Ghana

FY 2001 Program Description and Activity Data Sheets

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FY 2001 Program USAID supports Ghana's efforts to increase broad-based sustainable development through four mutually reinforcing objectives. Activity implementation under each of these objectives has been accelerated over the past year and further increases are anticipated in FY 2000. USAID's leadership in promoting sound macro-economic and trade policies will support broad-based economic growth. The Trade and Investment Reform Program (TIRP) will emphasize measures to improve the environment for domestic and international investment by reforming policies and removing impediments (e.g. inefficient customs procedures and bureaucratic "red tape"), and by improvements in revenue collection. This policy reform agenda is centered on creating a regulatory and policy environment conducive to broad-based, sustained and private sector-led economic growth. TIRP's corollary activities in the promotion of non-traditional exports and private enterprise development will also continue. A new component aimed at bringing the grades and standards for Ghana's exports into line with the standards of its principal markets (Europe and North America) will also be undertaken. USAID will continue to provide technical assistance to support the realization of the West Africa Gas Pipeline project. By FY 2001 USAID's primary education system reform and quality improvement activity will have expanded from 39 districts to 65 districts of the total 110 districts in Ghana, with Partnership schools in every region of the country. Students in these schools will begin to exhibit higher retention rates and improved performance on assessment examinations in both English and mathematics. The education activity will also continue to focus on increasing enrollment of girls. USAID continues to be the lead donor for maternal and reproductive health in Ghana. The recent expansion of the program to include child survival health activities has enabled the Mission to undertake an integrated approach and the emphasis of community-based service delivery will increase access in many under served areas. Child survival activities will continue to focus on child immunizations and polio eradication as well as improved nutrition. The HIV/AIDS prevention programs will also be expanded. USAID's support to consolidation of Ghana's democracy and better governance will emphasize forging stronger links between civil society and government, increasing the access of citizens and government agencies to information through the use of appropriate information technologies and a corollary increase in their capacity to communicate with each other and share experiences and lessons learned. USAID assistance will contribute to strengthening the capacity of Parliament's permanent staff to originate and draft legislation, rather than depend on the executive branch for these functions. USAID's assistance to civil society will also enhance government accountability and improve transparency to include support for activities developed by a coalition of public and private sector anti-corruption groups. The monetization of P.L. 480 Title II assistance contribute directly to supporting activities that are integral to achieving results in USAID's private sector, education, and health programs, which are successfully addressing short-term food aid needs, especially in the food insecure regions of northern Ghana. Food aid is promoting sustainable forestry and improved agricultural productivity (Adventist Development and Relief Agency); small/micro-enterprise development (Technoserve) and increased primary school enrollment and improved nutrition (Catholic Relief Services). [an error occurred while processing this directive] ACTIVITY DATA SHEET PROGRAM: Ghana TITLE AND NUMBER: Increased Private Sector Growth 641-001 PLANNED FY 2000 OBLIGATION AND ACCOUNT: $12,780,000 (DA), $7,134,000 (P.L.480 II) PROPOSED FY 2001 OBLIGATION AND ACCOUNT: $10,437,000 (DFA), $7,622,000 (P.L.480 II) STATUS: Continuing INITIAL OBLIGATION: FY 1997 ESTIMATED COMPLETION DATE: FY 2003 Summary: USAID's Increased Private Sector Growth activity is intended to support Ghana's national goals of poverty alleviation and achievement of middle-income status through the encouragement of broad-based, private sector-led growth. While Ghana has made great progress toward sustained, broad-based economic growth since its economy effectively collapsed in the early 1980s, much remains to be done. The destructive legacy of dysfunctional statist economic policies of the immediate post-independence period continues to be felt in the form of high inflation and unemployment, excessive and counterproductive regulation, an oversized, inefficient public sector, and a banking sector handicapped by high interest rates and large numbers of non-performing loans. The Trade and Investment Reform Program (TIRP) is a five-year activity to enhance Ghana's potential to earn critically needed foreign exchange and compete more effectively in the global marketplace. The program supports key macro and sectoral policy reforms and provides technical assistance and training to improve the investment environment and technical capacity of Ghanaian enterprises. Policy reforms focus on eliminating or revising regulations that adversely impact Ghana's international competitiveness in sectors that have the potential to contribute to exports, such as horticultural and wood products. This activity also utilizes P.L. 480 (Food for Peace) Title II funding to promote increased food security in impoverished rural areas through the development of sustainable rural enterprises and small and micro-credit programs. The TIRP activity also enhances the sustainability of efforts now underway in Ghana's Central Region to support economic growth and generate revenue from tourism in the Central Region. USAID activities in the region include assistance in the restoration and preservation of the historic castles and forts and Kakum National Park, a 360-square kilometer forest reserve that is one of the last vestiges of the original Guinea rainforest which once covered almost the entire West African littoral region. The overall TIRP program also supports efforts to increase U.S. trade with, and investment, in Ghana. It will bolster economic growth that will increase demand for imports of U.S.