Improving the impact of sexual and reproductive health development assistance from the like-minded European donors.

Aid from Denmark, Finland, Germany, Netherlands, Norway, Sweden and UK provides essential support for sexual and reproductive health and rights. Recent research, however, has revealed conflicting values in how their aid is programmed, resulting in a reduction in both quantity and quality of support provided. The strong commitment of these donors to country ownership has, in practice, invested decision-making primarily with developing country governments, with civil society playing a much weaker role. In most countries, strong civil society organizations are needed for effective advocacy of sexual and reproductive health and rights and health service delivery, and the restricted role of this sector has slowed progress towards universal access to reproductive health. The research documented also that these donors' respect for the autonomy of multilateral health agencies has resulted in some reluctance to encourage more attention to SRHR. In addition, their commitment to "impact" has not translated into the incorporation of relevant and practical outcome measures by which to assess the results of their investments. Almost 80% of the money they earmark for sexual and reproductive health and rights goes to UNFPA, underscoring its critical role. This article recommends donor support for a stronger civil society role in the design, implementation and evaluation of SRHR funding; strengthening civil society so that it can successfully undertake this role; use of better outcome measures to assess impact; and active support for UNFPA to implement the recommendations of recent external reviews.