Post-Cairo Reproductive Health Policies and Programs: a Study of Five Francophone African Countries
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Post-Cairo Reproductive Health Policies and Programs: A Study of Five Francophone African Countries Justine Tantchou Ellen Wilson August 2000 POLICY is a five-year project funded by the u.s. Agency for Intemational Development, under Contract No. CCP-C-O~95-00023--04, beginning September 1, 1995. The project is implemented by The Futures Group Intemational in collaboration with Research Triangle Institute (RTO and The Centre for Development and Population Activities (CEDPA). '--14lh ~-~: H ••••••• , .11111' The POLICY Project Justine Tantchou Ellen Wilson August 2000 Photo Credits All photos are printed with pennission from the JHU/Cenrer for Commwzication Programs. Contents iv Preface v Acknowledgments vi Executive Summary vii Abbreviations 1 Introduction 3 Reproductive Health Context in the Five Countries 5 The Policy Process: Definitions of Reproductive Health, Policies, and Priorities 15 Participation, Support, and Opposition 21 Policy Implementation 28 Financial Resources for Reproductive Health 33 Summary and Conclusion 37 Appendix 44 References Preface The mission of the Network for Reproductive Health Research in Africa (RESAR) is to improve reproductive health through research and training. The organization receives grants for operations under project performance contracts with governmental and nongovernmental organizations as well as with bilateral and multilateral donors involved in reproductive health. RESAR is currently made up of 10 national units in Francophone Africa called CRESARs. The goal of the POLICY Project is to create supportive policy environments for family planning and reproductive health programs, including HIV/AIDS, through the promotion of a participatory policy process and population policies that respond to client needs. The project has four components-policy dialogue and formulation, participation, planning and finance, and research- and is concerned with crosscutting issues such as reproductive health, HIV/AIDS, gender, and intersectoral linkages. POLICY Occasional Papers are intended to promote policy dialogue on family planning and reproductive health issues and to present timely analysis of issues that will inform policy decision making. The papers are disseminated to a variety of policy audiences worldwide, including public and private sector decision makers, technical advisors, researchers, and representatives of donor organizations. An up-to-date listing of POLICY publications is available on the project's website. Copies of POLICY publications are available at no charge. For more information about the project and its publications, please contact: Director, POLICY Project The Futures Group International 1050 17th Street, NW, Suite 1000 Washington, DC 20036 Telephone: (202) 775- 9680 Fax: (202) 775- 9694 E-mail: [email protected] Internet: www.policyproject.com www.tfgLcom Acknowledgments This paper reflects findings from five case studies conducted by RESAR with financial and technical support from the POLICY Project. RESAR's Justine Tantchou coordinated the research, which was carried out by country teams. Country case studies were conducted and written by RESAR members and reviewed by Tantchou and POLICY's Ellen Wilson. Titles and authors of the case studies are given below: • Formulation de politiques post-Caire: Le cas de la Republique du Benin by Beatrice Aguessy and Elisabeth Fourn. • Formulation de politiques et mise en ceuvre des programmes post-Caire: Etudes de cas sur la sante de la reproduction au Burkina Faso by Stanislas Paul Nebie and Idrissa Ouedraogo. • Formulation de politiques et mise en ceuvre des programmes post-Caire: Etudes de cas sur la sante de la reproduction au Cameroun by Paschal Awah and Justine Tantchou. • Formulation de politiques et des programmes post-Caire: Le cas de la Cote d'lvoire by Zoumana Kamagate and Aminata Noelle Sangare. • Formulation de politiques et mise en ceuvre des programmes post-Caire: Etudes de cas sur la sante de la reproduction au Mali by Hafsatou Diallo, Tamo Tamboura, and Mahamadou Traore. The full text of the individual country reports, in French, can be obtained by contacting RESAR at the following address: Dr. Justine Tantchou Vice President in Charge of Training and Research RESAR PO Box 8176 Yaounde, Cameroon E-mail: [email protected] We heartily thank everyone who contributed to this evaluation of reproductive health policy development and program implementation in Francophone Africa. We give special thanks to the respondents in the five countries who found the time for multiple interviews in spite of their busy schedules and who so graciously provided the interviewers with numerous documents. We also give thanks to the POLICY Project