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About Our Country> National Population Report:Index>National Population Report: Part 6 |
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NATIONAL REPORT FOR THE ICPD - Continued 6. THE OPERATIONAL
ASPECTS OF POPULATION 6.1 POLITICAL AND NATIONAL SUPPORT Real support for the integration of population and other macro planning concerns, particularly in terms of the implementation of population policies and programmes, is evident in all segments of the community - at the political, social and economic levels. Clear moral and financial support is demonstrated at the highest political level, the private sector, non-profit organizations, the GRO and NGO sectors as evidenced in the magnitude of resources targeted at improving the status of the population. The Council of Ministers's, the highest political authority, has approved a number of measures designed to materialize support for population activities including family planning services, enhancing the status of women, improving the welfare of the youth, drug abuse counselling services, intensifying the fight against HIV/AIDS and improving the sexual and reproductive health of the country. These activities are all programmes financed in part or whole and implemented from year-to-year under the regular National Budget. In addition, Government has actively supported and requested regional programmes from bilateral and multilateral sources such as the U.K., UNFPA, UNICEF, UNESCO, etc. Other concrete measures indicating firm political will are the establishment of a Women's Desk, a National Drug Council and the recent approval of and support for a national survey on the conditions of the Youth in the BVI. A further measure is the recent decision to review in a comprehensive way the legal and administrative framework of immigration and labour operations. Further national support for the implementation of population policies and programmes is manifested in the countrywide involvement of NGO's, GRO's, non-profits organizations and other special interest groups in the policy making process. Groups such as the Women's Focal Point and a number of other small organizations dedicated to improving the welfare of women have actively participated with government departments in population activities involving information, education and communication especially in the areas of reproductive and productive issues. These groups have worked co-operatively with the Departments of Health and Information to produce programmes to fight against HIV/AIDS and other infectious diseases mostly affecting women, children and other less able-bodied persons. The department of education and NGO's have collaborated on the development of programmes at the primary and high school levels to effectively promote sex education, combat drug use, reduce teenage pregnancy, better identify care of abuse and deal with the problems of the youth. Churches and religious organizations, within the parameters of their beliefs, have supported education, information and communication activities designed to address the issues of the youth including drug abuse, family structures and sexual and reproductive health. Countrywide support for expressed, written and articulated population policies related to health, immigration, labour and education. Government's support for population policies and programmes is manifested in the agreement to establish a Population Unit and a National Population Committee and the placing of financial resources behind them. The political will of the GBVI to fully integrate population policies in the development planning process is abundantly present in the commitment of resources and the participative approach of including all competent and qualified groups in relevant dialogue and policy formulation. 6.2 NATIONAL IMPLEMENTATION STRATEGY The main mechanisms employed to formulate and implement activities proposed under the National Population Programme are to be found in the national planning process, the national budget process and the use of Non-governmental Organizations and the private sector. Before formulation of the NIDP population policies were formulated separately and apart from socioeconomic and environmental policies and strategies. In fact policies were formulated in an atmosphere or crisis or on an adhoc basis. This essentially meant that policy integration and co-ordination were hardly present. Implementation was the responsibility of the individual departments or ministries and some co-ordination was only present if agencies or departments came functionally under the same ministry. Programme activities implemented by NGO's and the private sector were not co-ordinated with the activities of the Public Sector. To undertake the delivery of family planning services, the Department of Public Health adopted a strategy of providing services directly to the public at community outlets through the Public health system at subsidized prices. Besides the element of cost recovery in prices, the IEC component is financed by the Public Service and assisted by the audio, print and video media. Non-governmental Organizations, religious organizations and private businesses assistance have been actively sought and received to assist with implementation of all components of the national family planning programme. The main strength of the strategies employed is the fact that activities received support at the highest political levels and resources required are passed into law in the national budget. Secondly, the involvement of NGO's and the private sector in areas where they enjoyed comparative advantage took the public sector out thereby eliminating the problems traditionally associated with trust. The limitations of this strategy were associated with the planning horizon, the long budgetary justification process and the ability to respond quickly to unanticipated situations. IEC activities regarding internal migration is not a priority nor is it required as the population distribution does not warrant such actions. Population distribution is largely determined by centres of economic activity and traditional community boundaries. The country's infrastructure and size is such that persons can move around easily to attend work. Additionally, being a country of islands, people tend to live where they work as commuting would prove expensive and time consuming. The situation is similar for international migration except in terms of how immigrants are distributed through the population. On the other hand, the entry of immigrants is regulated by the Immigration Act of 1969 and subsequent regulations. These regulations are intended to address issues relating to the impact on demand for social services, housing, public services, utilities, environmental systems carrying capacities and the absorptive capacity of the economy. Mechanisms for the delivery of maternal and child health and family planning services encompass the