Strategies (1997-2002)

Health and Population

Strategic Objective: Increased Use of Sustainable Basic Health Care Services and Practices

HIV/AIDS/STI Programs to Prevent Infection and to Care for Affected Persons

For over 10 years, USAID/DR has been the major donor in support of HIV/AIDS Prevention programs. USAID has contributed to improving the country’s capability to respond to the HIV/AIDS epidemic by strengthening both public and private institutions. USAID’s support has enable indigenous NGOs to work with hard to reach populations (e.g. commercial sex workers and gays). The National AIDS Program at the Secretariat of Health is better positioned to play its normative and coordinating role in developing and implementing national HIV/AIDS plans. With USAID’s assistance and wide stakeholder participation the National Program developed a three-year Strategic Plan, which served as a framework for drafting provincial and municipal operational plans.

The program focuses on the expansion of proven effective prevention interventions aimed at: reducing risky behaviors among core transmitters and those identified as most vulnerable to infection youth, in particular ; improving the management of STIs; promoting integration of HIV/AIDS prevention in decentralized health programs and the formation of public/private partnerships; and, supporting the implementation of pilots on voluntary counseling and testing for HIV and prevention of vertical transmission. In addition, and as part of the prevention-care continuum, USAID supports innovative community-based care pilot interventions. USAID collaborates with UNAIDS and the European Union in a joint effort to support the promotion of policy reforms and the implementation of effective HIV/AIDS programs.

Reproductive Health Services for Targeted Populations

USAID has been the major international donor in family planning and reproductive health in the Dominican Republic since the 1970s. Over the past decades, substantial gains have been made. The country is now considered a high prevalence country with 65% of married women using a modern contraceptive method, a five percentage point increase over the rate reported in 1996. The Total Fertility Rate has declined to 2.6 from 3.2 in 1996. Access to family planning services is relatively good for most urban Dominican women. There have also been some advances in the quality and availability of reproductive health care. However, the country still has serious problems in many areas including maternal mortality, adolescent pregnancy and incidence of abortion, which is illegal under all circumstances.

With this in mind, USAID has defined an assistance strategy emphasizing sustainability of public and private sector reproductive health services and activities that currently receive some type of USAID financial or programmatic support. It also addresses the need to provide a stable resource base for subsidized care into the future for low-income groups, as well as the need to expand services for underserved women and for adolescents. Some activities include providing technical assistance and financial support to ensure the long-term survival of private sector NGOs providing reproductive health care services and to support expansion and quality improvement in clinical family planning services at Government of the Dominican Republic (GODR) hospitals. Support is also provided for policy, changes research and technical inputs.

Increased Access to Selected Child Survival Services

USAID is supporting technical assistance policy, analysis, strategic planning and pilot testing of cost-effective approaches to selected child survival interventions. USAID is facilitating GODR-NGO collaboration, leveraging government, donor and private sector resources, and providing technical expertise in areas where USAID has a comparative advantage. This approach improves immunization coverage, introduces community-based features of the Integrated Management of Childhood Illness (IMCI) approach in partnership with NGOs, and improves access to and management of potable water and sanitation systems. Limited, targeted child survival interventions will contribute to reducing child mortality and have a synergistic effect on USAID's ability to achieve increased use of effective and sustainable basic health services and practices. Some activities include providing technical assistance to the Dominican Water Authority to test the Total Community Participation approach to development and management of rural water systems in one province, assisting the GODR to develop and implement a strategic plan for an expanded immunization program, and promoting the use of community-based IMCI for delivery of child health services.

Increased Efficiency and Equity of Basic Health Services, Especially at Decentralized Levels

In recent years the Dominican Republic has initiated a health sector reform process to address the inefficiencies and inequities of the system. For the past two years USAID has increasingly assumed an important role in this process. The recently approved General Health and Social Security Laws provide the legal framework to transition into a system that will provide universal health coverage for Dominicans. USAID-funded study on equity and health provided critical input to the discussions of the draft social security law. USAID has made important contributions to the development of National Health Accounts and the monitoring and evaluation framework for the reform.

Currently USAID’s assistance focuses on decentralization of health care by strengthening the Provincial Health Directorates' capacity to manage basic health services, strengthening of the Secretariat of Health's capacity to oversee a decentralized system, and contributing to an improved health policy environment that supports the sector transformations. The reform will foster increased access to and quality of basic services and practices which will impact on the health status of the Dominican population.

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Last updated on May 20, 2005