Organizing for Effective Family Planning Programs (1987)

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114 Even under a centralized bureaucracy, precise data on domestic funds are difficult to compile for the following reasons (Nortman, 1981: 288-289) ; @ De jure allocations are not always realized as de facto expenditures. @ Expenditures flow through "pipelines" of varying length and at different rates, so that different cross-sections of measure- ment yield different estimates. @e Infusions into the "pipeline" at points other than the main reservoir are not always accounted for. @ In some countries, Mexico for example, several government agencies, independent of each other, provide family planning services, and their records are poorly coordinated. @e Joint and shared costs are a major unresolved accounting prob- lem. With the increased tendency to deliver family planning services in a package of health and other services, it has become increasingly difficult to isolate the cost of a particular service. Nevertheless, imperfect as the funding data may be, as orders of magnitude they adequately reflect the sources, trends, and levels of funds and serve as an empirical base for policy decisions on resource allocation for family planning programs. FUNDING LEVELS AND TRENDS Following a brief overview of funding levels and trends, this section addresses the relationship between program duration and domestic ver- sus foreign funding, the family planning share of government budgets, and the impact on funding of the worldwide recession. ‘Overview of Levels and Trends Excluding China, expenditures on organized family planning in LDCs have increased from $400 million (U.S.) in 1971 (Robbins, 1973) to a present (c. 1982) level of about $1 billion (U.S.) per year (Popula- tion Information Program, 1983). While this is a tenuous comparison because strong worldwide support for family planning was still in its infancy in 1971, the 150 percent increase in dollar expenditures on family planning in LDCs in 1982 compared with 1971 amounts to only a 13 percent increase in constant dollars (based on OECD GNP defla- tors). The $1 billion includes over $400 million from domestic LDC budgets, almost $500 million from developed country governments and private donors, and about $100 million from LDC individuals paying

115 for their own supplies and services. To the extent that population assistance other than family planning assistance is included in the $500 million estimate from foreign donors, the $1 billion figure is overstated. Nevertheless, accepting this estimate yields about §2.00 per year spent by or on each LDC married woman of reproductive age (MWRA) outside of China. This figure includes not only the cost of providing contraceptive supplies and services, but in addition, all the ancillary activities of family planning programs. Expenditure data per MWRA vary widely not only from country to country, but also over time. While poor-quality data probably have something to do with the variance, differences among countries and within countries over time are real. The UNFPA and U.S. Agency for International Development (AID), as well as researchers in other Organizations, attempt periodically to monitor country-specific pro- gram expenditures. The 11 editions of the Population Council's Population and Family Planning Fact Book (with the 12th edition forthcoming) represent the most regularly published source of infor- mation on program expenditures. An examination of this publication for time trends of expenditures shows highly erratic patterns. This is hardly surprising: in addition to different concepts of “expen- diture” (sometimes reported as allocation, sometimes including sizable indirect contributions from the health and other ministries), exo- genous forces over which program administrators have no control (e.g., donor contributions and political and economic events) can have a momentous impact on program resources. Recent annual per capita expenditures in 32 countries are shown in Table 1. The median is 51 cents, ranging from a high of $3.20 in Swaziland, where the contraceptive prevalence rate among MWRA is about 3 percent (Speidel, 1983), to a low of 14 cents in Thailand in 1981. That Thailand ranks at the bottom is surprising considering that it represents one of the family planning success stories; however, its 14 cent 1981 per capita expenditure represents only the direct monetary input earmarked for family planning, and Table 1 indicates that, in- cluding the indirect input, the figure was 27 cents in 1983. (Unfor- tunately, no breakdown into direct and indirect components is avail- able.) To assess the effects of financial inputs on a program output mea- sure such as contraceptive prevalence, it is important to note that a given prevalence rate is influenced by the cumulative effect of finan- cial inputs into a program. Thus, it is not surprising that a nonsig- nificant correlation exists between the single-year per capita expen- dGiture data in Table 1 and contraceptive prevalence about one year later. In contrast, Lapham and Mauldin (1985:127; see also Chapter 23 in this volume) found a high correlation (R2 = .82) between 1982 program effort and contraceptive prevalence. Important as funding is, especially sustained funding over several years, the Lapham and Mauldin work demonstrates the significant contribution of policy, managerial, and implementation aspects of programs to the level of contraceptive use.

