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 inenabling, 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 experiencerecessionary 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 vulnerablegroups of the population, particularly in the rural areas, and toensure 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, insupport 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:

1. 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-buildingthrough 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;
2. 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;
3. 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;
4. 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 andcountries 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 costsof 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:

1. 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;
2. 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 healthimpact 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;
3. 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 $1.5billion in 2010 and $1.5 billion in 2015;
4. 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 needsfor 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 programmesaddressing 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 strengthenthe 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. Theeducation 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 programmesdirected to improving the status and empowerment of women and their full participation in the development process (beyond ensuringt heir basic education). The full involvement of women in the design, implementation, management and monitoring of alldevelopment programmes will be an important component of such activities.

13.19. Additional resources will be needed for action programmesto 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 povertyeradication 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 ofAction 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 thecontext of sustainable development; and overall improvements in the quality of life.

Objective

13.21. The objective is to achieve an adequate level of resourcemobilization 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 forall, 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-planningservices, particular emphasis must be put on meeting the needs ofunderserved population groups, including adolescents, taking into account the rights and responsibilities of parents and the needs ofadolescents and the rural and the urban poor, and on ensuring the safety of services and their responsiveness to women, men andadolescents. 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 privatesector 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), themultisectoral 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 socialsectors, as well as an increased proportion of official developmentassistance, 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.