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THEMATIC PRESENTATION & DISCUSSION OF THE REPORT ON AFRICAN EXPERIENCES IN THE IMPLEMENTATION OF DND & ICPD-PA

Introducing this agenda item, the Secretariat highlighted the goals of the DND and the ICPD-PA in the areas of reproductive health (RH) and reproductive rights (RRs); family, youth and adolescents; gender equity, equality, empowerment of women and male involvement; role of NGOs and the private sector in program implementation; population policy and development strategies; institutional mechanisms for implementation, monitoring and evaluation and coordination of population policies and programs; sub-regional institutions; advocacy and IEC strategies.

The meeting then established Working Groups to discuss these thematic areas. Based on a synthesis of the discussions, the following achievements, best practices and constraints in the implementation of each of these thematic areas were identified. The recommendations for the way forward aimed at further implementation of the DND and the ICPD-PA in each of these thematic areas are presented in the second part of this section.

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Proceedings - Reproductive health & rights

Achievements and best practices

Due to the sensitization of policy makers since Cairo, the RH concept is better understood and the provision of integrated RH services has started in some member States. Measures have been taken in 80 per cent of the 39 member States that responded to the Country Questionnaire to ensure that men and women are aware of their RRs (Table 4). Some member States have adopted specific policy measures to eliminate female genital mutilation (FGM) and about 85 per cent of them have laws setting the minimum age at marriage ranging from 18 to 21 years. Laws prohibiting the advertisement of contraception in French-speaking African member States have been repealed.

Specific components of RH are being implemented by member States with consequent improved access to services. For instance, there is improved access to family planning methods through community based distribution (CBD) of contraceptive supplies, private sector, pharmacies, social marketing, etc. The use of a common basket approach to contraceptive supplies (for increasing availability and acceptability of contraceptives) has been proposed in Côte d'Ivoire, Ghana and Tanzania.

RH information and service needs of special groups, such as adolescents and refugees have been recognized and action is being taken in many member States. Awareness of the magnitude of domestic and gender sexual violence is increasing. Women professionals and NGOs are giving attention to this problem.

Efforts to control the spread of HIV/AIDS is widespread despite the current small impact in most member States. An AIDS Commission within the President's Office as well as an emergency obstetric care and FGM have been established in Uganda; this is an example of steps being taken by governments.

The system of supplying drugs has improved.

Recent fertility decline has been recorded in some member States (Cape Verde, Kenya, Nigeria, Rwanda, Senegal, Tanzania, Zambia and Zimbabwe).

Cost-sharing schemes such as the proposal for endowment fund in Ghana have been put in place and Government financial support to NGOs has been initiated in some member States.

Constraints

Available family planning services tend to target largely females at the expense of males. There are also storage problems and limited surgical methods.

The concentration of RH services and infrastructure in urban areas has resulted in the marginalization of the rural needs of the population.

There are political and technical difficulties with the prioritization of how to deal with HIV/AIDS; maternal mortality; and cancers of the reproductive system.

There are financial and human resource limitations as well as cultural obstacles which inhibit the provision of RH services particularly given the range of new skills and attitudes required for decentralized planning and the increased need to train new staff as well as the provision of equipment and supplies.

Quality control of imported drugs through the formal and informal channels has been difficult.

Emergency obstetric care is only provided in few areas and on a pilot project basis.

There are problems with laws and regulations that govern health workers including nurses, midwives and medical assistance.

Existing abortion laws are restrictive and service delivery points (SDPs) such as Health Centers are ill prepared to manage abortion complications.

There is continued compartmentalization of RH components particularly the training of different service providers on different RH components and some providers on all components at different times.

Safe motherhood services are limited to antenatal, normal delivery and postpartum care. Midwives are not allowed to prescribe drugs; give injections; perform vacuum extraction/forceps delivery; and suture of lacerations.

There is non-functional referral system mainly due to financial constraint.

The needs of disabled persons are either largely neglected or are not met.

In spite of the key role of men in RH decision making, most programs still do not make sufficient efforts to sensitize men to the importance of RH and to gain their full support.