-made equipment, agricultural and industrial inputs and capital goods, as well as promote Ghana's exports to the United States. Over 90% of the jobs generated by TIRP will be for workers in small-scale agriculture and fishing and in microenterprises. Currently women own 24% of the horticulture, wood, African cloth/garment and handicrafts industries. Women-owned businesses will continue to grow in number and size as a result of this program. This USAID activity directly supports the U.S. Mission Performance Plan's (MPP) goal of promoting broad-based growth, by creating an enabling environment for such growth and building the capacity of private enterprises to take full advantage of the improvements. It also supports the MPP goal of expanding U.S. exports, by promoting and facilitating trade between the two nations. Key Results: With USAID assistance, Ghana has expanded its export base beyond its traditional exports, and earned an estimated $43.5 million in 1998 from selected non-traditional exports (NTE) receiving USAID assistance. Overall increases in NTEs such as fish and seafood, horticulture crops and wood products have directly resulted in the creation of approximately 69,000 new full-time equivalent jobs, a significant accomplishment in an economy which has recently been experiencing rising unemployment and widespread underemployment. Income from tourism at those sites receiving USAID assistance rose from $15,760 in 1994 to $217,500 in 1998. Performance and Prospects: Under TIRP's policy reform component, the Inter-Ministerial Coordinating Committee (IMCC) - an economic policy coordinating body created with USAID assistance - approved a four-and-a-half year policy reform work plan developed with assistance from USAID's contractor. The contractor also developed and received approval for a plan for national policy consultations and for its Draft Policy Reform Agenda. Key reforms include better bank loan portfolio management, streamlined tax revenue collection, elimination of disincentives to foreign investment and updated labor legislation. U.S. technical assistance and training help Ghanaian firms working throughout the export production and marketing chain to improve their managerial skills, identify and penetrate viable markets, and create links to increase market presence and strength. The latter is particularly important in benefiting smaller producers, including thousands of smallholders and micro-entrepreneurs that are playing an increasingly important role in supplying Ghana's larger exporters. Through 1998, over 251 firm operators received training. A total of 129 business linkages were established, exceeding the target of 43 set for the period. In the Central Region Project, the sites provided with USAID assistance - the Castles and Kakum National Park - received a major international tourism award from British Airways, winning out over several other, currently better-known sites, and thereby increasing considerably their visibility in the travel industry and their potential as catalysts of growth for Ghana's nascent tourism industry. A new initiative has been added which focuses on assistance to the development of a more sustainable and efficient energy supply and improved demand management. This activity supports activities under the private sector program by promoting a more reliable energy supply, which is critical because the energy sector impacts directly on Ghana's potential for growth, and current resources are inadequate. Reliable long-term, cost-effective supplies of energy, coupled with more efficient consumption and utilization of that energy, help to build the foundation for Ghana's long-term, sustainable economic growth. USAID is providing technical assistance for the development of a 400-mile West Africa gas pipeline (WAGP), which will carry natural gas from Nigerian oil wells to Ghana, Togo and Benin. WAGP will provide these countries with an inexpensive source of energy for electricity generation. The governments will be assisted in developing a Concession Agreement between them and the private corporations that will build and operate the pipeline on fair and favorable terms. The completed Concession Agreement is the expected result of the activity. A new activity under TIRP is in development to assist Ghana in developing grades and standards for its export products that meet the requirements of its overseas markets for quality and health. Possible Adjustments to Plans: USAID may modestly expand its involvement in the West Africa Gas Pipeline project beyond the activities described above. However, the Ghana Mission will limit its involvement to bilateral technical assistance to Ghana for the project. The Mission is also exploring the potential for promotion of eco-tourism in Ghana. The Mission will seek an extension of two years to its current (1997-2001) Country Strategic Plan, in order to further consolidate results and to avoid new strategy development in the middle of Ghana's national election, which is certain to bring a new government. The