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118 Relationship Between Program Duration and Domestic Versus Foreign Funding Donors like to think of their contributions as seed money. In the early stages of program adoption and implementation, they are less concerned with stimulating local funding than with helping to lay the foundations for successful operation. Hence, an initial rise in for- eign funding is often sought and welcomed by both recipients and donors if the evidence suggests that the program is getting off the ground. In time, however, donors and recipients alike begin to appre- ciate the advantages of relying more heavily on in-country resources. The expectation is that foreign support as a proportion of total ex- penditures will peak after a relatively short time and will gradually taper off thereafter. The government proportion is expected to rise with program duration. Cross-sectional data, like those in Table 1, support this expecta- tion: the African countries, with more recent programs, provide a smaller domestic share than the Asian countries with older programs. However, a more appropriate, longitudinal approach suggests that other forces are also at work. Some African countries adopted antinatalist policies and programs almost as long ago as did the Asian nations-- Egypt in 1965, Ghana in 1969, Kenya and Tanzania in 1970--yet their family planning programs are still financed more by outside aid than by their domestic budgets. Mauritius, hardly typical of Africa, shows the expected progression, the government's share increasing from 38 percent in 1974 (Nortman, 1975) to 59 percent in 1979 and to 72 per- cent in 1982 (Table l). Since widespread international support for family planning activi- ties had yet to develop when Asian countries first began to adopt antinatalist policies in the 1950s and early 1960s, the domestic share of family planning expenditures was necessarily large. Outside sup- port was provided chiefly by private organizations and foundations, notably the IPPF and the Population Council, and by a few governments concerned with population issues, notably Sweden. As more foreign governments became donors, the domestic share declined, at least for a time. Thus in Korea, for example, the government provided 7.0 out of 7.4 cents per capita expended in 1966, 7.2 out of 8.1 cents in 1967, 7.0 out of 9.6 cents in 1968, and 6.2 out of 10.4 cents in 1969 - (Nortman, 1971). With the maturing of (some) Asian programs and economies, this trend reversed. By now, as can be seen in Table l, India (which al- ways largely financed its own program), Indonesia, Korea, Malaysia, the Philippines, and Thailand, if one includes the latter's indirect contribution, finance their programs mostly with their own funds. The estimated share of the Bangladesh and Nepal government contribu- tions, 49 and 39 percent, respectively, as reported by Speidel (1983), look high, while the Sri Lanka proportion, 20 percent, seems low. The difficulties of compiling the data, however, are such that impressions are not entirely to be discarded. The situation in Latin America is complicated by the strong role of the IPPF in many countries. Governments often give sizable funds

119 to the IPPF affiliate and thus subsidize family planning through the private sector. An interesting finding is that Latin American coun- tries with annual per capita gross domestic product (GDP) below $1,000 provide a much smaller share of their family planning expenditure out of domestic budgets than do countries with annual per capita GDP over $1,000. In Latin American as in African countries, budget constraints seem to be more important than program duration in explaining the gov- ernment proportion, although the data are too meager for a statistical test. Mexico's relatively high per capita expenditure, 88 cents, and accompanying high government share, 78 percent in 1980, can be hypoth- esized to stem from that country's continuing strong commitment to fertility decline following the adoption of an antinatalist policy in 1974. In sum, the government share of program cost is the result of numerous interactive determinants. Worthy of note are the prevailing demand for family planning services, government commitment to fertil- ity decline, date of program start, availability of foreign funds, GDP per capita, and, to a limited extent, the level of per capita family planning expenditure. To conclude this section, Table 2 presents the findings from one study that collected information on the proportions of budgets pro- vided from domestic sources. Note that this table refers to the following question: What proportion of the funds for the family planning/population program are provided by the government from its own national budget--that is, from nonexternal sources? Consider funds used both for family planning services and other population activities. Please complete the following table for as many years as you know . « « « The key reference year is 1982, but when these data were not avail- able, respondents provided information in some cases for 1981, 1980, or 1979. Details on procedures for the translation of questionnaire information into composite answers (scores) are found in Chapter 23. Note that only 10 countries provide 85 percent or more of their budgets from domestic sources: 5 in East Asia and 5 in other regions. Another 13 countries provide 65-84 percent, and 10 more between 51 and 64 percent. Thus some 33 countries, as of 1982 approximately, were providing one-half of their public-sector program budgets from domes- tic sources. (Table 2 does not include 33 countries that have very limited family planning program effort; in none of these countries does the domestic share of the budget reach 50 percent.) Family Planning Share of Government Budgets Another perspective from which to view an LDC government's family planning expenditure is in relation to its health and total budget. Neither a priori considerations nor empirical data suggest a univer- sal proportion as a test of adequacy. Governments vary not only in

