USAID: Ethiopia FY 2002 Congressional Budget Justification

PROGRAM: ETHIOPIA
TITLE & NUMBER: Improved Family Health, 663-008
STATUS: New
PLANNED FY 2001 OBLIGATION AND FUNDING SOURCE: $11,470,000 CSD, $4,650,000 DA
PROPOSED FY 2002 OBLIGATION AND FUNDING SOURCE: $12,803,000 CSD, $4,652,000 DA
INITIAL OBLIGATION: FY 2001 ESTIMATED COMPLETION DATE: FY 2006

Summary: Ethiopia's health status is among the lowest in the world. Approximately one-fifth of Ethiopian children die before their fifth birthdays, primarily from a combination of acute respiratory infection, diarrhea, malaria, measles and malnutrition. The HIV-positive population is almost three million, while Ethiopia already has 750,000 AIDS orphans. The corresponding increase in active AIDS cases could potentially overwhelm an already burdened health care system. Other infectious diseases (tuberculosis and malaria) are major health and development problems, accounting for most adult deaths. At the same time, with a 2.76% growth rate, Ethiopia is the second most populous nation in sub-Saharan Africa with an estimated population of 64 million. The contraceptive prevalence rate is estimated at 8%, and current surveys register a high level of unmet family planning needs.

This new strategic objective (SO) builds on achievements of SO 2, Increased Use of Primary and Preventive Health Care Services, and integrates USAID activities into the Government's Health Sector Development Program. The primary goal is to improve family health by promoting preventive primary health care. To reach this goal, USAID will use an integrated set of interventions in child survival and nutrition; infectious diseases, including HIV/AIDS; reproductive health (including family planning); and health-sector financing reform. The beneficiaries will be Ethiopians at high risk of suffering from disease and malnutrition, especially children and mothers.

Child Survival and Diseases (CSD) funds will support child survival interventions, on-going primary health care programs, health care reform, and programs combating polio and other infectious diseases. It will also provide HIV prevention services and target interventions for the care and support of people affected by HIV/AIDS.

Development Assistance (DA) funds will finance contraceptive procurement and reproductive health services in rural areas. These efforts will focus on the provision of family planning services, including behavior change and communication activities. These funds will also finance demographic health survey support, the monitoring and evaluation of reproductive health services, and research in maternal health. Other DA-funded activities support improvement in the policy environment for implementing family planning programs and in the Government's capacity to deliver quality family planning services.

Agreements under this notification will incorporate clauses that implement the President's recent directive reinstating the Mexico City Policy.

Key Results: The Government has continued to increase the level of public resources available for preventive primary health care by an average of 11% annually. By FY 2006, CSD resources will have decreased stunting (low height for age) among children 6-24 months. DA funds will be used to increase the contraceptive prevalence rates.

Performance and Prospects: The Government has become proactive in dealing with the HIV/AIDS pandemic. Local non-governmental organizations (NGOs), faith-based organizations, other donors and the military have initiated an aggressive program to prevent the spread of HIV/AIDS. In FY 2000, USAID funded faith-based organizations such as the Ethiopian Orthodox Church and the Islamic Council in the fight against HIV/AIDS. To date, the program has reached an estimated 10 million Ethiopians. As the majority of Ethiopians belong to the Ethiopian Orthodox Church, the potential to reach higher numbers in the coming year is significant. USAID has also undertaken advocacy activities resulting in an increased awareness and commitment by high-level policy makers, including the President of Ethiopia.

To date, performance in improving reproductive health has been encouraging. The Ministry of Health's service statistics indicate a steady increase in the national contraceptive prevalence rate (CPR) from 4% in 1995 to a current level of 8%. In CY 2000, social marketing initiatives sold over 49 million condoms and over one million cycles of oral contraceptives, both of which contribute to the increased CPR. In one focus area, a reproductive health NGO supported by USAID showed a contraceptive prevalence rate increase from a baseline of 12% in 1996 to 44% in 2000.

