January 30,2014 — Summary of "From Millennium Development Goals to Post-2015 Sustainable Development: Sexual and Reproductive Health and Rights in an Evolving Aid Environment," Hill et al., Reproductive Health Matters, November 2013.
For this paper, Peter Hill of University of Queensland's School of Population Health and colleagues reviewed country case studies to explore "global changes in development assistance for sexual and reproductive health" from 2005 through 2011. They also aimed to explore how the Millennium Development Goals (MDGs) framed those issues, how the World Health Organization and United Nations Population Fund (UNFPA) helped build country-level capacity to respond to changes and how new challenges are "shaping the post-2015 development goals."
The researchers focused on a collaboration between UNFPA and the WHO Reproductive Health and Research (RHR) Department from 2005 through 2012 that involved "grants and agreements on developing the capacity of their country offices to support sexual and reproductive health within the context of aid effectiveness."
They reviewed four country case studies from 2005 that took into account peer-reviewed literature, policy documentation, various data and informant interviews that explored social, political and economic changes and the role of sexual and reproductive health in politics and policy. The researchers also reviewed a second round of country case studies that was conducted in 2011 as the UNFPA/WHO project closed. These studies focused on "the changes in the aid environment for sexual and reproductive health, and country responses to those changes."
Key Findings and Discussion
The researchers highlighted several themes from their review. They noted that in 2005, "There was acute awareness at both global and country level[s] of important changes in aid architecture that were under way." Staff members at established agencies -- such as WHO, UNFPA and various NGOs -- were concerned about how they might adjust their roles and missions to capitalize on the emergence of new development partners, such as the Bill and Melinda Gates Foundation. Meanwhile, U.N. country offices worried that "the plethora of new actors, each with their own modus operandi, was complicating country development processes," the researchers wrote.
By 2011, stakeholders were more accustomed to the "new aid environment," but "there was a widespread perception on the part of government and donor respondents that there had been a compounding of the complexity already documented in 2005," according to Hill and colleagues.
Nonetheless, each of the 2011 case studies documented "the relative confidence that country offices, Ministries of Health and civil society organizations now demonstrated in framing development interactions in terms of the principles of the aid effectiveness agenda," they added.
The researchers also found that the expanding participation of new agencies and their efforts to "extend their engagement beyond their narrowly defined mandates" required Ministry of Health staff and WHO and UNFPA advisers to navigate a greater number of mechanisms to coordinate stakeholders and programs. By 2011, all of the countries "had faced requirements for new coordination structures," the researchers noted.
In addition, the 2005 studies noted "a lack of connection" between calls for reducing maternal mortality through national-level planning and the implementation of related program responses, such as resource allocation and human resources development. The 2011 case studies suggested that the problem had not been resolved.
The next stage of the process for the post-2015 development goals "provides a unique opportunity for sexual and reproductive health and rights to locate itself centrally in terms of social sustainability," the researchers wrote.
However, "a complex of issues" shapes the global policy agenda, and member states will need to develop "concrete policy and programme positions" on sexual and reproductive health and rights, as well as exercise "the political will to advocate for these locally, nationally and into the global debate," the researchers added.
More immediately, the research suggests "there is a tactical window through which to raise the profile of sexual and reproductive health and rights priorities, and integrate them into multiple policy windows: universal health coverage, health systems strengthening, adolescent health -- as part of health at every life stage, as well as within gender equality, and in the increasing recognition of the centrality of gender and sexuality issues to HIV," according to the researchers.
They concluded by cautioning, "Fragmentation of the health agenda and of the aid effectiveness agenda can too easily lead to a fragmentation of the sexual and reproductive health and rights agenda -- something to guard against in the context of the continuing dynamic complexity of development assistance."