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Programme of Action of the International Conference on Population and Development
Chapter 13 : National Action
A. National policies and plans of action
B. Programme management and human resource development
C. Resource mobilization and allocation
A. National policies and plans of action
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Basis for action 13.1. During the past few decades, considerable experience has been
gained around the world on how government policies and programmes can be designed and
implemented to address population and development concerns, enhance the choices of people
and contribute to broad social progress. As is the case with other social development
programmes, experience has also shown, in instances where the leadership is strongly
committed to economic growth, human resource development, gender equality and equity and
meeting the health needs of the population, in particular the reproductive health needs,
including family planning and sexual health, countries have been able to mobilize
sustained commitment at all levels to make population and development programmes and
projects successful.
13.2. While such success can be facilitated by developments in the overall social and
economic context, and by success in other development efforts, population and development
are intrinsically interrelated and progress in any component can catalyse improvement in
others. The many facets of population relate to many facets of development. There is
increased recognition of the need for countries to consider migration impacts, internal
and international, in developing their relevant policies and programmes. There is also
growing recognition that population-related policies, plans, programmes and projects, to
be sustainable, need to engage their intended beneficiaries fully in their design and
subsequent implementation.
13.3. The role of non-governmental organizations as partners in national policies and
programmes is increasingly recognized, as is the important role of the private sector.
Members of national legislatures can have a major role to play, especially in enacting
appropriate domestic legislation for implementing the present Programme of Action,
allocating appropriate financial resources, ensuring accountability of expenditure and
raising public awareness of population issues.
Objectives
13.4. The objectives are:
(a) To incorporate population concerns in all relevant national development strategies,
plans, policies and programmes;
(b) To foster active involvement of elected representatives of people, particularly
parliamentarians, concerned groups, especially at the grass-roots level, and individuals,
in formulating, implementing, monitoring and evaluating strategies, policies, plans and
programmes in the field of population and development.
Actions
13.5. Governments, with the active involvement of parliamentarians, locally elected
bodies, communities, the private sector, non-governmental organizations and women's
groups, should work to increase awareness of population and development issues and
formulate, implement and evaluate national strategies, policies, plans, programmes and
projects that address population and development issues, including migration, as integral
parts of their sectoral, intersectoral and overall development planning and implementation
process. They should also promote and work to ensure adequate human resources and
institutions to coordinate and carry out the planning, implementation, monitoring and
evaluation of population and development activities.
13.6. Governments and parliamentarians, in collaboration with the international
community and non-governmental organizations, should make the necessary plans in
accordance with national concerns and priorities and take the actions required to measure,
assess, monitor and evaluate progress towards meeting the goals of the present Programme
of Action. In this connection, the active participation of the private sector and the
research community is to be encouraged.
B. Programme management and human resource development [ UP ]
Basis for action
13.7. Building the capacity and self-reliance of countries to undertake concerted
national action to promote sustained economic growth, to further sustainable national
development and to improve the quality of life for the people is a fundamental goal. This
requires the retention, motivation and participation of appropriately trained personnel
working within effective institutional arrangements, as well as relevant involvement by
the private sector and non-governmental organizations. The lack of adequate management
skills, particularly in the least developed countries, critically reduces the ability for
strategic planning, weakens programme execution, lessens the quality of services and thus
diminishes the usefulness of programmes to their beneficiaries. The recent trend towards
decentralization of authority in national population and development programmes,
particularly in government programmes, significantly increases the requirement for trained
staff to meet new or expanded responsibilities at the lower administrative levels. It also
modifies the "skill mix" required in central institutions, with policy analysis,
evaluation and strategic planning having higher priority than previously.
Objectives
13.8. The objectives are:
(a) To improve national capacities and the cost-effectiveness, quality and impact of
national population and development strategies, plans, policies and programmes, while
ensuring their accountability to all persons served, in particular the most vulnerable and
disadvantaged groups in society, including the rural population and adolescents;
(b) To facilitate and accelerate the collection, analysis and flow of data and
information between actors in national population and development programmes in order to
enhance the formulation of strategies, policies, plans and programmes and monitor and
evaluate their implementation and impact;
(c) To increase the skill level and accountability of managers and others involved in
the implementation, monitoring and evaluation of national population and development
strategies, policies, plans and programmes;
(d) To incorporate user and gender perspectives in training programmes and ensure the
availability, motivation and retention of appropriately trained personnel, including
women, for the formulation, implementation, monitoring and evaluation of national
population and development strategies, policies, plans and programmes.
