Consistent Efforts, Persisting Challenges

Evaluation of Dutch contribution to sexual and reproductive health and rights (2012–2022)

Report

Kunstenaar maakt activistische graffiti tegen kindhuwelijken in Mozambique

Results – Evaluation of Dutch contribution to sexual and reproductive health and rights

IOB conducted an evaluation of Dutch policy on sexual and reproductive health and rights (SRHR) – including HIV/AIDS. It focuses on the period 2012–2022, and includes both development cooperation and diplomatic efforts.

Background

Promoting universal fulfilment of SRHR has been a priority of Dutch development cooperation for many years. The previous IOB evaluation on SRHR covered the period 2007–2012 and was published in 2013. Between 2012 and 2022, Netherlands Ministry of Foreign Affairs allocated 10% of the Dutch development-cooperation budget to this theme, nearly EUR 5 billion. Diplomatically, the Netherlands is an outspoken actor on SRHR issues.

Through its policy on SRHR, the Netherlands strives to contribute to commitments made in the Sustainable Development Goals. Despite global progress on various SRHR-related indicators, such as HIV incidence, major challenges persist. These include issues like the autonomy of women to make informed decisions about their sexuality, and the denial of sexual and reproductive rights for certain groups.

The evaluation draws on primary data collection in Uganda and Bangladesh, and includes an analysis of Dutch diplomatic efforts. Additionally, it incorporates findings from available evaluation reports of supported SRHR-projects. To broaden the evidence base about what works and what doesn’t, IOB commissioned a systematic search, which yielded a comprehensive database of 368 systematic reviews on SRHR interventions in sub-Saharan Africa.

Collage van aidswerkers in verschillende landen

Central question

To what extent has the Netherlands contributed to the improvement of Sexual and Reproductive Health and Rights and contributed to halting the spread of HIV/AIDS in low- and lower-middle-income countries, and what lessons can be learned for future policy?

Main conclusion

Icoon van een vergrootglas voor conclusies en bevindingen

IOB concluded that the Netherlands has contributed to improvements in SRHR and a reduction of the burden of HIV/AIDS in low- and lower-middle-income countries. Dutch support of SRHR contributed to improved SRHR outcomes through increased access to reproductive- and health commodities. At the same time, the evaluation also revealed that various supported interventions did not lead to the expected results, including behavioural change of and decision-making by young people about sexuality or reproduction. There are, furthermore, various ‘blind spots’ for which there was either no evaluation available at all, or the evidence on effectiveness was inconclusive or of insufficient quality.

Consequently, IOB has been unable to determine the extent of the contribution of the entire Dutch policy to SRHR.

IOB bases this main conclusion on the subsequent six sub-conclusions, described in full in the evaluation report.

Sub-conclusion 1:
Dutch policy on SRHR has been consistent over the years and has simultaneously responded to the existing and emerging needs of intended target groups in low- and lower-middle-income countries. However, key policy assumptions were often not clearly articulated, and policy choices were not always evidence-based.

Sub-conclusion 2:
Efforts towards enhancing SRHR and addressing the spread of HIV/AIDS in low-and lower-middle-income countries have resulted in a variety of effects.

Sub-conclusion 3:
Although Dutch parliament and the general Dutch public are annually informed of the results achieved on SRHR, the M&E systems have several limitations that hinder the validity and reliability of reported results, especially at outcome and impact levels.

Sub-conclusion 4:
Economic efficiency of supported SRHR projects and interventions is unknown. The organisational efficiency and timeliness of supported organisations presents a mixed picture, with room for improvement, both for multilateral and international organisations and for NGO partnership projects.

Sub-conclusion 5:
Coherence within and between instruments and organisations supported by the Netherlands was insufficient.

Sub-conclusion 6:
SRHR projects generally come to a halt once Dutch funding ends, since there are hardly any stakeholders willing and able to take over supported activities. In addition, there is only limited insight into the sustainability of results achieved.

Collage, van links naar rechts: Het hijsen van de LGBTQ+ vlag, Minister op event voor feministisch buitenlandbeleid, en een event voor familieplanning in Oeganda

Recommendations

Icoon van een netwerk met verbindingen voor de aanbevelingen

IOB formulated six recommendations. Under each one, practical suggestions are offered for implementation. These are described in full in the evaluation report.

The updated policy document could include:

an analysis of all policy assumptions, including those concerning coherence and sustainability;
existing high-quality evidence to assess the validity of the assumptions;
an explicit poverty focus, a strategy that outlines to which degree and how the ministry intends to reach people of lower socio-economic status, and a strategy for including gender mainstreaming;
where possible, the policy decision to decrease health-sector support could be reconsidered;
a strategy for policy dialogue on health and SRHR with the governments in the SRHR target countries.

Given the human-rights-based approach of Dutch SRHR policy, and considering the often limited national and international ownership, possibilities to hand activities over are inherently narrow.

With this in mind, the Netherlands could:

acknowledge that in the SRHR target countries there might be little national ownership of the rights aspect of SRHR;
if this is the case, make a political commitment that it intends to continue supporting SRHR activities;
introduce longer time frames for projects;
investigate possibilities to continue funding activities that have proven to be effective.

Indicators at these levels generally require (i) independent evaluation, (ii) robust research designs, and (iii) longer time spans to validly establish a causal relationship between results and supported interventions.

Therefore, the ministry could:

jointly with implementing organisations, strategically select a limited number of indicators for monitoring, with a focus on activities, inputs and outputs, and the quality of implementation;
reformulate both overall budget indicators for SRHR for the Ministry of Foreign Trade and Development Cooperation’s budget Article 3.1 (SRHR).

Therefore:

the ministry could ensure that ex-post evaluations can be conducted;
implementing organisations could hire evaluators for baseline, mid-term and end evaluations already before project implementation;
the ministry, implementing organisations and evaluators could jointly identify a number of outcome indicators, for a number of strategically-selected, large projects, to be independently measured at baseline, mid-term and ex-post, possibly also in comparison areas;
evaluations could include an assessment of gender mainstreaming;
evaluations could include an assessment of economic efficiency;
the ministry could assess the uptake of statements and resolutions derived from SRHR diplomacy at country level.

Report

Report – Evaluation of Dutch contribution to sexual and reproductive health and rights

Sexual and reproductive health and rights (SRHR) have been a priority in Dutch international policy for years IOB has evaluated ...

Report | 07-12-2023

Consistent Efforts, Persisting Challenges

Results – Evaluation of Dutch contribution to sexual and reproductive health and rights

Background

Central question

Main conclusion

Recommendations

Recommendation 1: Clearly formulate the Dutch policy on SRHR in an updated policy document (the previous one was published in 2012), which could include the objectives, policy choices, priorities, channels and the relationship of SRHR with the Dutch global health strategy.

Recommendation 2: Attach more weight to programme management, balancing it with diplomatic and more ad-hoc activities of the policy staff responsible for SRHR.

Recommendation 3: To reduce high management costs and fragmentation at the country level, reconsider the current strategic-partnership operational model.

Recommendation 4: Have a realistic outlook on the limited possibilities to achieve continuation of activities beyond project support.

Recommendation 5: Be cautious about what can realistically be monitored at the (intermediate) outcome and impact levels.

Recommendation 6: Improve the quality of decentralised evaluations, managed by implementing organisations or by involved policy departments of the ministry.

Report

Report – Evaluation of Dutch contribution to sexual and reproductive health and rights