Dr. Sultan Aziz
Director, UNFPA Asia Pacific Division

UNFPA has been involved in population, reproductive health and gender issues for many years. Regarding the gender issue, women, as half of the world’s population, do not have the same access to resources that men have. On reproductive health issues, the UNFPA mandate can be very controversial, proposing that relatively conservative societies confront the issue of sex education. 

This is not for the purpose of discussion. It is to save lives. Two-thirds of the world’s population live in Asia, and every minute, 7 women die from complications from pregnancy, every 3 seconds a person is infected with HIV/AIDS. In a continent where 750 million people are aged between 10 and 25 years old, these numbers alone must make policy makers pause and wonder how to tackle the situation.

How do we trust our institutions to deliver effective services? In Asia there is much central government planning. We have to know people are involved in planning at other levels too. 

People want to know, and need to understand clearly what governments are doing. How can we work together to understand the ways that ideas are communicated and policies are made? Can we communicate with the provincial and central levels of governments, and what can make systems work more effectively? 

When decentralization occurs, the question is “How do the district and central levels of governments communicate?” It is important to know who is providing services, and what their incentives are. For example, if there is more reward to build a road bridge than to build a health clinic for dying women, what will change that situation? 

Demand from the bottom level is important, and creating trust and understanding with local bureaucrats is important too. If you sit down to discuss situations and analyze the problems with the right people, then they will want to make the big changes. 

If administrations cannot access high technology solutions, we have to find out who can provide the technology. We also have to face up to problems such as corruption, which can stop many initiatives. 

At UNFPA, we have found that if we provide directly, for example by building 10 health clinics, that does not achieve large-scale change. We have to work with local, provincial and central government levels simultaneously, so that each level works together. 

Poverty and population are closely linked, so we need to access much more data on both factors. Then we can sit down with policy makers and carry out a proper analysis, and we can understand the range of policies and choices to be made.

Questions and Answers

The following is a summary of the question and answer session on issues related to population and development, which followed the presentation given by Dr. Aziz at the First 2007 AUICK Workshop.

Q: Regarding the MDG indicators, should the focus be on process indicators or impact indicators?
A: The Outcome Indicators are what governments should be held responsible for. The UN’s international process indicators may be difficult to adapt to each country. They entail psychological and social behavioral issues, requiring information, techniques, and specific behavioral attitudes to change. What would happen if, with funding, you mixed up the top-down hierarchy of a government system? Reform is difficult to carry out – even in the case of the UN itself. Funding can be withdrawn due to city auditing problems. 

Q: Accounting processes necessitating 70 signatures to buy one ball-pen could compromise fund allocation. What are your opinions? 
A: Government Officials sometimes feel they don’t have ownership of a process that we impose. We need a report on how the money is spent, as do national governments on our executive board. If money is subject to fraud or corruption, we have to find a better way. The root is for governments to simplify their accounting rules. In Asia we seem to ask for 12 signatures when two would suffice. We have to reduce transaction costs. Accounting entails the culture of suspicion, causing arguments. An idea from Olongapo is to place the money in a special trust fund, with shorter procedures. Having dealt with procurement issues, I realize we need to train auditors as managers, so that they understand project implementation. Auditors only learning one craft - and assuming everyone is guilty until proven otherwise - is a universal problem which has to change. 

Q: You mentioned the need for data. AUICK has been pushing for a City University Partnership (CUP) in the 3 areas of Khon Kaen (Thailand), Danang (Vietnam) and Surabaya (Indonesia). 
A: The UNFPA country programs are helping to get social and natural scientists from local universities to help cities collect data needed to make good decisions. It is a slow process, but it is nice that the country programs are supporting it. It is that experience which I will widen and see what kind of partnership we can enter in developing a more institutionalized approach to get data. Cities have human resources, but do they need technical assistance? Do they need money for computers for number-crunching? UNFPA can train statisticians, and we will be looking to see how we can develop that process.

Q: In Shanghai, people over 60 make up 20% of the population, in Weihai 16%. Chinese cities have ageing societies and the situation may get worse. The workforce will not be big enough, and one young couple will be supporting two families of people who will be living longer. 
A: Our information is that China has 280 million people over 68, which will rise to 400 million in 2010. A multi-pronged sustainable system of being able to fund retirement and medical care has to be adopted. The tax situation in China is still developing. Internally people are becoming wealthy. There has to be a systematic taxation review. Nihon University data on the issue will be useful.

Q: A WHO system of vouchers in Bangladesh gives pregnant women access to life-saving health care. What are the UN plans? 
A: Maternal mortality is high in Bangladesh. We suggested this system and it was adopted. Proof of no corruption gets more money. Poor women can get a rickshaw to the hospital. In the villages, numbers of trained personnel and skilled birth attendants are slowly increasing, but more are needed. The issue of condoms is unmet though, with husbands influencing women to choose costly injections. Governments should pay more attention to these situations, and publish details of money and resources. Sometimes there are two steps forward and one step back, and sometimes three steps forward. But change doesn’t have to be painful. 

Q: The Vietnamese government applied a family planning policy to encourage 1 or 2 children. This was less effective in the mountain and coastal areas, as implementation was difficult. Do you have any advice? 
A: In Vietnam, resources can’t address the entire population. In mountainous coastal areas, itis a classic case of ‘How does the government invest and why should it?’ Despite the central government’s best intentions, isolated ethnic communities see it as coming and telling them what to do, without understanding them. This is not the case in Laos or Thailand, but most problems discussed at the New York conference of indigenous ethnic people were communication -related. We are developing a resource and translation process. Governments must provide accessible services to unreachable mountain communities. Coming from a mountain tribe in Afghanistan, where 32% live in areas with no roads, I understand isolation problems. The per capita cost of investing is high, which is an excuse for governments not to act.