Strengthening UNFPA Business Model

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

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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

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Inequality is also declining

…but not within countries

World Bank (2016). Poverty and Shared Prosperity: Taking on inequality

Global inequality, 1988-2013

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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

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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

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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)

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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)

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Bull’s eye remains relevant in new landscape

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• 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

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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

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Current country classification criteria (2014-2017)

Need

Gross National Income

per capita (GNIpc):

–LIC

–LMIC

–UMIC

–HIC

Ability to finance +

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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

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Option 1 cont. Factors of country classification change

“Need” indicators

—

Improving or worsening trends

9 country programmes

Income classification

—

Upward or

downward trends


A combination of

factors


18 UNFPA country programmes will switch quadrants, upwards and downwards

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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

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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

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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

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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


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”

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Option 2 cont. “Need” Proposed way forward

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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

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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

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Section III: Modes of Engagement

Option 1:

No change

Option 2:

Revised

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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


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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

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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

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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


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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.

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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

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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

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• 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)


• 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

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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

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SECTION IV: Resource Allocation

Option 1

No change

Option 2

Strengthen current approach

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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

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Option 2: Strengthen resource allocation system


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

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Resource allocation system (RAS) – Option 2


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

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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 annual internal review and links with non-core resource and performance

Summary of recommendations

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Thank you

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Strengthening UNFPA Business Model

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