Investing in People: Health and Education

USAID Primary Goal

Help the people of the Dominican Republic build and sustain a democratic, well-governed state that responds to the needs of Dominicans, reduces widespread poverty and conducts  itself responsibly in the international system.

• Total Planned Contribution:
• Health: $47 million
• Education: $17 million

BACKGROUND

The Dominican Republic is mired by inadequate attention to the two most important social sectors: Health and Education.

Specific health challenges include the needs of poor women, adolescents and children under five, high HIV prevalence (especially among at risk groups), high tuberculosis incidence, low GODR investments in health, and high out-of-pocket health care expenditures.  An estimated 1.1% of the adult population is living with HIV/AIDS. Tuberculosis incidence is approximately 100/100,000 persons. Unmet need for contraceptives remained at 11% for all women. Maternal mortality is estimated at 159/100,000 live births and neonatal mortality is 21/1000 live births. Vaccination rates were reported at 64% for DPT3 and 65% for 3 doses of polio vaccine, way below the required goal of 85% coverage.  Health indicators demonstrate the inability of the system to adequately respond to the health needs of the population.

The Dominican Education system is overwhelmed by poor infrastructure, few hours of actual class time, frequent teacher absences and limited didactic materials, all of which result in poor quality of instruction.  Consequently, Dominican children have fewer opportunities to develop into productive citizens and are subsequently at increased risk of economic and social abuse.  The Education sector needs special attention.  The Secretariat of Education is developing a new 10-year plan to address the shortcomings of the public school system.

WHAT IS USAID DOING TO OVERCOME THESE CHALLENGES?

In order to achieve long-term improvements in Dominicans’ wellbeing and productivity, USAID programming focuses on increasing equitable access to sustainable quality health and education services.

USAID supports the improvement of quality of care; USAID emphasizes improvement of technical and managerial capabilities of health personnel; introduction and implementation of norms and protocols; and MOH implementation of a service provider accreditation system.  The program also concentrates on advocacy and policy support to expand access to quality health services by vulnerable populations.  USAID works with vulnerable populations to empower them to improve their health-seeking behavior and community involvement to ensure the health system is responding to their needs.

HIV/AIDS

USAID, in coordination with the Presidential Council for AIDS (COPRESIDA), supports the GODR’s efforts to curb the HIV/AIDS epidemic through programs in HIV/AIDS prevention, treatment and care. USAID focuses activities in Heath Region V and Haitian border. System strengthening and human capacity development are key elements for sustainability. 

Tuberculosis

USAID supports the strengthening of the National Tuberculosis Program for effective prevention, detection, treatment and cure of the disease.  The program emphasizes: a) implementation of the direct observed treatment short course (DOTS), which requires increasing the number of treatment centers, staff training and community-based outreach; b) strengthening of the national laboratory network; c) expansion of multi-drug resistance (MDR) treatment facilities, and d) improvement of HIV/AIDS co-infection management.

Maternal and Child Health

USAID activities aim to increase access to quality maternal and child heath care with the ultimate goal of reducing maternal and child morbidity and mortality. Activities include quality improvements in pre-natal, obstetric, and neonatal care; quality standards improvements of the national vaccination program, which contribute to the Millennium Challenge Corporation goal of vaccination coverage; strengthening the management capacity of health providers and the stewardship role of health directorates to improve transparency and efficiency; strengthening the role of hospital administration councils and the oversight role of the communities; and expanded implementation of the family health insurance.

Family Planning

USAID works with the Ministry of Health and NGOs to ensure contraceptive security and access to quality FP services for vulnerable populations (poor women, adolescents) is strengthened. In addition, USAID supports the integration of FP services into existing HIV and RH programs, and supports NGOs to act as both service providers and advocates for vulnerable populations.

Public Primary Education

USAID interventions address improvements in basic education, community participation in public schools, and proper use of educational resources.  The program encourages appropriate policy and curriculum reform and enhances human resource development so that the GODR can meet the education needs of its citizens, resulting in increased competitiveness and future economic growth. The long term goal is to improve the quality of basic education, through programs that improve teacher training and effectiveness, school governance and transparency to fight corruption, and national capacity to implement education reform. USAID promotes advocacy from civil society, private sector, communities and families for education reform. In addition, USAID supports innovative interventions for at-risk children and youth that provide life skills training resulting in enhanced education and employment opportunities so that Dominican youth can become productive citizens.

WHAT DOES USAID EXPECT TO ACHIEVE?

Increased, equitable and sustainable access to quality HIV/AIDS prevention, care and treatment programs.

Improved effectiveness of the National Tuberculosis Program.

Increased equitable and sustainable access to quality maternal and child health System-wide increases in reading, writing and mathematics scores by Dominican Public School students.

Increased participation by the private sector and communities in national education policy dialogues and local school management.