policy reform agenda in particular requires full participation and ownership by the government, and therefore an extension will allow the Mission time to bring the new government into the policy reform partnership, and thereby better plan follow-on activities. Other Donor Programs: The Government of Ghana continues the implementation of its trade and investment initiative, with support from the World Bank and the United Nations Development Program. The World Bank is also implementing a $50 million Private Enterprise Export Development Program, as well as infrastructure investments. USAID's planned assistance under TIRP is equal in size to the World Bank's, and is complementary to the other donors' efforts. Principal Contractors, Grantees or Agencies: TIRP will continue to be implemented by U.S. institutional contractors and grantees, as well as U.S. private voluntary and local non-governmental organizations. For the Development Assistance-funded component of the private sector program these include Bechtel Corporation (energy sector development), Sigma One Corporation (policy reform), AMEX International (enterprise development), and Conservation International (tourism development). For P.L. 480 Title II activities, the Cooperating Sponsors are TechnoServe, Catholic Relief Services, and the Adventist Development and Relief Agency. The process to competitively select implementing contractors and grantees is largely completed, with the exception of that of the planned Grades and Standards for Ghanaian Exports activity. Selected Performance Measures: Baseline (1998) Estimated (1999) Target (2000) Target (2001) Government Policy Reform Benchmarks Met All All All All Nominal Values of Selected NTEs $43.5 m $62 m $80 m $100 m Number of Financial Institutions Providing Credit to Microenterprises 2 4 6 8 Foreign Exchange Earnings from Tourism in the Central Region $217,500 $254,000 $274,000 $296,000 U.S. Finance Table (Microsoft Excel file) ACTIVITY DATA SHEET PROGRAM: Ghana TITLE AND NUMBER: Increased Effectiveness of the Primary Education System 641-002 PLANNED FY 2000 OBLIGATION AND ACCOUNT:$5,870,000 (CSD), $6,659,000 (P.L.480 II) PROPOSED FY 2001 OBLIGATION AND ACCOUNT: $5,870,000 (CSD), $6,899,000 (P.L.480 II) STATUS: Continuing INITIAL OBLIGATION: FY 1996 ESTIMATED COMPLETION DATE: FY 2002 Summary: USAID has been closely involved in the reform and revitalization of Ghana's primary education system since the early 1990s. USAID's Quality Improvements in the Primary Schools (QUIPS) program is a six-year activity designed to assist the Ministry of Education (MOE) in improving primary education by (a) establishing 330 Partnership (model) Schools in all 110 districts in Ghana, and (b) revising and implementing key education policies to ensure that the best practices and lessons learned from the Partnership Schools will be widely replicated throughout the primary school system. The QUIPS program is committed to gender equity through the creation of a learning environment free of gender bias. Using a holistic approach, QUIPS builds capacity in the areas of classroom instruction and supervision, school and district management, community empowerment, and monitoring and evaluation. The main beneficiaries of this program will be approximately 132,000 students in the 330 Partnership Schools; the indirect beneficiaries include the rest of Ghana's 3 million primary school children who will benefit as changes introduced become more widespread throughout the system. Other beneficiaries include approximately 3,300 teachers and head teachers along with 750 district education personnel. USAID also supports the primary education sector in Ghana through its P.L. 480 (Food for Peace) Title II food program in 24 districts in Ghana's three northern regions. Approximately half of the P.L. 480 resources are utilized for direct feeding and the other half generates local currency through monetization. The program, which is managed by Catholic Relief Services (CRS), seeks to improve pupils' nutrition through the provision of on-site feeding in over 1,300 primary schools, increase enrollment and retention of girls (take-home food rations to girls with over 85% attendance rate in school), increase community participation in school management, and improve infrastructure (improve buildings, provide desks, build latrines etc.). It complements the QUIPS program in that it supports activities to increase community participation in better schooling at the primary level, it supports a match process whereby community identified needs in the area of school infrastructure are jointly identified and addressed through community resources and external funds, and it initiates "schemes" (plans) that encourage gender balance in school access and participation. QUIPS does not use feeding programs but the gender objective is shared by both Title II and QUIPS. In addition, CRS has recently signed a Cooperative Agreement under the USAID/Ghana Education Program to help implement the Quality Improvement for Primary Schools program in the north. This will include adding such quality improvement activities as in-service training for head teachers, teachers and circuit supervisors and additional work with the communities. As Title II is working through a well-developed network of counterparts in the Ghana Education Service at the District level, it is expected that the new activities will also spread fairly rapidly throughout the region's primary schools. Activities include a process of "listening" to the community through exercises like Participatory Rapid (or Rural) Appraisals (PRA) and providing support to Parent Teacher Associations and School Management Committees in basic financial management skills. The