for its moral, financial, and technical support. In particular, we wish to thank Jen Marenberg for her tireless assistance with the editing of this paper and Karen Hardee and Kokila Agarwal for reviewing earlier versions. Finally, we would like to thank Elizabeth Schoenecker and Barbara Crane for their helpful comments. The opinions expressed in this report, however, do not necessarily reflect those of USAID. Executive Summary, The 1994 Cairo International Conference on Population and Development (ICPD) increased worldwide focus on reproductive health. Many countries have been working to revise their reproductive health policies in accordance with the ICPD Programme of Action. In 1998, the Network for Reproductive Health Research in Africa (RESAR), with support from the POLICY Project, conducted case studies in five Francophone African countries-Benin, Burkina Faso, Cameroon, Cote d'lvoire, and Mali-to examine field experiences in formulating and implementing reproductive health policies. Findings were based on in-depth interviews with key informants active in the reproductive health field in their respective countries. Because the five countries are located in the same region, they exhibit many similarities, yet each differs slightly in the challenges it faces and the approaches it takes to confront them. In general, the five countries have made considerable progress in integrating the concept of reproductive health into policies and programs, although more needs to be done to disseminate new policies and implement effective programs. While some aspects of reproductive health generate opposition, particularly programs for youth and programs against female genital cutting, overall support for reproductive health has increased in recent years. Governments are allowing nongovernmental organizations (NGOs) to participate in policy formulation, and most countries are devoting more internal resources to reproductive health. Though these changes are encouraging, continued resistance on the part of the public sector to full partnership with NGOs, as well as the varying capabilities of many NGOs, has hindered NGO participation. Moreover, countries are still highly dependent on support from international donors for their funding. Less progress has been made in program implementation than in policy formulation. Some concrete changes are apparent, but the task of converting the concept of reproductive health into a reality in the field is sure to be a long, slow process. Poverty and underdevelopment in the region are major constraints to reproductive health programs; consequently, countries must focus their efforts on priority interventions and use their existing resources more efficiently. The case studies also highlight the need to continue efforts to create broad-based support for reproductive health programs, improve coordination among stakeholders, strengthen NGOs so that they can effectively participate in the policy process, and enhance the financial sustainability of programs. Abbreviations ABBEF Association for Family Well-Being of Burkina Faso ABPF Beninese Family Planning Association AIBEF Association for Family Well ness of Cote d'ivoire AIDS Acquired immune deficiency syndrome AMPPF Malian Association for the Promotion and Protection of the Family BUNAP National Population Bureau (Cote d' ivoire) CNLS National Committee for AIDS Control CONACOPP National Committee for the Coordination of Population Programs (Mali) CONAPO National Population Council (Burkina Faso, Cote d'ivoire) DHS Demographic and Health Survey DSF Directorate of Family Health (Benin) GNP Gross national product GTZ German Technical Cooperation Agency HIV Human immunodeficiency virus ICPD International Conference on Population and Development IEC Information, education, and communication IMSC Integrated Management of Childhood Disease IPPF International Planned Parenthood Federation KFW Kreditanstalt fur Wiederaufbrau MCH Maternal and child health NACP National AIDS Control Program NGO Nongovernmental organization PSSP Health and Population Policy (Mali) RESAR Network for Reproductive Health Research in Africa ROBS Network of Beninese Health NGOs SFPS Family Health and AIDS Prevention Project STD Sexually transmitted disease UNAIDS Joint United Nations Programme on HIV/AIDS UNDP United Nations Development Program UNESCO United Nations Educational, Scientific, and Cultural Organization UNFPA United Nations Population Fund UNICEF United Nations Children's Fund USAID United States Agency for International Development WHO World Health Organization Post-Cairo Reproductive Health Policies and Programs: A Study of Five Francophone African Countries Introduction situation regarding reproductive health. In addition, given that all respondents are Since the ICPO in 1994, reproductive prominent in the reproductive health field,