Social unrest and civil strife on the African continent is a major constraint to planning, organising and implementing programme activities to meet reproductive health needs in many countries on the continent.

With at least 30 per cent of the world's refugees and more than 50 per cent of the internally displaced people being found in ECA member States, there is a tremendous burden of unmet reproductive health needs in these special population where women and children make up 50 to 75 per cent of the population.

Visit the Reproductive health & rights thematic area or read the introduction to the thematic areas identified in the assessment of African experiences.

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Proceedings - Family, youth & adolescents

Achievements and best practices

While population programme activities in most of the member States had not paid specific attention to the family, the measures taken for the improvement of the quality of life in the context of population programme activities may have positively impacted on the family.

Equally, while 84 percent of the member States have taken action to promote equal opportunities and legal protection for the girl child, about 79 per cent have reported enacting laws and formulating policies/strategies favorable to adolescent RH including legislation on minimum age at marriage, prevention of FGM; etc.

A rich mixture of diverse approaches to reach youth and adolescents and to win their trust has developed including the enhancement of girls' opportunities with respect to access to education; the provision of information, especially on their menstruation process and sexual/RH issues as well as on health and other basic social services.

About 85 per cent of the member States have put in place measures to increase age of consent to sexual intercourse to 16 years and minimum age at marriage to 18 years and some to 21 years.

Virtually all member States have formulated IEC strategies relating to children, youth and adolescents in their sectoral programs.

Constraints

The majority of families are increasingly threatened with absolute poverty and thus are being rendered less able to cope with meeting basic social needs; this minimises the possibilities for planning their lives including planning the size of their families.

The social unrest in most parts of the ECA region containing about 30 per cent of the world's refugees and over 50 per cent of the internally displaced people promotes instability in the family including eroding the social safety net from the social network of extended families thus rendering most families vulnerable.

Difficulties in communication between spouses themselves and between parents and children are creating an environment that makes it difficult to negotiate and promote the type of relationships in which matters of equal opportunities and the rights of women and children can be addressed.

Threatened by social unrest and adhering to the concepts of family stability even if some family members are deprived and oppressed, makes it difficult to recognise what is required to promote life-enhancing family stability in which the quality of life of all members is improved.

Changes in residential arrangements have resulted in older family members living away from their children; consequently a systematic approach on how to provide for the elderly has not emerged.

Many older people without any earnings or the physical stamina to earn livelihood with their work/labour are being left with AIDS orphans as head of households without any provision of how to access means of support.

Even where legislation has been enacted and policy and programs have been formulated, (e.g. on minimum age at marriage or on consent to sexual intercourse), evidence of widespread implementation within member States is either minimal or is yet to be operationalized.

Conducting research on the needs of adolescents and the extent to which these needs are being met is difficult due to taboos and entrenched traditional practices some of which are harmful.

There are financial and social barriers to implementing programs even where these have been formulated and good will and intention exist.

Some member States have openly objected to and obstructed efforts at the introduction of Family Life Education in schools.

There is little involvement of youth and adolescents in formulating policies or programs that concern them; this results in "misplanning" for them which is sometimes worse than no planning at all.

Single families, especially female-headed households "fall between the cracks" in several current societal arrangements. With the increasing number of children in these families, more and more children have become victims.

Preference for sons in most traditional settings create an environment in which girls have few opportunities. This compounds female low self-esteem and promotes traditions preferring males "because they make it". There has been little or no socio-cultural research in the dynamics of the resulting vicious cycle and on how to break this vicious cycle.

Visit the Family, youth & adolescents thematic area or read the introduction to the thematic areas identified in the assessment of African experiences.

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Proceedings - Gender empowerment

Achievements and best practices

The CEDAW convention has been ratified and is being implemented by most member States.

Mechanisms for increasing opportunities for females' employment in the formal labor sector as well as for improving female's access to resources (e.g. loans, credit) have been established in many member States.

Laws to abolish gender discrimination; inequalities and harmful practices have either been enacted or are being revised in most member States.

