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Strengthening UNFPA Business ModelAddressing Inequality of Access to Sexual and Reproductive Health
Executive Board 23 March 2017
Guiding principles
Trends and evidence
Focus areas
Section I—Overview
2
Guiding principles
Alignment with Agenda 2030 Leaving no one behind
Reaching furthest behind and hardest to reach, including in humanitarian and fragile contexts
Addressing poverty and inequality
Embracing universality
Alignment with QCPR 2016 A differentiated rather than one-size-fits all approach
Adjustment to local development contexts, priorities and specificities
Opportunities in the changing development financing landscape
Maximizing achievement of transformational results; focus on adolescents
girls, women and young people
Consistency, continuity and transparency Building on lessons learned and evaluative evidence
Furthering gains and adjusting as necessary
3
Geography of global extreme poverty is changing
Global poverty declines, 1990-2013 Distribution of world’s poor
World Bank (2016). Poverty and Shared Prosperity: Taking on inequality
4
Inequality is also declining
…but not within countries
World Bank (2016). Poverty and Shared Prosperity: Taking on inequality
Global inequality, 1988-2013
5
Multi-dimensional inequality remains major challenge
Maternal mortality is key indicator of health inequality (WHO)
…Maternal mortality shows
wide gaps between rich and
poor, both between and
within countries.
Developing countries
account for 99% of annual
maternal deaths globally.
World Health Organization (2011). 10 facts on health inequities and their causes
6
Need for tailored approach
“…the [MDGs] progress has been uneven, particularly
in Africa, least developed countries, landlocked
developing countries, and Small Island Developing
States
…Some of the MDGs remain off-track, in particular
those related to maternal, newborn and child health
and to reproductive health…..
We recommit ourselves to the full realization….by
providing focused and scaled-up assistance to least
developed countries and other countries in special
situations, in line with relevant support programmes”
Agenda 2030 states:
UN (2015). Transforming our world: The 2030 Agenda for Sustainable Development, para.16
7
QCPR 2016
• “Underscores that there is no “one size fits all” approach to development…” (Para 2)
• “Calls upon the United Nations funds, programmes and specialized agencies, at the request of national Governments,…but not restricted to, carrying out the following functions:
• Providing evidence-based and integrated policy advice
• Assisting countries through normative support
• Strengthening their support to national institutions/capacities
• Assisting Governments in leveraging partnerships;
• Supporting North-South, South-South and triangular, regional and international cooperation,….including through improved coordination among existing mechanisms..” (Para 21)
• “Calls upon the entities of the United Nations development system, in full compliance with their respective mandates, to enhance coordination with humanitarian assistance and peacebuilding efforts ” (Para 24)
8
Programme countries’ requests for UN support
Programme Countries,
including MICs, continue
to request UN support for:
1. Policy advice
2. Technical assistance
3. Capacity development
4. Convening national
development processes
& CSO engagement
5. South-South and
triangular cooperation
6. Resource mobilization
UN DESA programme countries’ survey (2016)
9
Bull’s eye remains relevant in new landscape
10
• Modes of Engagement
• Resource Allocation System
• Government, CSOs, think-tanks, private sector, and other partners
• Country, regional and HQ level programmes
• Country Classification
• MICs, SIDS/Multi-
country programmes,
fragile contexts
• Bull’s eye
What Where
HowWho
Focus elements
11
Option 1: Keep the current approach;
only update data and adjust accordingly
Option 2: Strengthen the measurement of “ability to finance” and “need” criteria
Section II—Country Classification
12
Current country classification criteria (2014-2017)
Need
Gross National Income
per capita (GNIpc):
–LIC
–LMIC
–UMIC
–HIC
Ability to finance +
13
Option 1: Keep current approach & update data
Methodology
Update all core indicators with most recent data
“Need” indicators: Maternal mortality ratio, Skilled birth attendance,
Adolescent birth rate, HIV prevalence, Percentage of demand for family
planning satisfied, Gender inequality index, Quintile income ratio &
Risk/Humanitarian index
Ability to finance: GNI per capita
Maintain existing mechanisms, such as:
Correlated data, where possible
Percentile and point scoring system
Use of weighted regional averages for missing data
Keep the existing need output thresholds
14
Option 1 cont. Factors of country classification change
“Need” indicators
—
Improving or worsening trends
9 country programmes
Income classification
—
Upward or
downward trends
4 country programmes
A combination of
factors
5 country programmes
18 UNFPA country programmes will switch quadrants, upwards and downwards
15
Proposed way forward
Consider “Equitable Access to
Health Initiative (EAI)” proposal to
adjust GNI per capita for health
access and income inequality, using
Disability Adjusted Life Years
(DALY)
Recognize 2030 Agenda and the
QCPR emphases on multi-
dimensional poverty and
inequality, LNOB, reaching the
furthest behind, etc.
