The national commitments resulting from the 1994 International Conference on Population and Development have delivered real gains in health, gender equity, and reproductive rights.
But as the world’s nations convene in Nairobi this month to mark the ICPD’s 25th anniversary, we must also ask how we can modernise national commitments and maximise their effectiveness to accelerate progress.
Twenty-five years ago, at the ICPD in Cairo, the world agreed that sexual and reproductive health is a human right, a requirement for equity, and an indispensable element of any development strategy.
Looking back, there is much to celebrate.
WOMEN AND GIRLS
Commitments made under ICPD and related initiatives such as Family Planning 2020 (FP2020) and Every Woman Every Child have improved the lives of women and girls, driven real progress on sexual and reproductive health, and paved the way for developmental gains.
But as the United Nations Population Fund marks the anniversary by asking national governments to renew and expand their ICPD commitments, we urge governments to develop truly modern commitments. How? By employing three key principles: engage civil society organisations and other key stakeholders from the start; align commitments with national action strategies, and ground commitments in relevant data.
FP2020 commitments made by Ethiopia and Indonesia illustrate two of these best practices.
Ethiopia’s national government used fertility data to inform where increased investments would yield the greatest returns, then designed a commitment focused on improving contraceptive access for young people.
As a result, millions more Ethiopian women have access to contraceptives, and the government has implemented programmes focusing specifically on the youth.
Indonesia’s government had already prioritised the development of a national health insurance system. Because its FP2020 commitment to cover family planning services aligns with that priority, it is already being translated into policy.
But such cases are the exceptions.
Kenya’s experience illustrates the way most countries have approached commitments.
With a modern contraceptive rate of 60 percent, Kenya has actually surpassed its FP2020 commitment to increase the modern contraceptive rate among married women to 58 percent.
But Kenya’s progress also masks problems of equity and quality.
Yes, most Kenyans have access to contraceptives, but those who do not are arguably populations who are already underserved — unmarried young people and adolescents, those who are differently able, economically vulnerable, linguistically or culturally isolated, or who face other barriers to care.
And access to contraceptives is not enough.
High quality sexual and reproductive health services include medically accurate and culturally sensitive information and counselling as well as supplies.
Kenya made its commitment in isolation, without engaging civil society organisations and other key stakeholders like international NGOs, foundations, healthcare providers, local governmental and cultural leaders, and donors.
Civil society organisations are closest to the communities they serve and best understand their needs.
Engaging these organisations from the beginning would have given Kenya a better chance to improve equity and quality, as well as overall contraceptive use.
Engaging civil society organisations now is the best way Kenya can make progress on those issues going forward.
When governments make commitments as Kenya has, the resulting commitments can be unrealistic or disconnected from the institutional leaders who will ultimately shape their success or failure.
Not surprisingly, unrealistic commitments for which stakeholders feel no ownership are unlikely to be sustained. When that happens commitments can make earnest reform efforts seem ineffective, undermine stakeholders’ confidence in government, and reinforce perceptions that problems are impossible to solve.
How do we know what works?
The Motion Tracker developed by Uganda’s Samasha Medical Foundation and implemented with support from PAI helps bring civil society organisations, national governments and other stakeholders together. It helps them clarify a country’s commitments and make them more explicit. It then helps collaborators identify useful and accessible process indicators, assess obstacles and opportunities, and develop shared plans to accelerate progress.
The Motion Tracker essentially reverse-engineers national commitments to answer key questions. Who will be instrumental in reaching targets set through our commitment? How can we engage them in the process by which we set those targets in a way that fosters a sense of shared responsibility and accountability for success? How can we, together, set targets that are ambitious, attainable, and measurable, based on action plans already in place? What plans must we, together, put in place to accelerate progress toward our shared targets?
These are simple, logical, and indispensable considerations. They should define the process every national government uses to develop its commitments under ICPD+25 starting right now.
Donors can also do more to facilitate effective national commitments. They should advise national governments to integrate the critical principles of engagement, alignment and evidence-based into their commitment-making processes.
Donors should also do more to help national governments align their own commitments, by identifying specific opportunities to align commitments to different initiatives with each other. They should then offer meaningful guidance to help national governments design commitments that reinforce each other.
The time for action is now.
LEARN FROM PAST
Let’s take advantage of the opportunity presented by ICPD+25 to start a conversation about how the world’s nations can learn from the past and modernise the process by which they make sexual and reproductive health commitments.
And let’s challenge donors to strengthen their alignment and support systems so countries committed to progress are ready and able to develop real partnerships in the making of national commitments.
We don’t have to settle for impractical or ineffective commitments.
With 25 years of experience, we now know what works, where the pitfalls are, and how to circumvent them.
Let’s learn from that experience and build national commitments that accelerate improvements in the lives of women and girls and lay a strong foundation for development.
Elisha Dunn-Georgiou is the Interim CEO, PAI while Moses Muwonge is the Executive Director, Samasha Medical Foundation