120 TABLE 2 Proportion of Family Planning and Population Budget Provided 67 Countries Classified by Region, for 1982 or from Domestic Sources: Slightly Earlier® Region Percent of Budget from Domestic Sources Number 85 or more 75-84 65-74 51-64 of 50 or less Countries Fast Asia South Asia Caribbean and Central America South America West Asia and North Africa Sub-Saharan Africa Number of Countries China Korea, Rep. Singapore Taiwan Hong Kong? Mexico Trin. & Tobago Colombia Venezuela Algeria 10 Indonesia? Malaysia? India Sri Lanka Panama Mauritius Korea, PDR Pakistan Cuba El Salvador Jamaica Chile Zimbabwe Philippines Thailand Vietnam Costa Rica Domin. Rep. Morocco Tunisia Turkey Rwanda Zambia 10 Fiji 14 Papua N.G. W. Samoa Bangladesh 5 Nepal Guatemala 12 Haiti Honduras Nicaragua Brazil 7 Ecuador Guyana Peru Cyprus 9 Egypt Jordan Lebanon Yemen, PDR Botswana 20 Congo Gambia Ghana Guinea-Bissau Kenya Lesotho Liberia Mozambique Nigeria Senegal Sierra Leone Tanzania Togo Uganda Zaire 34 67 “rable includes sStimate right at the cut-off point; may belong in the next lower category. Sources all countries with program effort scores of 15 or more; see Chapter 24 for a @escription of the program effort scale. Special tabulation from the Lapham and Mauldin 1983-84 family planning program effort study.

121 their per capita resources, but also in their nondiscretionary and urgent obligations. Differences in family planning program absorp- tive capacity (discussed below) and unmet contraceptive need also influence government allocations to family planning support. While these legitimate considerations might explain country differentials, it is difficult to reconcile the frequent government rhetoric on the importance of family planning practice with the budget proportions allocated for this purpose--a small fraction of 1 percent. Among the 12 countries with recent data listed in the Population Council Fact Book (Nortman, 1982:Table 10), the median was 3 per 1,000 units (local currency) of government budget. The health proportion of government budgets depends greatly on the definition of health, as well as on the actual funds appropriated for health. Whatever the definition, health rarely represents as much as 10 percent of the total government budget. Among 14 countries, health ranged from 1.1 (Indonesia, FY 1980) to 10.2 percent (El Salvador, 1980) of the total budget. Just as health is typically a minor part of the total budget, family planning is typically a small part of the health budget. Notable exceptions are Bangladesh, India, Indonesia, Pakistan, and the Philippines, countries where family planning ranks high as a health service. For these countries, family planning as a percent of the health budget, including family planning, was recently 53 percent, 9 percent, 23 percent, 15 percent, and 11 percent, respec- tively (Nortman, 1982). Impact of Worldwide Recession Recent family planning expenditure data are too scanty to permit a quantitative appraisal of the effect on them of the early 1980s world- wide recession. The decline in the government allocation in the Philippines from 74 cents per capita in 1981 to 43 cents in 1983, and in Mauritius from $1.39 in 1979 (Table 1) to 91 cents in 1982, may be a consequence of the recession. On the other hand, the 1983 alloca- tion in Indonesia seems not to have been affected, being almost 50 percent greater than that in 1979 (46 cents compared with 31 cents per capita); and in India, the program was resurrected in 1982 from the political limbo into which it had fallen in 1978, with a doubling of the 1979 per capita expenditure. Nevertheless, it is not necessary to know the full effects of the recent recession to appreciate that it took its toll on family plan- ning as on other social programs. According to the United Nations (1984a:7-8), “Development prospects have been set back... . The economic adversity presently faced by many developing countries has not only depressed investment, and with it prospects for growth, but has also refocused attention on the relationship between prevailing economic conditions and the social health of nations." Annual GDP growth rates in LDCs fell from 5.5 percent during 1976- 79 to 1.3 percent during 1980-83. Except in Southeast Asia, the de- cline was pervasive in all regions, with GDP growth rates reaching a virtual standstill during 1980-83 in Africa (0.6 percent per year) and