Actions
13.9. Countries should:
(a) Formulate and implement human resource development programmes in a manner that
explicitly addresses the needs of population and development strategies, policies, plans
and programmes, giving special consideration to the basic education, training and
employment of women at all levels, especially at decision-making and managerial levels,
and to the incorporation of user and gender perspectives throughout the training
programmes;
(b) Ensure the nationwide and efficient placement of trained personnel managing
population and development strategies, policies, plans and programmes;
(c) Continuously upgrade the management skills of service delivery personnel to enhance
the cost-effectiveness, efficiency and impact of the social services sector;
(d) Rationalize remuneration and related matters, terms and conditions of service to
ensure equal pay for equal work by women and men and the retention and advancement of
managerial and technical personnel involved in population and development programmes, and
thereby improve national execution of these programmes;
(e) Establish innovative mechanisms to promote experience-sharing in population and
development programme management within and among countries at subregional, regional,
interregional and international levels in order to foster relevant national expertise;
(f) Develop and maintain databases of national experts and institutions of excellence
in order to foster the use of national competence, giving special consideration to the
inclusion of women and youth;
(g) Ensure effective communication with, and the involvement of, programme
beneficiaries at all levels, in particular at rural levels, in order to ensure better
overall programme management.
13.10. Governments should give special attention to the development and implementation
of client-centred management information systems for population and development, and
particularly for reproductive health, including family- planning and sexual health
programmes, covering both governmental and non-governmental activities and containing
regularly updated data on clientele, expenditures, infrastructure, service accessibility,
output and quality of services.
C. Resource mobilization and allocation
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Basis for action
13.11. Allocation of resources for sustained human development at the national level
generally falls into various sectoral categories. How countries can most beneficially
allocate resources among various sectors depends largely on each country's social,
economic, cultural and political realities as well as its policy and programme priorities.
In general, the quality and success of programmes benefit from a balanced allocation of
resources. In particular, population-related programmes play an important role in
enabling, facilitating and accelerating progress in sustainable human development
programmes, especially by contributing to the empowerment of women, improving the health
of the people (particularly of women and children, and especially in the rural areas),
slowing the growth rate of demand for social services, mobilizing community action and
stressing the long-term importance of social-sector investments.
13.12. Domestic resources provide the largest portion of funds for attaining
development objectives. Domestic resource mobilization is, thus, one of the highest
priority areas for focused attention to ensure the timely actions required to meet the
objectives of the present Programme of Action. Both the public and the private sectors can
potentially contribute to the resources required. Many of the countries seeking to pursue
the additional goals and objectives of the Programme of Action, especially the least
developed countries and other poor countries that are undergoing painful structural
adjustments, are continuing to experience recessionary trends in their economies. Their
domestic resource mobilization efforts to expand and improve their population and
development programmes will need to be complemented by a significantly greater provision
of financial and technical resources by the international community, as indicated in
chapter XIV. In the mobilization of new and additional domestic resources and resources
from donors, special attention needs to be given to adequate measures to address the basic
needs of the most vulnerable groups of the population, particularly in the rural areas,
and to ensure their access to social services.
13.13. Based on the current large unmet demands for reproductive health services,
including family planning, and the expected growth in numbers of women and men of
reproductive age, demand for services will continue to grow very rapidly over the next two
decades. This demand will be accelerated by growing interest in delayed child-bearing,
better spacing of births and earlier completion of desired family size, and by easier
access to services. Efforts to generate and make available higher levels of domestic
resources, and to ensure their effective utilization, in support of service-delivery
programmes and of associated information, education and communication activities, thus,
need to be intensified.
13.14. Basic reproductive health, including family-planning services, involving support
for necessary training, supplies, infrastructure and management systems, especially at the
primary health-care level, would include the following major components, which should be
integrated into basic national programmes for population and reproductive health:
(a) In the family-planning services component - contraceptive commodities and service
delivery; capacity-building for information, education and communication regarding family
planning and population and development issues; national capacity-building through support
for training; infrastructure development and upgrading of facilities; policy development
and programme evaluation; management information systems; basic service statistics; and
focused efforts to ensure good quality care;
(b) In the basic reproductive health services component - information and routine
services for prenatal, normal and safe delivery and post-natal care; abortion (as
specified in paragraph 8.25); information, education and communication about reproductive
health, including sexually transmitted diseases, human sexuality and responsible
parenthood, and against harmful practices; adequate counselling; diagnosis and treatment
for sexually transmitted diseases and other reproductive tract infections, as feasible;
prevention of infertility and appropriate treatment, where feasible; and referrals,
education and counselling services for sexually transmitted diseases, including HIV/AIDS,
and for pregnancy and delivery complications;
(c) In the sexually transmitted diseases/HIV/AIDS prevention programme component - mass
media and in-school education programmes, promotion of voluntary abstinence and
responsible sexual behaviour and expanded distribution of condoms;
(d) In the basic research, data and population and development policy analysis
component - national capacity-building through support for demographic as well as
programme-related data collection and analysis, research, policy development and training.