Institutional mechanisms to address gender issues (e.g. Women Commissions, Councils, Association, Cooperatives, Family Centers) have been established in most member States.

Considerable improvement has been recorded in most member States regarding women sharing in wielding decision-making power and participation in Parliaments, Local Government Councils, and Statutory Commissions.

In the area of training, member States have embarked upon (i) establishment of centers for females such as the International Training Center on Gender in Tunisia; and (ii) skills improvement for females.

The role and leadership of First Ladies in gender affairs have become very prominent in many member States.

A few member States have initiated or are modifying policies, which recognize economic contribution of women's work (Tunisia).

A few member States have established Banks that specifically target females to enhance their income earning power and self-sufficiency.

Programs for improvement in girls' education have now been put in place in some member States such as Egypt, Uganda and Senegal.

The collection, analysis, dissemination and utilization of gender sensitive data has been initiated and implemented in several member States (e.g.Tanzania, Algeria and Tunisia).

Organized women coalitions/caucuses have been formed [e.g. Cameroon, Senegal, South Africa, Uganda]

Quotas for women in Parliament have been introduced. [e.g. Eritrea, Mali, Tanzania, Uganda].

Genderized development centers have been put in place [e.g. Burundi].

Policies and action plans on gender and empowerment of women have been developed. [e.g. Central African Republic, Ethiopia, Eritrea, Mauritania, Tanzania, Uganda, and Zimbabwe].

Gender Focal Points (GFPs) have been established in line ministries [e.g. Ethiopia, Rwanda and Zimbabwe].

Credit for income generating activities and technical advice to female entrepreneurs have been provided [e.g. Ghana, Kenya, Nigeria, Namibia, Mauritius]

Female's participation in the labor force has been promoted [e.g. South Africa, Eritrea, Zambia, Uganda, Zimbabwe, Botswana, Ghana, and Namibia].

Constraints

Contrary to expectation, some institutions that have been established to improve social and economic situation for women in the member States, have instead perpetuated traditional stereotype to justify existing division of labor.

Current programs on gender concerns have been developed on ad hoc basis, and hence there is lack of long-term plan to mainstream gender into all development sectors.

Entrenched socio-cultural barriers make it difficult to change attitudes and behavior toward gender issues.

Lack of equal opportunities in female education of some member States has promoted high female illiteracy.

Lack of specialized trainers in gender issues inhibits understanding of the concept of gender.

There is absence of effective national IEC/Advocacy strategy to focus on women's rights.

There is lack of clear guidelines on programming and mainstreaming gender into national population policies and programs.

There is inadequate staff in Departments and Ministries dealing with women's concerns as well as lack of gender analysis skills.

Visit the Gender empowerment thematic area or read the introduction to the thematic areas identified in the assessment of African experiences.

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Proceedings - NGO & private sector roles

Achievements and best practices

NGOs have tackled many difficult and sensitive problems including those relating to the sexual activity of adolescents and the complications of abortion. In many instances, they have introduced innovative cost-effective approaches and have been able to initiate programs and implement them rapidly.

The potential contribution of the private sector to the formulation and implementation of population policies and programs is now better understood and more widely recognized. Varied modalities for the participation of the private sector in population activities have emerged, including social marketing programs and greater reliance on private practitioners.

A wide range of links between Government and the private sector is developing in many member States as well as increased awareness of diverse potential roles of the private sector in the field of population. For instance, there is increased recognition of the need to involve various components of civil society in discussions and decision-making relating to population. Equally, the advantages of involving civil society are more widely acknowledged.

Interaction between formal government structures (at national, regional, local levels) and in specific sectors (e.g. health, rights, research) and elements of civil society has increased. Governments are increasingly willing to take action relating to concerns expressed by elements of civil society.

Constraints

Some NGOs lack the necessary technical and managerial capacity, solid commitment to national objectives and a time horizon consistent with the development of national capacity and sustainability.

There is lack of a national strategy or plan, which sets out clear and complementary roles for Government and for NGOs because comparative advantages of either party are not identified and recognized.