entire range of health care services through the national network of clinics and private providers. Integration of MCH/FP services are integrated at the policy, programme, project and beneficiary level through the national health care delivery system. Issues related to training of service delivery personnel, logistics and supplies, informed choice, quality of services, method mix and linkages with HIV/AIDS activities are integrated with general health policies and strategies. The department of Public Health programme of activities related MCH and FP services are formulated in accordance with the relevant strategies identified by Pan American Health Organization (PAHO) and the United Nations Fund for Population Activities (UNFPA). IEC programme activities in support of maternal and child health as well as family planning have benefitted form additional resources both public and private. MCH and FP have enjoyed country-wide coverage across all forms of media, religious organizations, Community and Grass Root Organizations and have been most successful as evidenced by the vital statistics and other related health indicators. Given that our implementation strategy is modelled after those recommended by the concerned international agencies the success achieved was anticipated. In summary, the national implementation strategy for the implementation of population activities is a decentralized one operated essentially through the financial and other procedures of the public services. Policies and strategies for programme formulation and implementation are national in character and content except in the case of those by NGO's GRO's and the private sector. Monitoring and evaluation of population programme activities that are decentralized to a number of organizations throughout the public service, although formalized, are not co-ordinated by a single unit. In this regard establishing the totality (scope, nature and characteristics) of the national population programme is difficult at best. In the experience of the BVI, this decentralization coupled with the lack of co-ordination has impacted negatively on our national ability to reformulate and refine programmes to meet unanticipated needs brought on by changed population dynamics especially due to rapid demographic changes such as immigration. Inspite of the above statements monitoring is effectively undertaken by the ministries, departments or agencies which are functionally responsible for implementing the particular activity. Due to small volume, the uncomplicated nature of activities and small target population, monitoring through the regular procedures of the Public Service is effective, but at times not flexible or responsive to unanticipated changes over the annual budget period. Monitoring is essentially linked to the budgetary process on the Public Sector side. Although there is scope for internal evaluation, it is doubtful whether this is infact effective given that the National Budget process does not always require Programme Based Budgeting (PBB). In addition, the disincentive for not submitting significant rationale and evaluation for resource allocations is minimal. The monitoring and evaluation of the activities of NGO's, GRO's and private sector organizations are subject to the systems and rules they have developed. However, in the event that they are implementing activities with public sector resources, accountability, transparency and responsibility are required without exception. Reformulation and modification of programme activities are limited due to the absence of effective co-ordination, decentralized implementation and the lack of systematic evaluation of programme strategies as activities of a national population programme. Impact assessment and cost analysis benefit are limited in that the norm is the budgetary process and the absence of data which flows from a well defined, co-ordinated, implemented, evaluated and monitored programme of population activities. The process of resource mobilization is linked to the national budgetary process where priorities for population activities are linked to and are expected to be consistent with general development priorities. Resource allocations are guided by an assessment of the problem, determination of objectives (target population) and the overall quantum of resources and priorities on the national level. Typically, resource mobilization is through the Central Government sources in addition to UNFPA financial and technical support of the Family Planning Programme and PAHO support of the HIV/AIDS Programme. Resources obtained through the annual budgets are complemented with the use of the Department of Information and Public Relations for IEC programme activities concerning Women Affairs, the HIV/AIDS Programme and other Population Programmes. Utilization of resources allocated for population activities is in accordance with the financial management guidelines of the National Budget and are accordingly subject to the full Accounting/Audit procedures of the Office of Auditor General. Resources obtained from international donor financing agencies and other external sources are subject to both domestically established Accounting/Audit regulations and the agreements reached with the financing sources. Resources have been utilized for purchase of goods, services and consultancies as well as for the remuneration of relevant employees. Performance to date has indicated full compliance with financial management regulations. Population and family planning activities are acknowledged by Government as priority to ensure the well-being of the communities and persons therein. Financing of these activities comes from the Central Government budget, 88.5%, external donor financing agencies, 10.0% and local and domestic private resources, 1.5%. It is acknowledged that technical co-operation resources such as consultancies and agency personnel services are not included under this accounting framework. New strategies adopted to augment allocations and to more efficiently utilize resources are highlighted by the development of a clear plan of action for population related priorities, new and expanded use of private sector resources, more canvassing of resources form international donor financing agencies and the enlargement of the role of the Non-government organizations. These strategies would effectively assist with decentralization of the process and an increased participation of the targeted population or their non-political agents in the implementation of programmes and projects. Beginning in the 1995 Fiscal Year, the regular budget of the Development Planning Unit will include a line item expenditure allocation for the planning and co-ordinating of Population activities at the national level. Additionally, NGO's will receive grants for the administration and management of limited and selected population activities consistent with their organizational goals. Another primary strategy