Option 2: “Ability to finance” proposed criteria
Lessons learned and evidence
UN, World Bank, policymakers and
think tanks agree that GNI per capita
is insufficient to measure ability to
pay for health, because:
GNI does not reflect actual resources
available for health
Masks inequalities and variations
within and amongst countries
Potential to graduate countries
prematurely
Potential to undercut external funding
and technical support to countries in
great need
16
Launched in 2015 by nine organizations:
GAVI, Global Fund, UNAIDS, UNDP, UNFPA, UNICEF, UNITAID, WHO & WB
Considers alternatives to GNI as measure of health needs for:
Eligibility/country classification
Investment prioritization, given domestic financing policies for health
Co-financing policies and external financial support
Conveners commissioned 4 expert academic groups to produce options:
University of Oxford
University of Sheffield-Imperial College, London
Norwegian Institute of Public Health
Institute of Health Metrics and Evaluation, University of Washington
Initiative report synthesizes ideas from groups with suggestions and
recommendations, but no global action on the way forward.
Option 2 cont. Equitable Access to Health Initiative
17
University of Oxford, UK’s final report to Equitable Access to Health
Initiative agreed with GNI per capita problem statement, especially for
measuring access to health services, and proposed framework that takes
into account a country’s:
Income level and resource potentials
Access to healthcare services
Quality of health system
The major option for re-classifying countries is based on adjusted-GNI per
capita, measuring health access and health quality.
Option 2 cont. New health classification framework
18
Proposed way forward
Consider Youth Development Index
produced by Commonwealth,
measuring 5 dimensions:
Levels of education
Health and well-being
Employment and opportunity
Political participation
Civic participation
Consider availability of national data
for Skilled Birth Attended, Need for
FP Satisfied and GBV:
Aligned with SDG17.18.1
SDG indicators produced at
national level with full
disaggregation to reflect
population dynamics and data
Option 2 cont. “Need” proposed criteria
Lessons learned and evidence
Need clearer link with Bull’s eye and
following two outcomes:
Adolescent and Youth
Multi-dimensional nature of youth
outcome needs is not sufficiently
reflected
A&Y evaluation finds need to:
“...Continue to deliver multi-sectoral,
holistic support for adolescents and
youth, ensuring the centrality of the
needs of adolescent girls in
particular.”
Population data
No indicator reflects the outcome on
population dynamics and data
Census evaluation finds need to:
“…continue support to censuses and
increase its weight and profile within
the UNFPA”
19
Option 2 cont. “Need” Proposed way forward
20
Comparing country classification Options 1 and 2 (indicative)
Quadrant 2013Option 1
2016Data update
Option 2
DALY[CMPN]
Red 40 36 45
Orange 21 23 14
Yellow 16 16 18
Pink 44 46 44
Total 121 121 121
Number of quadrant shifts from
201318 24
*CMPN: Communicable, Maternal, Perinatal and Nutritional conditions
The DALY (CMPN*) option better aligns with key principles for strengthening Business model
45 LDCs excluding Vanuatu, Tuvalu and Kiribati are part of Pacific multi-country programmes
21
Operationalizes SDGs and QCPR emphasis on multi-dimensionality of poverty, inequality
and principles of Leave No one Behind, reaching furthest behind and hardest to reach first
Better reflects SP outcomes, country contexts, realities and priorities
Reinforces institutional emphasis on Sexual and Reproductive Health, as per bull’s eye
Adds morbidity dimension and holistic approach through DALY by:
Capturing disabilities arising from unwanted pregnancies and unsafe abortion, early
marriage, poor health choices, unequal access to FP services, etc.
Accounting for inequality of access to health services and effectiveness of health system
Option 2 cont. Key benefits
22
Section III: Modes of Engagement
Option 1:
No change
Option 2:
Revised
23
Need to further clarify MoE definitions
Need to clarify application of MoE by
contexts including humanitarian settings,
organizational levels and funding
channels, e.g.:
Applying MoE to non-core resources
in ‘Pink’ contexts
Resource mobilization challenges
with perceived restrictive MoE
Option 1: Modes of engagement (MoE), 2014-2017
Need to clarify links among different
modes of engagement and with other
implementation strategies, e.g. results-
based management, risk-informed
programming, etc.
Based on evaluation recommendations,
need to clarify uncaptured engagement
including humanitarian coordination,
and partnerships such as SSTC
Lessons learned and evidence
24
Adolescent & Youth evaluation
recommendations (2008-2015)
5. Facilitation of
partnerships and
coordination,
including multi-
sectoral, South-South
and triangular
collaboration
6. Mainstreaming of
A&Y issues
within other
programmatic
areas
25
Proposed way forward
Elaborate further on MoE definitions,
inter-linkages and applications
Re-introduce 5th MoE in SP—
Coordination* and partnerships, incl.