There is limited expansion of the roles and activities of the private sector due to uncertain, complex and opaque legal, fiscal and regulatory frameworks.

There are doubts about the quality and efficacy of services provided by private practitioners and private enterprises persist in a number of member states.

Because of the diversity and complexity of civil society, it is difficult to establish satisfactory mechanisms for full participation of civil society in the formulation and implementation of population policies and programs. The contribution of the private sector to the formulation and implementation of population activities is limited by a relative lack of relevant technical know-how and practical experience.

Groups mainly concerned with population issues and programs have not formed effective coalitions in such related areas as poverty alleviation, environmental protection and the status of women.

Visit the NGO & private sector roles thematic area or read the introduction to the thematic areas identified in the assessment of African experiences.

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Proceedings - Policy & development strategies

Achievements and best practices

Major changes are taking place in the ways in which population policies are being formulated and implemented. A number of member States have either reformulated their policies or are in the process of preparing such policies based on the ICPD-PA.

Recent policies also recognize the need to increase 'male involvement' both in order to overcome resistance to family planning and to get men more actively involved in planning and implementing population activities.

There has been a high involvement of concerned individuals and groups both in the formulation and implementation of population policies (e.g. Uganda, Kenya, and Tanzania).

There has also been increased emphasis on the relationship between population, social and health dimensions of well-being and, implementation of population activities, especially those relating to RH information, services and rights.

Progress has also been made in terms of the numbers of relevant staff trained and training has been extended from Central Statistics Offices and Population Planning Units to Sectoral Ministry Planning Units.

Many member States have either established or designated NPCs and/or inter-departmental and/or inter-ministerial bodies to oversee and monitor implementation of the ICPD-PA.

In view of the new ICPD orientations, Regional Research and Training Institutes (RTIs) have reviewed their training and research curricula to respond adequately to emerging needs of the member States that they serve. Additionally, RTIS have organized demand-driven and cost-effective in-country training programs in population and development for officials, NGOs and civil society organizations. They have also undertaken consultancy, advisory and research services for member States. Staff training and skill upgrading in new thematic paradigms have also been carried out.

Constraints

Policies have been developed without sufficient consultations from all stakeholders including the grassroots population.

Although many member States have adopted population policies, many of these policies lack clearly defined strategies and are therefore difficult to implement effectively.

The integration of population variables in development planning remains inadequate due largely to lack of expertise. There is inadequate population data as well as other socioeconomic indicators needed for the formulation, review and implementation as well as monitoring and evaluation of NPPs. For instance, lack of good knowledge of socio-economic and demographic characteristics, inter-relationships between factors, makes the use of population projections in planning unrealistic.

A number of member States are yet to fully appreciate the emerging reformed planning environment with emphasis on decentralized structures in such integration. Other inhibiting factors include political instability (which affect all aspects of development); persistence of socio-economic crisis; implementation of adjustment programs; abandoning of the medium and long term planning in the face of structural adjustment programs, and difficulty in mobilizing external and internal resources.

With respect to mechanisms for coordinating the implementation of population policies and programs, the efficacy of existing structures is limited by shortages of human resources and inadequate funding from member States. Although a number of countries have established National Population Offices or similar institutions, there is still a lack of strong institution which coordinates all population activities and act as a lead sector in a number of member States. Population Planning Units (PPUs) lack administrative authority partly because are located at low hierarchy in line ministries.

Other factors militating against proper functioning of the institutional mechanisms include weak technical capacity in human and material resources; poor financial support to the institutions that have been created; lack of evaluation skills; under-utilization of national institutions capacities; poor recognition and maneuvering power of the institution in the national administrative structures; and poor identification of major constraints to efficient functioning of the mechanisms. Results in the implication of the heavy dependence on external funding in implementing population and development activities, often interrupting activities once external funds are stopped.

There are still academic rigidities in the syllabus content of host RTIs. For example, syllabuses have to pass through several academic committees. There are also staffing constraints and specialization rigidities.