122 Latin America (0.4 percent per year) and turning a negative 1.9 per- cent in West Asia (United Nations, 1984a:4). While countries in sub- Saharan Africa have been particularly hard hit, “a great many devel- Oping countries proved very vulnerable to the recession and have emerged with difficulties which are crippling their present and pro- spective performance” (United Nations, 1984a:4). With the prospects dim for an early resumption of rapid economic growth throughout the developing world (p. 73), donors can anticipate increased requests for population, family planning, and other types of assistance. MAJOR CHANNELS OF FOREIGN ASSISTANCE Available data on donor contributions do not isolate family planning from the many types of population assistance. Thus, the funds flowing through major donor channels are presented below as contributions to total population assistance; a discussion of funds disbursed to reci- pient countries specifically earmarked for family planning concludes this section. Private, nongovernmental organizations, or NGOs, were the first foreign providers of population assistance to LDCs (see Chapter 16). They continue to play a pivotal role in research, training, evalu- ation, and the development of contraceptive technology; however, as primary sources of funds, private philanthropic organizations have dwindled to less than 5 percent of foreign population aid. This is shown in Table 2, where bilateral and multilateral funding represents more developed country (MDC) government contributions, and the NGO contribution represents funds channeled through the private sector but originating mostly from the public sector, i.e., MDC government grants. NGO population assistance held steady between 1977 and 1981 at about 20 percent of total population assistance, but only because of NGO ability to attract public grants. As can be seen in Table 3, pub- lic grants to NGOs increased steadily from §48 million in 1977 to $91 million in 1981, while the private-sector component of NGO population assistance declined from §20 million in 1977 to $17 million in 1981. To ascertain whether NGOs, flush with government grants, relaxed their efforts to procure private funds or whether they encountered increas- ing resistance from the private sector would make an interesting study; however, the fact is that the numerous channels of foreign population assistance now originate almost wholly from one type of source. LDCs that a decade ago “felt little concerned by what they regarded as ills and luxuries of wealthy countries" (OECD, 1973:101) today are aware of the importance of MDC policy decisions and eco- nomic health for continued population as well as other types of aid. Another feature to be noted in Table 3 is the tendency of MDCs to channel more of their population assistance through multilateral and NGO institutions, although bilateral arrangements, which accounted for as much as 44 percent of total assistance in 1977, did so for a sub=- stantial 29 percent in 1981. However, AID, which now funds population activities at over $200 million per year ($211 million in 1982, $221

123 TABLE 3 Population Assistance (expenditures) to LDCs by Source of Funds Source 1977 1978 1979 1980 1981 Amount, Millions of Current § U.S. Bilateral 154 136 140 119 142 Multilateral 126 175 226 254 241 NGOs 68 80 85 103 108 Public funds 48 58 67 87 91 Private funds 20 22 18 16 17 Total 348 391 451 476 491 Percent Bilateral 44 35 31 25 29 Multilateral 36 45 50 53 49 NGOs 20 20 19 22 22 Public funds 14 15 15 18 19 Private funds 6 6 4 3 3 Total 100 100 100 100 100 Sources Data from O'Connor (1983:Tables l, 8, 9). million in 1983, and $290 million in 1985, more than all other MDCs combined), still provides a significant proportion bilaterally--42 percent in 1983. (Another 42 percent was channelled through NGOs and the remaining 16 percent through UNFPA.) Under the new U.S. policy (proclaimed at the International Conference on Population in Mexico City in 1984) of withholding funds from NGOs that use any funds, pub- lic or private, to support abortion in any way, the NGO component of AID population assistance may decrease significantly, principally be- cause of the cessation of AID funding to the IPPF. A final point to note here is that private funding, such as that provided by foundations, makes possible certain types of assistance that would not normally be supported or cannot be funded under the 1984 U.S. policy, for example, studies of donor agencies in the popu- lation field or abortion-related activities. The remainder of this section focuses first on the major donors, addressing not only their expenditures, but also their commitments; a

