 per cent of the approximately $5.6 billion
available for global population and reproductive health programmes.
By the year 2000, developing countries were expected to be contributing
from domestic resources approximately $11.3 billion (a total increase
of approximately $7 billion over 1995 figures) and donor nations
were expected to increase their contributions by $4.4 billion to
$5.7 billion. The latest estimates suggest that funding from both
sources has lagged.3 In the year 2000 donor nations (including bilateral,
multilateral, foundation, development bank and private contributions)
contributed $2.6 billion. Developing countries contributed an estimated
$8.6 billion from their own resources. Development assistance has
not kept pace with requirements.4 Starting
from today's base from both recipient countries and donors, the magnitude
of required increase in resources remains a formidable challenge.
But considering the potential improvement in individual health and
well-being, the positive impact on overall sustainable development
and, especially, the improvement in the status and participation
of women, population assistance is a wise investment.
Since the ICPD estimates were developed, a broader
definition of resource needs has been recognized. The 1993 estimates
envisioned the costs of services delivered at the primary health
care level. It was originally recognized (Programme of Action paragraph
13.16) that additional service delivery needs above this level or
beyond basic preventive interventions had not been calculated. Additional
supportive investments are needed to strengthen the policy and institutional
frameworks. Efforts are under way (within UNFPA and its partner organizations)
to develop updated estimates beyond the original basic programme
definitions, including: supportive interventions at the tertiary
health system level; requirements for investments outside the health
system that facilitate positive outcomes; and expanded prevention
efforts directed to stemming the HIV/AIDS pandemic, whose scope and
dynamics were not fully appreciated a decade ago.5
When these technical analyses are completed, they
will be included in this publication and on the web site.
This report repeats the estimates made in 1995
of national resource needs to implement the basic population and
reproductive health package in the Programme of Action. These estimates
of the financial resources needed for population and reproductive
health programmes were derived from projections of demand based on
"unmet needs", with the goal of reaching "universal access" to reproductive
health services by the year 2015. These estimates were generated
in 1995 based on 1994 estimates and projections.6 In
calculating projected unit costs, account was taken of the fact that
higher usage
will lead to economies of scale and increasing efficiency and that
improvements in the quality of care will raise the cost per user
to some degree that will partially offset these cost reductions.
An estimated total annual resource requirement
is presented based on several components. The estimate for the reproductive
health component is a comprehensive figure including family planning,
reproductive health and safe motherhood, and diagnosis and prevention
of sexually transmitted infections, including HIV/AIDS. The cost
of the programme component for the prevention of sexually transmitted
infections and HIV/AIDS is based on estimates of the United Nations
Global Programme on AIDS (now UNAIDS). The data analysis and research
component costs are based on estimates of the expanded requirements
of each country for demographic and programme data to help them to
achieve the goal of providing universal access to reproductive health.
Efforts are under way at UNFPA, UNAIDS, WHO, the
World Bank and other organizations to update the estimates of resource
requirements for programme elements included in the "costed package"
in the ICPD and to generate estimates for additional programme areas
related to progress towards realizing the goals of the ICPD Programme
of Action and the Millennium Summit.
The first draft of the country policy overviews
was sent to the respective UNFPA Representatives and Country Directors
for comments and information. The insights and information provided
by the UNFPA Representatives, Country Directors and Geographic Divisions
helped to improve the content of the profiles.7
A glossary has been provided that explains common
abbreviations used to refer to programmatic efforts in population
and reproductive health.
A detailed series of notes are provided after the
profiles that provide information regarding the data sources for
key indicators. These notes also provide guidance to the interpretation
of the statistics. In general, United Nations sourced data have been
used, supplemented, as necessary, by additional standard data sources.
Details are provided in the Technical Notes
section.
1 World Population Prospects: The 2002
Revision was not available in detail at the time of this publication.
The web site will be updated. Estimates of recent indicators are not
likely to change much except when new data show dramatic trends.
Projections are more subject to variation, conditional on future
investments in health, education and population programmes.
2 Estimates of maternal mortality ratios
for the year 2000 were still undergoing interagency review (by WHO,
UNICEF and UNFPA) at the time of this publication. Updated estimates
will be available on the web sites of the participating organizations
after they are finalized. The database and web site related to this
publication will be updated to include them during 2003.
3 These resource flows are monitored
for UNFPA by the Netherlands Interdisciplinary Demographic Institute
and are published in the Report on Financial Resource Flows for Population
Activities series.
4 The global shortfall in contraceptive (and other
reproductive health) procurement resources is documented in Reproductive
Health Essentials: Securing the Supply (UNFPA, 2002). UNFPA's Global
Strategy for Reproductive Health Commodity Security monitors and
addresses these concerns.
5 A greater recognition has developed of the need
for integrated programmes of prevention, treatment and care regarding
the HIV/AIDS pandemic. ICPD estimates of needs for selected prevention
interventions need to be adjusted to reflect the further progress
of the disease and to accommodate additional coordinated programmatic efforts.
6 The 1995 estimates reflect the political situation
of that time. Several new states have been created in the intervening
years, and a number of countries have been added to the earlier collation.
No attempt has been made to reapportion resource needs among successor
states or within regions or to adjust the estimates in light of changing
social and demographic conditions. Further analyses (see text) will
be needed to update these estimates. They are indicative of the relative
magnitude of needs but are not precise guides to programming.
7 Most of the policy overviews were produced and
cleared during the second half of 2002. Some recent developments
may not be reflected in the policy descriptions. These will be updated
on the web site during 2003. A small number of countries had not
completed the process of clearing the policy descriptions when this
publication went to press. These are explicitly indicated. Finalized
versions will be posted on the web site when clearances are obtained.
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