KARL HOFMANN: You have taken over UNFPA at a momentous time, as the world population stands poised to pass 7 billion. Where do you want to take the discussion on population during your tenure?
BABATUNDE OSOTIMEHIN: Population continues to be an issue that is discussed at different levels – development, politics and security. The 7 billion mark, which we expect to be on October 31 of this year, is an opportunity to raise awareness around these issues, begin to address some of the challenges faced by most of the member states of the United Nations and to take advantage of some of the opportunities that this milestone presents.
Many developing countries have a population growth rate that is a little too high to help the growth of the economy. There has to be a deliberate effort in those circumstances to give visibility to the issues of reproductive health and the rights of people to choose how many children they want, when they want children and make sure they have access to voluntary family planning. That is the centerpiece of our conversation with governments, and we need to ensure there are policies and programs at play to attend to this issue.
We also cannot ignore the issue of aging that is challenging social systems across the world. We are working with member states to put policies in place to be able to meet the needs of the growing elderly population. In a sense, that is the tapestry around which we need to address the issue of population.
KH: Where do young people fit into this 7 billion milestone?
BO: The momentum of the population growth will depend on how we engage young people globally. Out of the 7 billion we’re talking about, 1.8 billion will be young people (aged 10 to 24) – young people who will determine the growth momentum of the next billions. Ninety percent of them are in the developing world. So, we should ensure that they have access to education and family planning information and services to ensure that they can make decisions about their futures.
KH: Demography can be a key to progress with the right policy environment in place, but it can also be a burden when we don’t have the right framework in place to take advantage of growing populations. Some have described this as the demographic dividend – growing populations as a potent driver of economic growth and development. Give us your perspective on that.
BO: I spoke at the 17th African Union Summit this year and one of my messages was that we have the opportunity right now to take advantage of the demographic dividend of young people. It’s important for African governments to understand that they have a youthful population. Most of Africa is under the age of 35. If 85 percent of the African population is under 35, the implication is that you have to have education, social services, housing, all of that, tailored to meet the needs of this population.
Beyond that, given what we’ve seen with the Arab spring uprising and others in many parts of the developing world, young people who are out of work want education and economic opportunities. We want to appeal to member states to provide skills appropriate to development and also ensure that we have continuing conversations with young people about their reproductive health and rights so they can make the choices that will ensure they plan for their families.
KH: In many parts of the world, family planning issues can be very divisive. How do we meet the needs of the 215 million women in the developing world who lack access to modern contraception?
BO: I like the way you framed the question because we’re talking about 215 million women, so the need is there. We in the field need to raise the visibility of this issue globally so donor countries understand that this is urgent and will invest necessary resources. We also need to raise the visibility of this issue in countries where these women live, so that governments can implement programs that reach out to the women. If you break it down to the average community leader in Africa or South Asia that family planning means saving the lives of young women and ensuring that they have healthy children, I don’t think that there is opposition to that.
KH: There are lots of conversations going on in global health circles these days around the synergy of integration. From your perspective, what are the barriers to this integration?
BO: I think it’s bipolar. Some countries are satisfied with vertical programs. Others are resistant to changing their system at the request of a donor. One argument for integration is that you can have the one-stop shop situation where one, two, three trained providers can deliver services at the same time. These include integration of HIV counseling, testing and treatment with family planning, with health education for non-communicable diseases, with immunization for children or with maternity services.
When you look at the components of an integrated system, it is very easy to sell. In terms of investment, it makes sense for the governments to build and put this together. The supervision becomes a lot easier, and the training of health workers would then capture all of the skill sets that would be required. Some countries, like India, Ethiopia and Nigeria have started this kind of integration.
KH: The private sector is responsible for so much of the health that is available, particularly to poor and vulnerable populations. So where does the private sector fit into this conversation?
BO: Private sector organizations could participate in this very actively. I welcome the development of health financing schemes around the world that respond to patients, so they can access health services from any provider, whether it is public or private, as long as the quality of services is good.
I also believe that the private sector is a very strong ally in the delivery system and the strengthening of delivery systems – making sure that they work with the government on commodity supplies and ensuring that economies of scale kick in so that you can actually begin to see reduction in the cost of drugs, condoms or other family planning commodities. Once you have a system that is established and working, it gives the private sector a handle on how to work in a more strategic way with governments.
KH: You know PSI well, particularly through the Society for Family Health, our affiliate in Nigeria. Throughout our 40 years, we have been working to address family planning needs. What can organizations like PSI do better, faster or more efficiently in the years ahead?
BO: What you’ve done well in the past is social marketing. Going forward, you might want to get involved with member states and governments to advocate for appropriate policies and programs that would provide better policy environments for your programs. Often, the knowledge of these issues within government circles is not great, and the turnover with governments is rapid. So, some consistent way of dealing and engaging with governments and policymakers would be a good thing. Working with parliaments is also very important, as they make resource decisions. We can work with you in selected countries to make sure that not only do they have policies and programs in place, but also local resources to provide sustainable support to reproductive health.