QUIPS program supports the U.S. Mission Performance Plan by contributing to its "Broad-based economic growth" objective. A literate and numerate human resource base is critical to sustain broad-based economic growth and to Ghana's ambition to achieve middle-income country status. The primary education system needs to be reformed and rehabilitated to be able to deliver quality education and to play its proper role in national development. During the coming year, the USAID-supported curriculum guide "Linkages in the Learning Sequence" (LLS), which assists the classroom teacher in operationalizing the primary curriculum, will be finalized. The main focus of the LLS is linking the syllabi in the subject areas of English, Mathematics, Ghanaian Languages, and Integrated Science with the newly developed Environmental Studies syllabus, which focuses on health issues, including HIV/AIDS. Working closely with the Democracy and Governance activity, the QUIPS program will use funding secured under the Education for Development and Democracy Initiative to establish a Ghana Education and Democracy Network. The network will enhance more effective education information sharing within the educational system itself and among civic organizations and educational institutions in the country. Key Results: After two years of interventions, USAID initiated the process of sharing 'good practices' gleaned from Partnership and non-Partnership Schools to school-,district-, and central-level education personnel and development partners through a National Forum to Share Learning. This event initiated a nationwide platform to introduce and disseminate processes and inputs that are making a difference in Ghanaian schools. As a result of this forum, the Ministry of Education itself sponsored a comprehensive public National Education Forum to discuss ways to sustain an effective national education system. Performance and Prospects: The QUIPS program met expectations for 1999. Direct activities were implemented in 45 schools. At the end of the year, 72 other schools (for a total of 117) were selected to join the program. The program is now in all 10 regions of the country. By the end of FY 1999, a total of 29,164 students (46% female) were benefiting from the program. The Partnership School component of QUIPS has three major objectives. The first is to improve the learning environment by strengthening the capacity of local government-District Assemblies-to bolster the Government of Ghana's decentralization program, in which authorities and resources are devolved to levels closer to their final intended beneficiaries. Approximately 330 District Assembly and district education personnel have been trained in administration and financial management under QUIPS. The second objective is to improve the quality of teaching through better classroom supervision and pupil-centered teaching methods. In-service teacher professional development programs were conducted and approximately 350 teachers, 50 head teachers, and 45 circuit supervisors received training in this area. During the upcoming year approximately 770 teachers (44% female) and 130 head teachers will receive in-service training. The third objective is to encourage greater community involvement and participation - Parent-Teacher Associations (PTA) and School Management Committees (SMC) - to ensure active local involvement. Data from the first cohort of schools, which have had two years of interventions, show a community participation rate of 83%, up from an initial assessment of 11% participation rate. During the year, approximately 525 PTA and SMC members were trained in basic financial and school management techniques. The policy reform component of QUIPS focuses on four critical areas: 1) curriculum development; 2) educational personnel management; 3) decentralization; and 4) school data and analysis. Educational policies in these areas that increase district authority and accountability are promoted and incorporated into school and district-level management, financial, and teacher training programs. USAID was the main development partner providing training to the district education sector in the Medium-term Expenditure Framework (MTEF) process which is a new initiative of the Government of Ghana for national resource planning and management. The Ministry of Education (MOE) accepted USAID's suggestion that education-working groups discuss policy and material development in the areas of teaching and learning; management; and access and community participation. As a result of its extensive involvement in the area of curriculum and instruction, USAID is the secretariat for the Teaching and Learning Thematic group. The Access and Community Participation Thematic group recommended the QUIPS-developed SMC/PTA Handbook for use throughout the system. In FY2000, USAID will be engaged in developing its national methodology for transitioning out of direct training, and mainstreaming its activities into a national MOE program. Possible Adjustments to Plans: A two-year extension of the activity will be requested for the following reasons: 1) to mainstream the QUIPS program into a national MOE program and 2) add a third year to the intervention cycle to sustain new strategies and ensure that systems are in place to support them. Other Donor Programs: The Government of Ghana continues to implement its decentralization initiative, with devolution of greater authority to the district level for the administration of schools. Involvement of non-governmental organizations including religious groups in education continues to increase. The British Department for International Development (DFID) has an $85 million program that provides budgetary support to