The uncertainties about future UNFPA support to RTIs alongside lack of non-host government funding commitment have resulted in irregular and unsustainable support of RTIs.

Visit the Policy & development strategies thematic area or read the introduction to the thematic areas identified in the assessment of African experiences.

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Proceedings - Advocacy & IEC Strategies

Achievements and best practices

Most member States have recognized the need to formulate and implement advocacy strategies within sectoral programs partly through the creation of multi-sectoral coalitions, networks alliances and consortia as well as the institutional structure for the design, implementation and co-ordination of advocacy and IEC programs (Tanzania, Uganda and Zambia). While some of them have developed IEC and advocacy strategies, as one package, others have developed strategies for both. Those, which have not developed any strategy, are in the process of implementing advocacy activities through coalitions, alliances and consortia. For example, advocacy and IEC strategies have been used to change laws and policies. In Ghana traditional advocacy and IEC strategies has been used effectively to eliminate practice of sacrificing girls as slaves to religious shrines as a way of atoning for the sins of their ancestors.

In some member States, advocacy and IEC strategies have been widely used especially by national NGOs to (i) mobilize political commitment and subsequent allocation of resources to address population and development issues; (ii) seek support for the promotion of practices that guarantee protection of women and men from abuse, for programs that prevent and treat STDs, including HIV/AIDS as well as for programs for eliminating traditional harmful practices; and, (iii) create awareness about the type of activities that should be undertaken on issues of adolescents and youth, environment preservation, poverty alleviation, gender equality and equity and population and development.

IEC strategies have been extensively used to (i) generate demand for RH services; (ii) Enlighten men and women about their RRs and responsible parenthood; (iii) promote safe sexual behaviors; and (iv) mobilize men to participate in RH programs.

There is evidence of some collaboration between government ministries (Education, Health, Information and Communication, Youth and Culture) and religious leaders in the development and dissemination of information on population and development issues.

There is also emergence of NGOs, grassroots and professional associations, pressure groups as well as several independent media channels due to the liberalization of the socio-political environment and development of political pluralism.

The use of contraception in some member States has almost doubled due to adequate briefing of District Development Committees in Kenya for example and of Regional Houses of Chiefs in Ghana and Kingdoms in Uganda. Other contributing factors include the use of such advocacy packages as video and fact sheets and of such propaganda slogans as "We Care Family Planning campaign" in Ghana.

NGOs working in coalitions have convinced governments to formulate laws against FGM (Burkina Faso, Ghana), pro-abortion (Republic of South Africa), sexual violence and women's inheritance (Tanzania, Uganda) girls' education with the support of Preferential Trade Agreements (PTAs) as in Côte d'Ivoire and Guinea; and young girls shrine slaves (Ghana).

User-friendly population profiles and projections (Senegal and Ghana) in relation to resources and overall development in order to create awareness among decision-makers and opinion leaders at national and regional levels have been developed.

The use of advocacy and IEC strategies has influenced the introduction of interpersonal communication and counseling in the service providers training curriculum and at the service delivery facilities as a way of improving the quality of care in member States. For instance, it has influenced the reduction of FGM in Kapchorwa district of Uganda.

Constraints

Unwillingness of major players to participate in the design of national IEC/Advocacy strategies.

Inability to define the institutional and co-ordinating mechanisms.

Non-involvement of target audience in the formulation, monitoring and evaluation of the impact of IEC/Advocacy programs.

Prohibitive cost of media production and hence donor dependency and unsustainability of programs.

Inadequate involvement of private organizations in message and material development.

Inadequate dissemination of materials to stakeholders due to lack of trained personnel, lingua franca, functional data banks and other resources.

Absence of socio-cultural research-based information and operations research geared to specific audiences and attitudinal and behavioral interventions.

Visit the Advocacy & IEC Strategies thematic area or read the introduction to the thematic areas identified in the assessment of African experiences.

Visit one of the six thematic areas identified in the assessment of the African experience.

Reproductive health & rights

Family, youth & adolescents

Gender empowerment

NGO & private sector roles

Policy & development strategies

Advocacy & IEC Strategies

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