South-South and Triangular Coordination
*includes coordination in development and
humanitarian context for GBV sub-cluster
Emphasize catalytic and interactive nature
of modes of engagement to achieve results,
especially in upstream contexts
Respond to emergencies, crises and
protracted situations with any combination
or the full modes of engagement, as
deemed fit
Clarify MoE application for core and non-
core resources
Option 2: Interactive Model of Modes of Engagement
Coordination,
Partnerships
& SSTC
26
Engagement with Middle Income Countries (MICs)
Current business model is
responsive, recognizes diversity
amongst MICs and reflects their
different needs
Need to address multi-dimensional
poverty and inequality
Need to respond to call for
universality
Need to adjust nature of support to
MICs to remain relevant
Need to address resource
mobilization and human capacity
constraints
Need to provide high-level policy
innovation and solutions and
strengthen institutional capacity
# MICs by UNFPA quadrants (2014-2017)
MICs Red Orange Yellow Pink
Lower – Middle 8 16 12 9
Upper-Middle 1 4 33
Total 8 17 16 42
Lessons learned and evidence
27
MICs require tailored support to achieve ICPD & SDGs
0
100
200
300
400
500
600
700
800
900
Maternal Mortality Rate in 42 MICs
In 42 MICs, MMR > 70,
with highest at 814
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Birth attended - poorest quintile
In 39 MICs, birth attended
for poorest quantile <75%
with lowest at 5.6%
0
10
20
30
40
50
60
Percentage of need for family
planning satisfied
In 39 MICs, less than 50% of need
for family planning satisfied, with
lowest at 12.3%
Support needed to
achieve universal access
to sexual and
reproductive health and
reproductive rights.
28
MICs request continued support
33 of 52 countries
requesting health
support are MICs
Source: UN DESA programme country survey (2016)
21 of 25 countries
requesting gender
equality support
are MICs
29
MICs engagement: Proposed way forward
Maintain global presence and diversify support
Better reflect country realities and priorities in classification decisions;
Deploy upstream innovative and integrated policy support, powered by knowledge
sharing, institutional capacity and resilience;
Strengthen focus on partnerships, improve access to regional and global technical
resources, and leverage domestic knowledge and expertise;
Create opportunities and capacities for resource mobilization, including domestic,
bi-lateral and multilateral resources;
Advance UNFPA efforts to facilitate South-South and triangular cooperation;
Strengthen country programming through regional and HQ support
30
Proposed way forward
• Harmonize approach to multi-
country programme with UNDP and
UNICEF
• Classify individual countries so that
business model can be tailored to
their specific needs
• Consider higher floor to respond to
diversity in resource allocation
• Provide support and strengthen
capacity for mobilization of
additional resources, including
domestic resources
Multi-country programmes (MCPs)
Lessons learned and evidence
• Need to address diversity of needs,
population size and development
stages within a multi-country
programme, e.g. Caribbean and
Pacific island multi-countries
• Need to respond to high
vulnerability due to risk associated
with climate change and other
development challenges
• Need to recognize that sub-regional
economic growth masks individual
country realities, particularly
inequality of access to SRH services
31
Modes of Engagement—Option 2:
Re-introduce 5th mode of engagement: Coordination & partnerships,
incl. SSTC
Deploy all modes of engagement to achieve results
Middle Income Countries (MICs)
Maintain global presence and provide tailored support
Multi-country programme (MCP)
Consider higher floor and classify individual countries
Summary of recommendations for MoE, MICs and MCP
32
SECTION IV: Resource Allocation
Option 1
No change
Option 2
Strengthen current approach
33
Lessons learned and evidence
Floor system based on GNI per
capita does not fully reflect
country needs
Allocation of resources is not
linked to performance
Need better linkage with non-
core resources
Option1: Maintain current resource allocation system
Country Classification
• $500,000/year: LIC,LMIC
• $300,000/year: UMIC/HIC
Floor system
• 10-24 Female population
• GNI per capita PPP
Additional factors
• One-to-one match
• Max $100,000/yea
Matching Funds in UMIC/HIC
34
Option 2: Strengthen resource allocation system
Proposed way forward
Consider floor system by quadrant
Consider regular resource allocation
system reviews
MTR – 2019
Annual internal review
Potential to link to performance
Linkages with non-core resources
Adopt same principles and base
criteria for resource allocation
Common systematic planning and
review approach
Country Classification
• $500,000/year: inequality adjusted LIC,LMIC, or Red and Orange
•
• $300,000/year: inequality adjusted UMIC/HIC, or Yellow or Pink
Floor system
• 10-24 Female population
• GNI pc PPP
Additional factors
• One-to-one match
• Max $100,000/year
Matching Funds in UMIC/HIC
35
Resource allocation system (RAS) – Option 2
Consider floor system by quadrant
Consider annual internal review and link with non-core resources and
potentially to performance
Key benefits
Strengthened links between resource allocation and country
classification
Regular reviews provide opportunity to adjust, if needed, to changing
circumstances
More systematic planning and review process for both core and non-
core resources
Recommended option for RAS and key benefits
36
Country classification – Option 2
DALY-adjusted GNIpc and “Need” criteria with youth and data components
Modes of Engagement—Option 2
Re-introduce a 5th Mode of engagement: Coordination and partnerships, incl. SSC
Opportunity to deploy KM, CD & CPS in support of A/P as package for upstream work
MICs and Multi-country programmes
MICs: Global presence maintained, and tailored support provided
MCP: Consider a higher floor, and classify individual countries
Resource Allocation – Option 2
Consider floor system by quadrant
Consider annual internal review and links with non-core resource and performance
Summary of recommendations
37
Thank you
38