124 TABLE 4 Population Assistance (expenditures) to LDCs: Millions of U.S. Dollars From Intergovern- From MDCs mental Organizations (current dollars) IPPF and Total Total Total FPIA (constant (current (current Percent World (private 1970 Year dollars) dollars) U.S. UNFPA Bank WHO sector) dollars) 1971 169 135 81 8.9 1.6 2.8 15.5 162 1972 187 159 76 19.8 5.7 9.8 19.5 173 1973 209 169 68 34.7 11.0 16.0 25.7 183 1974 251 181 61 57.5 14.8 18.9 33.7 198 1975 279 198 53 71.2 20.3 23.0 36.9 201 1976 303 240 50 75.8 25.9 29.2 38.0 = 207 1977 348 278 52 72.1 27.7 34.7 47.1 223 1978 391 320 52 95.7 31.4 38.2 58.2 233 1979 451 366 47 131.6 59.1 40.8 60.7 241 1980 476 354 48 147.5 80.3 45.4 64.0 224 1981 491 374 52 136.4 77.3 45.4 63.5 210 1982 n.a. 390 54 120.4 na. na. na. na. 1983 na. nea. na. 122.0 na. na. n.a. n.a. Source: UNFPA (1983:Table 1). 1982 and 1983 data from personal communication from Henna Ong, Deputy Chief, UNFPA Programme Planning and Statistics Branch. comparative assessment of MDC population assistance as a proportion of GDP is also given. This is followed by a discussion of the recipients of family planning (as opposed to general population) assistance. Major Donors When examining Table 4, it should be noted that the donors listed are neither. exhaustive nor mutually independent. In fact, the MDC data are incomplete in that they represent the bilateral and multilateral

125 contributions, but omit MDC grants to such NGOs as IPPF and FPIA. The data shown in Table 4 for the latter two organizations include their private-sector as well as MDC government funds. Virtually all UNFPA funds are from MDCs; UNFPA uses part of these funds to supplement or fund the population projects of other U.N. agencies. Because of the flow of funds among the donors, the individual columns in Table 4 are not additive. Under each category--MDC, intergovernmental, and pri- vate sector--only the top-ranking donors are specified. The total column represents UNFPA's best estimate of population assistance expenditures, excluding double counting. To the extent that it is incomplete with respect to private contributions, the total is understated, but probably not by much. In current dollars, the total population assistance increased from $169 million in 1971 to $491 million in 1981, at a mean average annual rate of 11.3 percent. In constant 1970 dollars, the increase was from $162 million in 1971 to a peak of §241 million in 1979, followed by a decline to §210 million in 1981 (UNFPA, 1983). Compared with 11.3 percent in current dollars, the mean real rate of increase between 1971 and 1981 was 4.1 percent per year. Among the MDC donors, the U.S. share remains dominant, although as more countries joined the roster of contributors, this share declined from over three-fourths in 1971 to about half by the mid-1970s, where the most recent comparative data indicate it remains. Other countries providing significant population assistance are Japan, at 10 percent, and Norway and Sweden, each accounting for 7 percent of the MDC bi- lateral and multilateral total in 1982; the Federal Republic of Ger- many, 6 percent; the United Kingdom, 5 percent; Canada, 4 percent; and The Netherlands, 3 percent (UNFPA, personal communication). Donor Commitments In terms of commitments rather than expenditures, UNFPA has managed to construct a time series that is free of double-count of population assistance by primary donors (see Table 5). Although population assistance commitments and expenditures are not synonymous, they are Closely correlated. UNFPA is omitted from the international organi- zations shown because virtually all its funds derive from government commitments included in the MDC category. U.N., WHO, and World Bank commitments shown in Table 5 also come mainly from MDC budget alloca- tions, but these commitments are drawn from general membership assess- ment accounts rather than from funds earmarked for population assis- tance. To exclude double counting among the NGOs, the data for the Population Council and the Pathfinder Fund exclude grants from the U.S. Government and the Ford and Rockefeller Foundations, which are shown separately. Summing current instead of constant dollars over time gives undue weight to more recent funding, but probably not sufficiently to in- validate the relative standing among the three donor categories. As in the case of expenditures, there was an appreciable decline in the share of private funding, from an average of 10.7 percent cumulatively