the MOE and complements the quality education approach taken by USAID. The World Bank has undertaken a $50 million Basic Education Investment Program aimed at improving access and quality, particularly in the most impoverished areas. The German aid agency, GTZ, is working on improving the quality of teacher training. The United Nations Children's' Fund program focuses on girls' education and community-based education programs. The European Union continues its financial support for non-wage MOE expenditures. It is expected that the Japanese aid agency, JICA, will begin implementation of its basic education program in FY2000. Principal Contractors, Grantees, or Agencies:QUIPS is implemented by the following U.S. contractors and private voluntary organizations: The Academy for Educational Development (with the Institute for International Research and Aurora Associates); The Mitchell Group (with Harvard Institute for International Development), and the Education Development Center (with CARE and Save the Children), the International Foundation for Education and Self-Help and the American Institute for Research administers the Improving Educational Quality II (IEQ) component. Catholic Relief Services' primary education improvement program, funded with P.L. 480 Title II resources, is complementary to, but not part of, QUIPS. Major Results Indicators: Baseline (1997) Actual (1998) Target (1999) Target (2000) Target (2001) % of teachers using pupil-focused instructional practices in Partnership Schools 15% 15% 20% 35% 55% % of communities active in school decision-making in Partnership Schools 11% 11% 65% 75% 80% No. of schools and communities in Partnership Districts Utilizing Community-School Improvement Plans 0 8 45 75 123 U.S. Finance Table (Microsoft Excel file) ACTIVITY DATA SHEET PROGRAM: Ghana TITLE AND NUMBER: Improved Family Health, 641-003 PLANNED FY 2000 OBLIGATION AND ACCOUNT: $5,900,000 (DA), $9,850,000 (CSD), $2,061,000 (P.L.480 II) PROPOSED FY 2001 OBLIGATION AND ACCOUNT: $9,400,000 (CSD), $8,930,000 (DFA), $1,754,000 (P.L.480 II) STATUS: Continuing INITIAL OBLIGATION: FY 1999 ESTIMATED COMPLETION DATE: FY 2003 Summary: Although many significant improvements in the health of Ghanaian families are underway, critical challenges remain to be addressed through this activity. The under-five mortality rate was estimated at 108 deaths per 1,000 live births in 1998. This represents a 43% drop over the last 20 years, yet one out of every 10 children continue to die before their fifth birthday. Although fertility has declined by two children over the last decade to 4.6 in 1998, there is still a significant unmet need for family planning in Ghana and modern contraceptive use remains low. HIV prevalence (4.6% in 1998) has reached a critical juncture in Ghana. Acceleration of interventions to prevent further spread of HIV is of paramount importance. Two key elements comprise this activity: (1) increased use of reproductive health services, including family planning, safe motherhood and HIV/AIDS/STI (sexually transmitted infections) prevention, and (2) increased use of selected child survival services. The ultimate beneficiaries are children under five years of age who will benefit from a reduction in child mortality and men and women who will benefit from reductions in fertility and the spread of HIV/AIDS. This activity supports the U.S. Embassy Mission Performance Plan by stabilizing population growth, improving human health and reducing the spread of infectious disease. During the upcoming year, USAID will use Child Survival and Disease (CSD) funding to support integrated case management of childhood illness, nutrition education, polio eradication and strengthening of routine immunization. Infectious disease funding will be used for commercial promotion of insecticide-treated materials and disease surveillance, while micronutrient funding will launch Vitamin A supplementation activities nationwide. HIV/AIDS funding will support continued social marketing of condoms, expanded training in syndromic management of Sexually Transmitted Diseases (STDs), behavior change activities with high-risk groups and will be used to launch national Information, Education and Communication campaigns. USAID will use Development Assistance (DA) funds to support improved access to quality family planning services, including expansion of community-based and social marketing approaches and improving the quality of clinical services through capacity building and training a range of health workers in family planning protocols and standards. Key Results: The results of the health program for FY 1999 were mixed. Program developments exceeded expectations in HIV/AIDS/STI prevention and met expectations in child survival. Early data indicate that family planning in term of couple years protection (CYP) fell shy of the target. Factors that contributed to this shortfall include funding constraints for the social marketing program, incomplete implementation of the community-based distribution program, and initial impact of the contraceptive price increases in the public sector. Fertility has declined steadily in Ghana from 6.4 in 1988 to 5.5 in 1993 and to 4.6 in 1998. This decline is only partially due to increasing contraceptive use. Modern contraceptive use rose from 5% in 1988 to 13.3% in 1998. Other factors that appear to have influenced fertility in Ghana include declining nuptiality and polygamy, increasing age of marriage and first birth, and relatively low frequency of sexual intercourse. Ghanaian women have narrowed the gap between desired and actual number of children, but there remains a high level of unmet need for family planning. USAID's emphasis on increased access to