Cablegate: Information On Unfpa Country Programs - Uganda

DE RUEHKM #0976/01 2370951
R 250951Z AUG 09




E.O. 12958: N/A

REF: STATE 81654

1. (U) Per reftel request, U.S. Mission Uganda comments on the
UNFPA Country Program 2010-14 follow below.

Host Government Buy-in and Coordination

2. (SBU) Political support for family planning programs in Uganda
is concentrated among a few key champions, the majority of which
work at the Population Secretariat of the Ministry of Finance,
Planning, and Economic Development. While the Ministry of Health
also has acknowledged the important role that family planning plays
in securing the health of Uganda's population, mothers and children
in particular, there appears to be a lack of will and/or capacity to
take the steps necessary to address the problem. Although many of
the right policies are in place - owing to the work of UNFPA and
USAID - for the most part they have not been adequately
disseminated or implemented. Financial commitments from the
government also are lacking; UNFPA has stepped in to fill this void
and provides a substantial portion of the budget of the Ministry of
Health's Reproductive Health Unit. Despite this challenging
environment, UNFPA has ensured that the GOU has been engaged in the
development of their program and that their program is coordinated
with the GOU's own efforts. UNFPA has been active in supporting the
integration of family planning and reproductive health into the
implementation of the Peace, Recovery, and Development Plan for
Northern Uganda, and in addition is working to improve family
planning services in 12 other districts across Uganda. UNFPA also
has been a critical partner of USAID in efforts to advocate for
greater GOU commitment to family planning and in the procurement of
contraceptive supplies for the public sector.

Technical Matters

3. (U) UNFPA's proposed program aligns well with the efforts of
USAID and other donors and the NGO community, and also with the
GOU's poverty eradication and national development plans. It places
appropriate emphasis on strengthening reproductive health systems,
improving the enabling environment, and addressing issues of gender
equality, including gender-based violence. The program sets out
ambitious goals for increases in contraceptive prevalence and
reductions in unmet need.

4. (U) Despite UNFPA's continued commitment to ensuring the
security of the contraceptive supply and past financial support for
commodity procurement, the program does not explicitly address the
issue of commodity procurement or what level of resources will be
devoted to it. Contraceptive supply needs are projected to increase
substantially as efforts to reduce unmet need are intensified, and
commodity procurement will represent an increasing share of UNFPA's
and USAID's budgets. Given that, it appears unlikely that the
funding available is sufficient to cover the entire proposed
program; yet, the program does not include a plan for expanding the
donor base. Although one of the objectives of the program, and of
the donor community more broadly, is to increase the GOU's budget
allocation for and expenditure on contraceptives, in light of the
limited commitment of the government to family planning generally,
it seems imprudent to assume that such allocations will be
forthcoming. The budgetary implications of promoting implants as
the primary long-term method also must be seriously considered given
their high cost relative to the IUD. Moreover, UNFPA's performance
in shipping commodities on time must be improved to prevent
central-level stock-outs of contraceptives and the monitoring and
evaluation plan should include an indicator for tracking stock-outs
of contraceptive commodities. An indicator is suggested for
monitoring contraceptive availability at the facility level and
could serve as a proxy for commodity security, however, it is too
narrow as it is currently defined-it measures only the percentage of
facilities providing at least three types of modern methods.
According to the 2007 Service Provision Assessment conducted by
Macro International, the vast majority of facilities already are
providing three modern methods. Such an indicator, therefore, would
not be useful for tracking additional progress in increasing the
availability of a range of contraceptive methods. UNFPA should
consider instead measuring the percentage of facilities providing at
least 5 types of modern methods.

5. (U) The other main weakness of the program is the population and
development component, which seems short on implementation and
monitoring and evaluation to track implementation. One of the key
output indicators for this area is that the National Population
Council and the Population Secretariat are integrated into the
institutional frameworks for national planning and review processes;
however, this provides no sense of what such integration is meant to

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accomplish or means of measuring that in fact those objectives were
achieved. It also is unclear how implementation of action plans and
policies will be tracked at the district level, which is critical in
Uganda's decentralized environment.


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