Achieving Universal Access

The Programme of Action of the International Conference on Population and Development (ICPD) held in Cairo in 1994 called for the provision of universal access to a range of population-related programs, including the following costed package of interventions:

• Family planning services
• Basic reproductive health services
• Sexually transmitted disease/HIV/AIDS prevention and treatment
• Basic research, data and population and development policy analysis

How Much Funding Is Needed?

At the ICPD conference, the international community estimated that by the year 2010, it would cost nearly US$30 billion annually in current dollars (or US$20.5 billion in 1994 dollars) to achieve the ICPD goals by 2015. The international community pledged to share the costs, with donor nations providing on average one-third, and domestic resources making up the remaining two-thirds.  

In 2005 the Millennium Development Goals (MDGs) reaffirmed the importance of the ICPD goals by adding Target 5.B.: Achieve universal access to reproductive health by 2015, as part of MDG 5: Improving Maternal Health.  Contraceptive prevalence rate, unmet need for family planning, and adolescent birth rate are indicators for monitoring progress towards this target. 

Collectively donors have never met their one-third share of the inflation-adjusted population assistance targets set at the ICPD.  In 2007 donor funding came within US$1 billion of their share of the original ICPD estimate, primarily due to strong funding for HIV/AIDS, particularly from the US President’s Emergency Plan for AIDS Relief (PEPFAR).  As is clear from Chart 1, donor funding for HIV/AIDS has increased dramatically, while donor funding for reproductive health services has increased slightly, and donor support for family planning services has fallen since 2002. 

UNFPA’s Revised Cost Estimates

In response to rising costs and growing need, in 2009 UNFPA updated the cost estimates to meet all four costed areas of the ICPD from 2009 onward.  The revised estimates are around double the original ICPD figures: the minimum annual resources needed to achieve the ICPD goals start at nearly US$50 billion in 2009, and grow to nearly US$70 billion in 2015. 

The revised UNFPA cost estimates present health system and program costs related to family planning and reproductive health services separately from direct costs to cover staff time and supplies in sexual and reproductive health.  When these costs are integrated, the average cost of providing modern family planning is $6.7 billion and the average cost of maternal and reproductive health is $23.7 billion per year (Table 1).  The donor share of these costs is still assumed to be one-third (Table 2).   These estimates were reaffirmed by another 2009 study by the Guttmacher Institute and the UNFPA which found similar funding needs for family planning and maternal health.  To learn more about these cost estimates and our methodology for integrating costs, see Funding Common Ground: Cost Estimates for International Reproductive Health.

Source: Dennis, S and C Mutunga. 2010. Funding Common Ground: Cost Estimates for International Reproductive Health. Washington, DC: Population Action International; UNFPA. 2009. Revised Cost Estimates for the Implementation of the Programme of Action of the International Conference on Population and Development: A Methodological Report. Technical Division. New York: UNFPA. Cost categories as defined by UNFPA.

Totals may not add up due to rounding. Source: Authors’ calculations based on Dennis, S and C Mutunga. 2010. Funding Common Ground: Cost Estimates for International Reproductive Health. Washington, DC: Population Action International; UNFPA. 2009. Revised Cost Estimates for the Implementation of the Programme of Action of the International Conference on Population and Development: A Methodological Report. Technical Division. New York: UNFPA.

Donor Funding Falling Short

Donor funding for population assistance, which reached US$8.7 billion in 2007, would need to more than double to reach the US$21.6 billion updated donor funding target for 2010 (final data on population assistance for 2008 and 2009 is not yet available).

Source: UNPFA/NIDI. 2009. Financial Resource Flows for Population Ativities in 2007. New York: UNFPA.

As demonstrated in Chart 1, donor funding for reproductive health has increased modestly since 2002 to nearly US$1.5 billion in 2007, the latest year for which final data is available.  However, this is far below the massive donor scale-up in funding needed to reach the average US$7.9 billion necessary to meet the ICPD and MDG goals each year (see Chart 2).  In fact, average donor funding for reproductive health since 2005 is one-fifth of the average annual donor share needed through 2015.

Sources: UNPFA/NIDI. 2009. Financial Resource Flows for Population Ativities in 2007. New York: UNFPA; Dennis, S and C Mutunga. 2010. Funding Common Ground: Cost Estimates for International Reproductive Health. Washington, DC: Population Action International.

The trend in donor funding for family planning is even more alarming.  It reached an all time low of US$394 million in 2006, and then climbed slightly to US$462 million in 2007.  Donors would need to more than quadruple 2007 funding levels for family planning to achieve their US$2.2 billion average annual share of funding to meet the ICPD and MDG goals (See Chart 3).

Totals may not add up due to rounding.  Sources: UNPFA/NIDI. 2009. Financial Resource Flows for Population Ativities in 2007. New York: UNFPA; Dennis, S and C Mutunga. 2010. Funding Common Ground: Cost Estimates for International Reproductive Health. Washington, DC: Population Action International.

Challenges Tracking Funding

Tracking exact amounts of donor funding for family planning and reproductive health is difficult due to donor funding increasingly channeled through country and health sector-wide programs, which may benefit family planning or reproductive health services but would not necessarily show up in the amounts detailed above.  Still, data on financial flows presented here are useful as they capture most funding for family planning and reproductive health.  As donors work to improve the effectiveness of their aid, it is important that they improve monitoring and reporting of funds to better track performance towards ICPD and MDG goals.

Focus on the Country Level

Insufficient donor funding for family planning and reproductive health services shifts even greater responsibility on developing country governments to step up funding in these areas.  Without sufficient government funding for family planning and reproductive health services and supplies, the largest financial burden will continue to be borne by consumers, and people with limited resources are likely to be unable to afford services.   Developing country governments must be held accountable to their commitments and responsibilities to achieve the ICPD and MDG goals and strengthen health systems.  Encouraging civil society and citizen participation in development planning and budgeting, and improving tracking and reporting on government expenditures for family planning and reproductive health services and supplies are important parts of enhancing accountability.

South-South Cooperation

As historic donors are investing insufficient amounts of funding in family planning and reproductive health, non-traditional donors such as China, India and Brazil are increasing their aid to countries in the global South.  Although “new” donors like China have been criticized for their environmental and labor practices, and their focus on infrastructure investments, this new source of funding may be a possible supplement to the inadequate funding now available for programs that support women’s reproductive health.