126 TABLE 5 Primary Donor Net Funding Commitments for Population Programs to LDCs: 1981 and 1969-81 Inclusive 1981 1969-81 Inclusive Donor $ Million Percent $ Milliona Percent MDC Governments 362 90 3036 74 United States 195 49 1734 43 Japan 32 8 136 3 Norway 30 7 230 6 Sweden 25 6 265 6 Germany, Fed. Republic 21 5 160 4 The Netherlands 14 3 93 2 Canada 13 3 118 3 United Kingdom 12 3 135 3 Others 20 5 165 4 International Organizationsb 21.6 5.4 605 14.8 U.N. 3.9 1.0 49 1.2 WHO 5.2 1.3 46 1.1 World Bank 12.5 3.1 510 12.5 NGOsc 16.5 4.1 437 10.7 Ford Foundation 7.6 1.9 271 6.6 Pathfinder Fund 0.9 0.2 6 0.2 Population Council 3.1 0.8 71 1.7 Rockefeller Foundation 4.9 1.2 88 2.2 Total 400 100 4079 100 aSum of current dollars. bUNFPA is not included since its funds come from MDCs. See text for further explanation of primary donor. CIt may be noted that the William and Flora Hewlett Foundation, which channels its population assistance through other Organizations, provided $8.5 million in 1984 and over $6 million in 1983 (personal communication). Source: UNFPA (1983:Table 5).

127 through 1981 to 4.1 percent for the year 1981. MDCs, which accounted for 74 percent of cumulative commitments, were up to 90 percent in 1981; U.N. agencies, excluding UNFPA, accounted for 5.4 percent of the §400 million committed in 1981, compared with a 15 percent share of cumulative commitments through 1981. It is clear that without a radical change in private funding levels, LDCs are almost wholly dependent upon a handful of MDCs for foreign population assistance. MDC Population Assistance as a Proportion of GDP For a comparative assessment of MDC population assistance, annual dis- bursements by individual countries are shown in Figure 2 as a propor- tion of corresponding GDP. This measure is a meaningful indicator of differences among countries because it relates population assistance to economic resources. The eight countries identified in Figure 2 account for 95 percent of population-related disbursements by MDCs. It will be noted from the figure that disbursements by Norway and Sweden as proportions of GDP so far exceed those of the other six countries that they are depicted on a separate scale. On average in the 1971-82 period, Norway's proportions were eight times the eight- country average shown in Figure 2, Sweden's five times as great. The third country to stand out is The Netherlands, which, after a slow start, reached a level of population aid relative to its GDP of 50 percent above the eight-country average. While in dollar amounts U.S. assistance exceeds all other MDCs combined, U.S. contributions rela- tive to GDP since 1979 have exceeded the average only slightly, 6 to 9 percent. Japan, Germany (Federal Republic), and the United Kingdom are at the bottom of the eight-country list showing population assis- tance as a share of GDP, but with an increasing trend toward narrowing their gap from the average. Similarly, Canada started with a low pro- portion in 1971, but in recent years has come close to the average. Over the 1971-82 period, the trend in the eight-country average fluctuated rather narrowly, between a peak of $73.9 per million of aggregate GDP in 1972 and a trough of $59.8 per million in 1980, with a mean of $65.2 per million. Given this narrow range, the great in- crease in dollar contributions (from $131 million in 1971 to §372 million in 1982 by the eight countries) should be attributed to a much larger GDP in current dollars, not to greater canmitment to popu- lation issues. If anything, the trend has been downward, initiated perhaps by onsets of economic recession, 1971-73 and 1979-80, with only partial recovery when economic conditions improved. The U.S. pattern shows a deterioration in population assistance relative to GDP, from a high of $103.7 per million of GDP in 1972 to a low of $65.1 in 1980, with a slight upturn to §68.6 in 1982, and then a pro- jected increase to $75.2 per million GDP in 1985 based on $287 million authorized for population assistance in 1985 and an estimated §3, 816.4 billion GDP.