quality services is essential to ensure that women can achieve their desired level of childbearing through safe and voluntary methods of family planning. The Ghana Demographic Health Survey (DHS) revealed a nearly universal awareness of HIV/AIDS in Ghana, but a low perception of risk and limited behavior change. Although sentinel surveillance data for HIV prevalence in 1999 are not yet available, program developments in 1999, including advocacy and policy development, have exceeded expectations. For child health, the 1998 DHS documented a continued steady increase in immunization coverage. Preliminary service statistics indicate that this trend continued in 1999. DHS findings also revealed the need for increased attention to quality of care for the sick child (both in the home and at health facilities), nutrition and malaria prevention. USAID's child health program evolved significantly during 1999 and will help address these needs. Performance and Prospects: During 1999, USAID in partnership with other donors succeeded in elevating the level of attention paid to HIV/AIDS. A mission of the International Partnership Against HIV/AIDS in Africa, which included USAID representation, resulted in increased political commitment at the highest level and has begun to generate a multi-sectoral response to the epidemic. USAID has also supported the Government with development of a national HIV/AIDS policy, which is now in draft form and which will be vetted and finalized with input from a variety of stakeholders in the coming year. Throughout 1999, the computerized AIDS Impact Model (AIM) has been shown to Parliamentarians, regional and district level leaders, religious groups and other government ministries to effectively advocate for an intensified response. USAID's targeted behavior change activities with the police and miners were accelerated during 1999 and over 200 physicians and medical assistants were trained in syndromic management of STIs. During the upcoming year, USAID will continue to support the above activities and will launch a major multi-media campaign against HIV/AIDS. During 1999, the child health program further evolved with the initiation of a number of key activities. IMCI (Integrated Management of Childhood Illness) was officially launched in a national workshop and USAID took the lead in supporting the Ministry of Health's adaptation and development of technical protocols. IMCI training will be launched during late FY2000. USAID also spearheaded the Roll Back Malaria Initiative in Ghana with a unique public-private sector partnership led by the Ministry of Health (MOH), and including representatives from USAID, UNICEF, WHO and the commercial private sector. USAID recently awarded a Grant to the Ghana Social Marketing Foundation (GSMF) to manage this effort and to launch the campaign to promote the use of bednets. USAID also provided technical assistance to develop strategies for vitamin A supplementation in the seven southern regions of Ghana. Implementation will be supported through a grant to UNICEF. USAID support will also enable UNICEF to expand the cold chain nationwide and strengthen social mobilization activities for immunization in the under-served northern regions. USAID supported capacity building of NGOs in community-based nutrition education and USAID is also supporting the Government to update integrated materials for community-based education on a wide range of maternal and child health issues. These materials will be finalized and produced early next year. In the area of family planning, early reports on contraceptives distributed during 1999 indicate a slight decrease in couple years' protection (CYP) provided nationwide from 596,000 in 1998 to approximately 590,000 in 1999. A closer look reveals that the results for the three major implementing agencies varied. The Planned Parenthood Association of Ghana (PPAG) was the only agency to achieve an overall increase in contraceptives distributed. PPAG was also the first to begin implementing the intensified community-based approach being promoted by USAID and its is through these activities that the increases were achieved. Although CYP levels for the MOH remained constant from 1998, public sector officials at all levels have reoriented their thinking and are now fully committed to expanding access to basic health services at the periphery through community-based approaches. With support from USAID, the Ministry has clearly documented and disseminated information on the successful community-based health and family program in Navrongo Health Research Center. The Mission's health team is assisting with the planning and analyses necessary to ensure a successful and sustainable replication of the Navrongo model to other parts of the country. For both the MOH and PPA, CYP figures indicate a decline in the fourth quarter of FY 1999. This may be due to contraceptive price increases implemented in July 1999. Further analysis and close monitoring of this issue are underway. The Ghana Social Marketing Foundation (GSMF) experienced a 9% decline in contraceptive sales between FY1998 and FY1999. A temporary set-back was due to a delay in FY1998 funding which in turn led to the absence of brand advertising and information, education and communication activities during late 1998 and early 1999. During this period USAID decided to assess GSMF's program to better understand the sales dynamic. Although overall evaluation findings were positive, they included some strategic and technical recommendations, which will improve marketing, increase distribution outlets and increase contraceptive sales. Funds began flowing again in late August and third quarter reports showed early signs of a turnaround in