related to finance will be the encouragement of private consumers to purchase on a commercial or subsidized basis population related services which are affordable. Multilateral agencies, (UNESCO, UNFPA, UNDP) bilateral agencies (BDD, USAID, CIDA) and Non-governmental Organizations will be approached to finance specific activities of our work programme of population activities. Resources expended on family planning accordingly to the Central Government budget only amounting to $33,362 in 1992 and does not cover the remuneration of personnel delivering family planning services. Unfortunately, financial record keeping does not permit a breakdown of family planning expenditure by method. As well, expenditure related to population IEC programmes, registration of vital events and maternal and child health care programmes are unstated due to aggregation within the account of the national health budget. Supporting expenditure is not easily disaggregated in Ministries expenditure and accounts for the remainder of expenses related to population activities. Given that population activities are multi-disciplinary cutting across all ministries and departments of Government and that the expenditure systems are designed on a functional basis, it would require an extraordinary effort to establish a co-ordinated financial reporting system separately from the budget. However, though, plans are being drawn up for the design of a multi-disciplinary accounting framework to cover expenditure on the various elements of population activities. From this framework expenditure in detail on all population elements in accordance with the Government Finance Statistics (GFS) manual (printed by the International Monetary Find (IMF) will become available next year. The expenditure pattern in respect of the financing of population activities shows that more than 90% has been financed from own resources. The element of cost recovery is demonstrated in user fees for some family planning services and some reproductive health services. Immigrants pay an annual fee for visa services and work permit holders pay a fee annually. 6.5 THE ROLE AND RELEVANCE OF THE WORLD POPULATION PLAN OF ACTION (WPPA) AND OTHER INSTRUMENTS The central objective of the World Population Plan of Action (WPPA) is to foster the integration of population policies with those of social, economic and environment objectives. Many of the WPPA principles and objectives as well as the Bucharest and Mexico recommendations together with those of the Amsterdam Declaration continue to be relevant in our effort to involve the explicit consideration of population variables in development planning. By taking into account the impact of population factors on development and the implications of development goals, strategies and programmes for population variables, the BVI is following the principle aim of social, economic and environmental development in which population concerns are integral. In recognizing that population and development are interrelated, the right of couples to freely decide on the numbers and spacing of their children within our legal context, and that women integrated in all aspects of life are most valuable, the BVIG is consistent with principles (a) through (h) of the WPPA. Although our population growth is substantially higher than recommended this is so for economic reasons i.e. net migration to satisfy demand in an acute shortage of labour economy that is rapidly growing. Recommendations on morbidity and mortality are relevant as manifested in measures to eradicate diseases, provide potable water and health and nutrition programmes for the most vulnerable segments of the population. The recommendations in respect of reproduction, family formation and the status of women are less relevant in that most of these are either achieved, are in progress or a legal/administrative framework has been established. The recommendations arising from the International Conference on Population, 1984 in Mexico City are of particular relevance to our National Integrated Development Plan, (NIDP), 1995-1999 and our recent establishment of a Women's Desk to recommendations 1,2,3 and 5-10, respectively. Recommendations addressing the issues of development and implementation of population policies, population growth, general guidance for health policies are all addressed in part of in whole in established strategies and programmes or are given strong consideration in the NIDP. Recommendations on family planning and reproduction are being implemented in health and social welfare programmes. International migration issues covered in recommendations 45 through 53 in respecting the basic rights and fundamental freedoms of individuals set out in the Universal Declaration of Human Rights, the International Convention or Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights are all being observed. The promotion of knowledge and policy is manifested in the population and censuses databases established in 1992 covers recommendation 60 - 69. The Amsterdam Declaration in its sections entitled "The Forum Participants Further Call on All Countries" and "All Development Countries" to among other things increase political commitment to population issues, to the integration of population and other development policies, to improving the role and status of women and to conduct research into population activities are all completely relevant to our national situation and the efforts being made to address them. Although indications are that recommendations contained in those population relevant instruments are being implemented or have been addressed, there remains a number of formalible constraints to implementing thoroughly or substantial parts of these recommendations. The integration of population concerns into the development planning process, the involvement of the private sector in the development of comprehensive population goals and objectives, the provision of Information, Education and Communication programmes present some serious constraints and challenges related to institutional arrangements, organizational capacities, co-ordination and development of financial and human resources and the involvement of the private sector and NGO's, in the day-to-day implementation of population strategies. Another relevant constraint is the political conviction of bilateral and multilateral agencies which finance our investment programmes to the concept of integrating population and development policies. To overcome this range of constraints which present fundamental difficulties for the BVI, there must be more focus on an integrated package or integrating population activities with general development activities. The developed countries should ensure that the resources constraint are alleviated and that the political will, the legal framework and administrative mechanisms are left for the account of the developing countries. |
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