128 800 P ° 700; 600F- : 6 500-- Norway dé jemecccoccnssen a”. o** “N 400 — °*” o a ° o awm* -” ‘XN ome —_ ®. P r o p o r t i o n of G D P 300r ~~ Sf Sweden ~ ; . © ag ee oo oe 200 s(«is“ ! 1 ! al ! L j I i ! | 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 Year 100 P \ \ Netherlands or 90 r- 8OF 70F- 40r- P r o p o r t i o n of G D P peo oe / W4 30k st - , / corpany sf Lo om aseah f7~ 7 - “” ‘NX aS. 7 7 —_~o “—* Japan - 10 r ee o ams © ~ 0 | l LL _| _| | L l l | jt 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 Year FIGURE 2 Annual Disbursements for Foreign Population Assistance as a Proportion (x 10-6) of GDP: Eight Top-Ranking Countries, 1971-82 Sources: UNFPA (1983:Table 1); 1982 disbursements from Henna Ong, UNFPA Programme Planning and Statistics Branch; GDP from U.N. (1984b).

129 Recipients of Family Planning Assistance Following the 1974 World Population Conference, donors greatly en- larged the scope of their population assistance. (For a checklist of activities, see Population Information Program, 1983:Table 4.) Al- though the distributions reflect donor preferences, the lion's share of population assistance goes for some form of family planning activ- ity. This applies even to UNFPA, "which, as a matter of deliberate policy, has gone furthest in the breadth of its population assistance coverage." Conversely, IPPF and the Pathfinder Fund, for example, whose mandates are to provide family planning services, "find no dif- ficulty at all about including support for such diverse activities as seminars for parliamentarians, training of religious leaders . .. ." (Wolfson, 1983:10). Since estimates of MDC bilateral and NGO expenditures are not rou- tinely available by category of population assistance, the best infor- mation on family planning assistance is UNFPA's time series of its family planning disbursements to recipient countries. From its incep- tion in 1969 through 1983, aggregated in current dollars, UNFPA has expended §432 million on LDC family planning activities (as defined by that agency). The addition of, let us assume, 50 percent of expendi- tures classified by UNFPA as directed to communication and education, a category that embraces projects strongly supportive of family plan- ning, increases the figure to §492 million. As a proportion of total UNFPA expenditures, these two figures amount to 44 percent and 49 per- cent, respectively. As shown in Table 6, 57.2 percent of UNFPA's total family planning expenditure went to health "action" projects, meaning maintenance and operational support of family planning programs implemented through health infrastructures; 12.8 percent to training; and 8.4 percent to information, education, and communication (IE&C) activities. Inter- estingly, community-based distribution (CBD) projects (see Chapter 14), heralded as a means of reaching the rural masses, received only 2.4 percent of the total. Regionally, over half the family planning expenditure went to Asia, primarily for the operation of family plan- ning projects through health infrastructures; and another 20 percent went to Latin America, again for projects implemented through the health sector. The 12.2 percent of the total expended on an inter- regional and global basis was primarily for research and evaluation and the development of fertility regulation methods. Although adjust- ment of the data in Table 6 for inflation would more accurately show the project distribution, the information presented provides general Orders of magnitude. The time trend of UNFPA annual family planning expenditures shown in Figure 3 shows the shifting emphasis of the Fund among broad re- gional categories. For all LDCs combined (Panel A, right), over five times as much was expended (in current dollars) per year during 1975- 80 as during 1969-74--§43 million compared with $8 million. While adjustment for inflation reduces the 5-fold to a 3.5-fold differen- tial, the latter half of the 1970s seems to mark the high point of assistance from UNFPA for family planning projects. Only in sub-