sales. During the upcoming year, distribution networks will be strengthened, training of salespersons will be intensified and communication activities will be more targeted to address constraints identified through the DHS (e.g., side effects and misconceptions). Contraceptive sales are expected to increase significantly as a result of these efforts. Possible Adjustments to Plans: USAID continues to refocus its family planning program from an emphasis on policy to increased access to quality services, especially in under-served areas. In line with this shift, PPAG, AVSC and GSMF have developed follow on programs that have just begun or will be initiated in early 2000. The MOH is developing a plan for nationwide expansion of the community-based Navrongo model. HIV prevention and child survival activities are now being brought to scale. Other Donor Programs: The health sector is a top priority for the Government of Ghana and the focus of a major sector reform effort that emphasizes decentralization. Between 1995 and 1997, there was an 18% real term increase in annual expenditures on health. The Government works closely with several "common account" donors including the World Bank, the United Kingdom, the European Union and Denmark. Outside of the common account, USAID is the largest health donor and contributes significantly in the key areas of reproductive health and child survival. Principal Contractors, Grantees or Agencies: This activity is implemented through the Government of Ghana; U.S. private voluntary organizations, including Africare and AVSC International; private non-profit Ghanaian associations and local non-governmental organizations, including Planned Parenthood Association of Ghana, the Ghana Social Marketing Foundation and the Ghana Registered Midwives Association; and Cooperating Agencies, including INTRAH, Family Health International, John's Hopkins University, Macro International, BASICS, Linkages and others. Selected Performance Measures: Baseline (1993) Actual (1998) Estimated (1999) Target (2000) Target (2001) Total Fertility Rate1 5.5 4.6 4.5 4.4 4.3 Modern Contraceptive Prevalence2 10.1cm 13.3 14 15 16.5 HIV prevalence 3 2.36 4.6 4.8 5-8% 6-9% Condoms Distributed (millions) 4.3 10.1 9.4 12 13.5 Infants Immunized with DPT34 57 68 70 71 72 Exclusive Breastfeeding - 17(b) 19 22 24 1 Targets were adjusted based on 1998 DHS finding that at 4.6, fertility had already dropped below the 2000 target of 5.0. 2 Targets were adjusted downward based on 1998 DHS finding and an evaluation of the previous project that found the previous targets were over ambitious. 3 Target is consistent with maintaining a declining rate of increase in the spread of AIDS at less than 1% per year. 4Targets have been adjusted upward as actual data for 1998 surpassed target of 63% by 2000. U.S. Finance Table (Microsoft Excel file) ACTIVITY DATA SHEET PROGRAM: Ghana TITLE AND NUMBER: Public Policy Decisions Better Reflect Civic Input, 641-004 PLANNED FY 2000 OBLIGATION AND ACCOUNT: $1,301,000 (DA) PROPOSED FY 2001 OBLIGATION AND ACCOUNT: $1,500,000 (DFA) STATUS: Continuing INITIAL OBLIGATION: FY 1997 ESTIMATED COMPLETION DATE: FY 2003 Summary: The purpose of this activity is to amplify the effectiveness of civil society and elected institution at the local and national levels - not only strengthening their independence, but also enhancing their ability for interaction. The result is a better policy-making environment that strives to incorporate the interests of civil society, members of Parliament (MPs) and local assemblies, and local/national officials with those of the executive branch. This activity was recently revised to focus more directly on the core problem of executive branch policy domination. While citizens of Ghana are the ultimate beneficiary of this program, the immediate beneficiaries are the 200 MPs, as well as over 700 officials of local government and leaders of civic interest organizations in 20 of Ghana's 110 district assemblies (DAs), who are mandated to carry out their representative function and to craft national and local policies. This activity includes the following elements: (1) Enhanced Effectiveness of Parliament to Represent Citizen Interests; (2) Improved Effectiveness of Local and National Civil Society Organizations to Influence Policy; and (3) Local Government Decision-Making Processes are More Participatory. USAID's Democracy and Governance goal is based on the premise that broad-based participation and democratic processes are integral elements of sustainable development. Effective democracy requires transparent and accountable government, open access to and use of information, and participation by citizens in the policy-making process. The U.S. Mission's goal in Ghana is to support the consolidation of Ghana's democratic institutions and contribute to the development of a healthy civil society, while promoting respect for human rights and rule of law. The U.S. supports democracy in Ghana because democracy is a core national value and because it creates a climate in which our other national interests can flourish. The USAID program is a integral component of the U.S. Mission approach to strengthening the role of civil society and building capacity in institutions of governance including those institutions that ensure free and fair elections in the year 2000 and beyond. Strengthening both national and local representative assemblies and the role of civil society in influencing policy will help to reduce the excessive influence of the executive branch. The Mission's democracy and governance program objectives are: (1) to develop an understanding by civil society organizations (both national level and local level) of the policy-making