WUNRN
"Quality
aid fully considers gender roles and inequalities in project design,
implementation and monitoring."
MEASURING
THE ROLE GENDER PLAYS IN DEVELOPMENT BANK LENDING
This
article originally appeared online in This is Africa, a publication of the
Financial Times
By Claire Lauterbach - 10 October 2012
Global
reproductive health has improved significantly over the past 20 years. The HIV
infection rate has slowed, the number of women dying in pregnancy and
childbirth has dropped. This trend has spawned ambitious talk about getting to
"zero" new HIV infections, discrimination and deaths. Donors boldly
pledged $2.6 bn to reproductive health at last June's London Summit on Family
Planning, adding to the billions of dollars of development aid so far from
private foundations, international donors including multilateral development
banks, and governments from South Africa to Nigeria.
Yet sub-Saharan Africa still has the World's highest percentages of HIV−positive
people and maternal deaths. To tackle these problems, the World Bank and
African Development Bank have spent almost two billion between them from 2006−2012.
Despite imposing loan conditions over decades that eviscerated Africa's public
healthcare sectors, they are still major funders of reproductive health and
HIV/AIDS programs in the region.
The World Bank and AfDB declare that women's full involvement is necessary for
good reproductive health. So why do they ignore key gender issues in their
reproductive health and HIV/AIDS investments?
Gender Action explores this gap in a new report, 'Banking on Health.' Together with
Cameroonian and Ugandan partners, Gender Action reviewed World Bank and AfDB
reproductive health and HIV/AIDS investments for their sensitivity to gender.
Their gender record needs improvement.
Many projects show surprisingly little attention to gender roles.
Economic dependence on male providers leaves many African women unable to
negotiate safe sex practices with their partners or choose if and when to bear
children. Women's unpaid, time−consuming care work can make it difficult
to travel long distances where and when clinics or services are available. Yet
projects often show little to no indication that these concerns were taken into
consideration.
The banks also promote user fees, which cover few project costs. Women are
particularly affected as they often do not control household revenues. When a
woman must choose between buying food and getting pre-natal care, as we saw in
Uganda, something is wrong.
The Banks also hardly track how specific investments affect women.
Project monitoring and evaluation frameworks frequently make no mention of
women, nor do they sex−disaggregate key indicators like whether women are
equally involved in project design or have equal access to project benefits,
like HIV services or recently refurbished clinics.
Quality aid fully considers gender roles and inequalities in project
design, implementation and monitoring. That means mandating
clear sex−disaggregated indicators to measure whether Bank − funded
projects are working for women. Quality aid actively engages women
'beneficiaries' before projects begin and at convenient times in places where
their voices won't be drowned out by men's. It engages men in their own sexual
health and encourages them to promote their partners'.
Quality aid at the institutional level should fund strengthening health systems
through grants. The World Bank and AfDB mostly make debt − burdening
loans whose payment squeezes funds for health services. A full 45 percent of
the World Bank's reproductive health and 60 percent of its HIV/AIDS investments
in sub−Saharan Africa from 2006−2012 were loans. At the AfDB this
figure is 60 percent.
Quality aid does not create empty clinics or programs that are inadequately
serviced by regularly − and sufficiently − paid, trained national
staff. Quality aid promotes the sustainable elimination of all financial
barriers to health care, especially unaffordable user fees for essential
services.
Finally, quality aid is accountable aid − judging aid's impact is
impossible without data on what or how we spend. Information on AfDB spending
amounts on reproductive health was "simply not available" according
to one official. This is surely not aid accountable either to 'beneficiaries'
or taxpayers. Tax-payer-funded banks need to better track and publish their
healthcare spending data.
While the momentum is still strong to make good on the London Summit on Family
Planning pledges, multilateral development banks and other donors should
recognize that good quality matters as much as high quantity reproductive and
sexual health and HIV/AIDS spending.