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132 Panel A. Millions of (current) US.dollars per region’ right scale aD raf 1969-74 F—j ZN + 40 . - 1975-80 77] ZX + 35 16 1981-83 [XN] ZN |" 3 OE iN |" 8 10F UN 1*° = : ZN + 15 s °F Ep N IN|. cE N EW AW EAT 3.0 - - 2.5 . 2.0 GZ | 7 s 1.55 \ Y L L “tN W NA AW Y IN WW A U; “EN WN A AW A 0.0 | AN UN YX VAN IW 7 FIGURE 3 Annual UNFPA Family Planning Expenditure by Region: Averages for 1969-74, 1975-80, and 1981-83 @Arithmetic average per time period. Constant instead of current currency would better reflect purchasing power, but trends are evident as shown. The per capita data are based on mid-period population computed from U.N. (1982). b Excludes China and West South Asia. In both panels, the latter is incorporated in the Middle East. Source: Computed from special tabulations provided by Henna Ong, UNFPA Programme Planning and Statistics Branch.

133 Saharan Africa was there an appreciable increase in annual UNFPA family planning expenditure in 1981-83 compared with 1975-80--§4.9 million compared with §2.4 million. In North Africa and Latin America, annual expenditures declined appreciably in the early 1980s compared with the late 1970s (by 45 and 33 percent, respectively), but held steady, in current dollars, in the Middle East (West Asia) and the South and East Asia-Pacific regions. Evidence of the erosion of donor financial support for family planning in the early 1980s (in contrast to the 1970s increase shown in Table 4) is indicated by Panel B of Figure 3, which shows the UNFPA expenditure per capita in the recipient countries. Only in _ sub- Saharan Africa was there an increase--from 0.7 cents per capita per year during 1975-80 to 1.3 cents per capita per year during 1981-83. In North Africa and Latin America, there was a major decline of 52 percent and 40 percent, respectively. For all LDCs excluding China, UNFPA spent 20 percent less per capita (in current value) on family planning in the early 1980s than in the latter part of the 1970s. What explains this decline? Positive factors such as program success, less need, and increased domestic government support may have played a role in some countries. Also, there are more countries now with programs, and others, especially in Africa, in which the major donors would welcome programs to support. Another factor is a shift in emphasis from the sheer magnitude of funds to better management as a precursor of program success. A third factor in the decline in family planning support is the economic recession that afflicted the world in the early 1980s, discussed above. The resulting funding constraints were already evident in early 1981 and were signaled at the International Conference on Family Planning in Jakarta in April of that year. In noting that “a shortage of funds is a fundamental and serious limitation for countries wishing to implement [family planning) programmes," the Conference called for "greater financial commitment, particularly from the developed countries and those with positive balance of payments" (UNFPA, IPPF, Population Council, 1981: 19). The record to date suggests that this call is going unheeded. Instead of greater financial commitments from developed countries, at least on a per capita basis, most of the major UNFPA recipient coun- tries are receiving less financial support for family planning pro- grams. The eight countries shown in Figure 4 (the counterpart of Figure 3 on a country instead of regional basis) were selected for their top ranking in UNFPA expenditure during 1969-83, over which time they accounted for 43 percent of total UNFPA family planning expenditure. Of the eight, only China is receiving more per capita in the 1980s than in the late 1970s. (Still, the per capita support to China is the least of the eight.) On the other hand, the experience of China, and to a lesser extent India, whose decline in the crude birth rate from 41.0 during the period 1961-71 to 34.0 in 1976-81 (Bhat et al., 1984:5) is insuffi- ciently appreciated, indicates that in the present era as well as the past, foreign aid is not a necessary condition for fertility decline. Neither is it a sufficient condition, as indicated by continuing high fertility in Botswana, Ecuador, Haiti, and Honduras, countries’ that