13.15. 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; these are cost-estimates prepared by experts, based on
experience to date, of the four components referred to above. These estimates should be
reviewed and updated on the basis of the comprehensive approach reflected in paragraph
13.14 of the present Programme of Action, particularly with respect to the costs of
implementing reproductive health service delivery. Of this, approximately 65 per cent is
for the delivery system. Programme costs in the closely related components which should be
integrated into basic national programmes for population and reproductive health are
estimated as follows:
(a) The family-planning component is estimated to cost: $10.2 billion in 2000, $11.5
billion in 2005, $12.6 billion in 2010 and $13.8 billion in 2015. This estimate is based
on census and survey data which help to project the number of couples and individuals who
are likely to be using family-planning information and services. Projections of future
costs allow for improvements in quality of care. While improved quality of care will
increase costs per user to some degree, these increases are likely to be offset by
declining costs per user as both prevalence and programme efficiency increase;
(b) The reproductive health component (not including the delivery-system costs
summarized under the family-planning component) is estimated to add: $5.0 billion in 2000,
$5.4 billion in 2005, $5.7 billion in 2010 and $6.1 billion in 2015. The estimate for
reproductive health is a global total, based on experience with maternal health programmes
in countries at different levels of development, selectively including other reproductive
health services. The full maternal and child health impact of these interventions will
depend on the provision of tertiary and emergency care, the costs of which should be met
by overall health-sector budgets;
(c) The sexually transmitted diseases/HIV/AIDS prevention programme is estimated by the
WHO Global Programme on AIDS to cost:
$1.3 billion in 2000, $1.4 billion in 2005 and approximately $1.5 billion in 2010 and
$1.5 billion in 2015;
(d) The basic research, data and population and development policy analysis programme
is estimated to cost: $500 million in 2000, $200 million in 2005, $700 million in 2010 and
$300 million in 2015.
13.16. 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. The estimated global requirements for
international assistance are outlined in paragraph 14.11.
13.17. Additional resources will be needed to support programmes addressing population
and development goals, particularly programmes seeking to attain the specific social- and
economic-sector goals contained in the present Programme of Action.
The health sector will require additional resources to strengthen the primary
health-care delivery system, child survival programmes, emergency obstetrical care and
broad-based programmes for the control of sexually transmitted diseases, including
HIV/AIDS, as well as the humane treatment and care of those infected with sexually
transmitted diseases/HIV/AIDS, among others. The education sector will also require
substantial and additional investments in order to provide universal basic education and
to eliminate disparities in educational access owing to gender, geographical location,
social or economic status etc.
13.18. Additional resources will be needed for action programmes directed to improving
the status and empowerment of women and their full participation in the development
process (beyond ensuring their basic education). The full involvement of women in the
design, implementation, management and monitoring of all development programmes will be an
important component of such activities.
13.19. Additional resources will be needed for action programmes to accelerate
development programmes; generate employment; address environmental concerns, including
unsustainable patterns of production and consumption; provide social services; achieve
balanced distributions of population; and address poverty eradication through sustained
economic growth in the context of sustainable development. Important relevant programmes
include those addressed in Agenda 21.
13.20. The resources needed to implement the present Programme of Action require
substantially increased investments in the near term. The benefits of these investments
can be measured in future savings in sectoral requirements; sustainable patterns of
production and consumption and sustained economic growth in the context of sustainable
development; and overall improvements in the quality of life.
Objective
13.21. The objective is to achieve an adequate level of resource mobilization and
allocation, at the community, national and international levels, for population programmes
and for other related programmes, all of which seek to promote and accelerate social and
economic development, improve the quality of life for all, foster equity and full respect
for individual rights and, by so doing, contribute to sustainable development.
Actions
13.22. Governments, non-governmental organizations, the private sector and local
communities, assisted upon request by the international community, should strive to
mobilize and effectively utilize the resources for population and development programmes
that expand and improve the quality of reproductive health care, including family-planning
and sexually transmitted diseases/HIV/AIDS prevention efforts. In line with the goal of
the present Programme of Action to ensure universal availability of and access to high-
quality reproductive health and family-planning services, particular emphasis must be put
on meeting the needs of underserved population groups, including adolescents, taking into
account the rights and responsibilities of parents and the needs of adolescents and the
rural and the urban poor, and on ensuring the safety of services and their responsiveness
to women, men and adolescents. In mobilizing resources for these purposes, countries
should examine new modalities such as increased involvement of the private sector, the
selective use of user fees, social marketing, cost-sharing and other forms of cost
recovery. However, these modalities must not impede access to services and should be
accompanied with adequate "safety net" measures.
13.23. Governments, non-governmental organizations, the private sector and local
communities, assisted upon request by the international community, should strive to
mobilize the resources needed to reinforce social development goals, and in particular to
satisfy the commitments Governments have undertaken previously with regard to Education
for All (the Jomtien Declaration), the multisectoral goals of the World Summit for
Children, Agenda 21 and other relevant international agreements, and to further mobilize
the resources needed to meet the goals in the present Programme of Action. In this regard,
Governments are urged to devote an increased proportion of public-sector expenditures to
the social sectors, as well as an increased proportion of official development assistance,
stressing, in particular, poverty eradication within the context of sustainable
development.
13.24. Governments, international organizations and non-governmental organizations
should collaborate on an ongoing basis in the development of precise and reliable cost
estimates, where appropriate, for each category of investment.
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