process and to expand their ability to advocate their position through public participation; and (2) to enhance the ability of Parliament to play an effective role in the legislative process. Key Results: Overall results are being achieved at the levels expected. Targets were met or exceeded for two of the three indicators. While the target for the indicator "percentage of local governmental decisions in project districts reached through participatory mechanism" was not attained, the results were significant. This indicator increased from 4% in baseline year to 35% (vs. 50% target) for civil society leaders and 21% baseline year to 33% (vs. 85% target) for district officials. The indicator for the legislative strengthening component (percentage and number of legislative initiatives by MPs) was met. Performance and Prospects: The program for legislative strengthening/national civil society organization participation focuses on: (1) strengthening the parliament committee structures, (2) enhancing parliamentary committee knowledge of substantive issues through research and analysis, and (3) increasing public input into legislation through hearings. Training activities have been expanded during the past year and have focused on training of parliamentary staff in the areas of research and drafting of legislation. There has been a marked increase in the number of motions introduced by Members of Parliament. In 1999 there were a total of 8 private member motions, up from 1 in 1998. In Ghana where the majority party dominates the political scene through a strong executive branch and their overwhelming majority in Parliament, minority party members introduce these motions as a means to debate important issues, raise public awareness, and improve transparency and increase executive branch accountability. Support is also being provided to consolidate decentralized democratic governance in Ghana. A program that has fostered a collaborative problem-solving relationship between District Assembly officials (local government) and civic leaders has been completed. Over 325 local officials and 420 leaders representing 226 civic interest organizations were trained under this program. The outcome was the formation of joint boards in 20 of Ghana's 110 districts consisting of District Assembly officials and civic leaders. These boards are responsible for setting priorities, establishing criteria for district development grants and ultimately grant approval. Women accounted for 34% of the civic interest participants. Interest is being shown by other donors in replicating this model in districts not served by the USAID program. Possible Adjustments to Plans: Declining USAID resources for the democracy and governance sector has resulted in prioritization of planned program activity. Support for strengthened non-government organization (NGO) advocacy will be curtailed, but the program to strengthen the parliamentary staff and committee system will continue. Initially, USAID had anticipated working with 30 district assemblies; however, funding constraints will limit assistance to 20 districts. This activity will focus on the application of information technology, which is part of the Education for Democracy and Development Initiative (EDDI). This new initiative will improve communication efficiency and improve access to information for democratic and educational institutions including those that promote enhanced accountability and improved transparency and foster an anti-corruption environment. USAID/Ghana will be requesting an extension of the Country Strategic Plan by two years through FY 2003 to enable activities under this new initiative to be implemented. Other Donor Programs: Canada, Denmark, Germany, Great Britain, World Bank and the European Commission (EC) figure prominently among donors involved in democracy and governance activities. Canada, Denmark, Germany and the EC are supporting local government capacity building in districts that are not included in USAID's activity. Most donors support various civic interest organizations involved in advocacy, media, and human rights with grants and training. Individual donor programs are in the range of $1-3 million per year, representing 3% to 7% of donor annual assistance programs. Matters pertaining to corruption, transparency, and increased accountability are of increasing interest to the donor community as these issues impact on the broader donor development assistance programs. This topic was discussed at the most recent GOG/Donor Consultative Group meeting in November and efforts are underway to identity an appropriate role for the donors in supporting Ghanaian-led initiatives in this area. Principal Contractors, Grantees, or Agencies: The National Democratic Institute and the International Foundation for Elections Support are the two main grantees for this program. A training program with Georgetown University was truncated this year due to funding constraints. Selected Performance Measures: Baseline (1997) Actual (1998) Target (1999) Target (2000)1 Percentage of legislation amended. 56% 67% 75% 75% Number of initiatives proposed by MPs. 0 1 2 4 Percentage initiatives that reflect civic input. 33% 50% 65% 70% Percentage of local government decisions reached through participatory mechanisms.   as reported by CSO leaders   as reported by DA officials 4% 21% 38% 33% 50% 85% 60% 85% Percentage of participating CSOs who report initiating contact with DA officials to advocate on behalf of their cause. 45% 60% 90% 90% 1 The Ghana Country Strategy extension is pending approval. Targets for 2001 will be set based on this approval. U.S. Finance Table (Microsoft Excel file)

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