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variety of reasons (some ideological, some simply humanitarian) object to family planning.
Family planning in the health context shows a concern for the well-being of the family as a
whole and not just for a couple's reproductive function.
Finally, providing integrated family planning and health services on a broad basis
would help the U.S. contend with the ideological charge that the U.S. is more interested in
curbing the numbers of LDC people than it is in their future and well-being. While it can be
argued, and argued effectively, that limitation of numbers may well be one of the most
critical factors in enhancing development potential and improving the chances for
well-being, we should recognize that those who argue along ideological lines have made a
great deal of the fact that the U.S. contribution to development programs and health
programs has steadily shrunk, whereas funding for population programs has steadily
increased. While many explanations may be brought forward to explain these trends, the fact
is that they have been an ideological liability to the U.S. in its crucial developing
relationships with the LDCs. A.I.D. currently spends about $35 million annually in bilateral
programs on the provision of family planning services through integrated delivery systems.
Any action to expand such systems must aim at the deployment of truly low- cost services.
Health-related services which involve costly physical structures, high skill requirements, and
expensive supply methods will not produce the desired deployment in any reasonable time.
The basic test of low- cost methods will be whether the LDC governments concerned can
assume responsibility for the financial, administrative, manpower and other elements of
these service extensions. Utilizing existing indigenous structures and personnel (including
traditional medical practitioners who in some countries have shown a strong interest in
family planning) and service methods that involve simply-trained personnel, can help keep
costs within LDC resource capabilities.
2. Commercial Channels. In an increasing number of LDCs, contraceptives (such as condoms,
foam and the Pill) are being made available without prescription requirements through
commercial channels such as drugstores.* The commercial approach offers a practical,
low-cost means of providing family planning services, since it utilizes an existing
distribution system and does not involve financing the further expansion of public clinical
delivery facilities. Both A.I.D. and private organizations like the IPPF are currently testing
commercial distribution schemes in various LDCs to obtain further information on the
feasibility, costs, and degree of family planning acceptance achieved through this approach.
A.I.D. is currently spending about $2 million annually in this area.
In order to stimulate LDC provision of adequate family planning services, whether alone
or in conjunction with health services, A.I.D. has subsidized contraceptive purchases for a
number of years. In FY 1973 requests from A.I.D. bilateral and grantee programs for
contraceptive supplies %% in particular for oral contraceptives and condoms %% increased
markedly, and have continued to accelerate in FY 1974. Additional rapid expansion in demand is
* For obvious reasons, the initiative to distribute prescription drugs through commercial channels should be taken by
local government and not by the US Government.
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expected over the next several years as the accumulated population/family planning efforts of the
past decade gain momentum.
While it is useful to subsidize provision of contraceptives in the short term in order to
expand and stimulate LDC family planning programs, in the long term it will not be possible to
fully fund demands for commodities, as well as other necessary family planning actions, within
A.I.D. and other donor budgets. These costs must ultimately be borne by LDC governments
and/or individual consumers. Therefore, A.I.D. will increasingly focus on developing
contraceptive production and procurement capacities by the LDCs themselves. A.I.D. must,
however, be prepared to continue supplying large quantities of contraceptives over the next
several years to avoid a detrimental hiatus in program supply lines while efforts are made to
expand LDC production and procurement actions. A.I.D. should also encourage other donors and
multilateral organizations to assume a greater share of the effort, in regard both to the short-term
actions to subsidize contraceptive supplies and the longer-term actions to develop LDC
capacities for commodity production and procurement.
Recommendations:
1. A.I.D. should aim its population assistance program to help achieve adequate coverage of
couples having the highest fertility who do not now have access to family planning services.
2. The service delivery approaches which seem to hold greatest promise of reaching these
people should be vigorously pursued. For example:
a. The U.S. should indicate its willingness to join with other donors and organizations to
encourage further action by LDC governments and other institutions to provide low-cost
family planning and health services to groups in their populations who are not now
reached by such services. In accordance with Title X of the AID Legislation and current
policy, A.I.D. should be prepared to provide substantial assistance in this area in response
to sound requests.
b. The services provided must take account of the capacities of the LDC governments or
institutions to absorb full responsibility, over reasonable time-frames, for financing and
managing the level of services involved.
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c. A.I.D. and other donor assistance efforts should utilize to the extent possible indigenous
structures and personnel in delivering services, and should aim at the rapid development
of local (community) action and sustaining capabilities. [ Pobierz całość w formacie PDF ]