USAID-funded activities will support Government efforts to mobilize and increase resources to the health sector, particularly to preventive primary health services, and will promote equitable access to, and quality of, health services. Within the public sector system, USAID will strengthen health services management, logistics systems, information, education and communications, monitoring and evaluation, and health management information systems. Improving management of increased resources to the health sector will have a direct impact on the access, quality and utilization of services, leading to better family health. Strengthening public health training institutes and regional training centers will also improve service delivery.

This SO will use FY 2001 CSD resources ($381,000 Child Survival) to increase the use of proven child survival interventions including nutrition, to improve the quality of child survival services and to promote optimal infant breast feeding practices. Other activities will implement micronutrient programs with an emphasis on Vitamin A and support the polio eradication initiative ($2,600,000 Child Survival - Polio). The SO will assist Government implementation of their infectious disease programs ($1,805,000 Infectious Diseases). Prevention of HIV/AIDS will be addressed by strengthening HIV/AIDS surveillance systems, providing services and supporting behavioral change and communication programs ($6,184,000 HIV/AIDS). In addition, a program will train 40 NGOs to increase their capacity for innovative service delivery for orphans, displaced street children, and other populations affected by HIV/AIDS ($500,000 HIV/AIDS-Vulnerable Children).

FY 2001 CSD resources and will also aim at surveillance, epidemic preparedness, and early detection in the treatment of other selected infectious diseases (tuberculosis, malaria, and polio), activities. For example, the Polio/Expanded Program of Immunization (EPI) supports polio eradication programs through the strengthening of routine EPI. Other activities promote integrated disease surveillance by strengthening the capacity of regional laboratories and linking them to the integrated surveillance system.

DA funds ($4,650,000 Population) will finance contraceptive procurement and reproductive health services. Funding of NGO networks will improve the quality of reproductive health services in rural areas by provision of family planning services, including behavior change and communication activities. These funds will also finance demographic health surveys, monitoring and evaluation of reproductive health programs and research in maternal health and HIV/AIDS. Other activities will improve the policy environment for implementing family planning programs and the Government's capacity to deliver family planning programs.

FY 2002 CSD ($12,803,000) and DA ($4,652,000) funds are requested to improve family health in Ethiopia through interventions in child survival, reproductive health, HIV/AIDS and other infectious diseases, and health-sector capacity building. To address the high levels of infant and under five mortality and morbidity, funding will support improved access to immunizations, access to integrated management of childhood diseases and improved feeding practices. Sub-grants to indigenous non-governmental organization (NGO) activities will help increase the availability of family planning services, while social marketing will expand the distribution of condoms and oral contraceptives. Capacity building is a critical element for achieving sustainable health care delivery, thus funding for training, commodity procurement and technical assistance will be provided. HIV and infectious disease awareness activities have a cross-sector approach. Agricultural cooperatives will have access to, and promote condom use; education programs will increase awareness of transmission risks and general prevention mechanisms, and NGO capacity strengthening will include innovative HIV/AIDS service delivery for targeted populations. FY 2002 DA population funds will support high impact reproductive health interventions, including maternal nutrition, and mobile clinics.

Host Country and Other Donors: USAID works collaboratively with the Government and other donors to implement an ambitious $600 million Health Sector Development Program. Other major donors in the health sector include the World Bank, African Development Bank, the Netherlands, Ireland, Sweden, Norway, UNICEF, the United Nations Family Planning Association and the World Health Organization (WHO). The United States is the largest bilateral donor to this sector, followed by Italy and the Netherlands. WHO and UNICEF are the two major international organizations supporting this sector.

Principal Contractors, Grantees and Agencies: USAID/Ethiopia's principal partners are John Snow International, Pathfinder, Population Service International, and the Consortium of Family Planning NGOs in Ethiopia. Participating Agencies Collaborating Together (Pact) receives assistance to strengthen NGOs that deliver health services.

Selected Performance Measures: This is a new Special Objective. Performance measures are to be developed as the new program is implemented.

U.S. Financing

(In thousands of dollars)

	Obligations		Expenditures		Unliquidated
Through September 30, 1999	0	DA	0	DA	0	DA
	0	CSD	0	CSD	0	CSD
	0	ESF	0	ESF	0	ESF
	0	SEED	0	SEED	0	SEED
	0	FSA	0	FSA	0	FSA
	0	DFA	0	DFA	0	DFA
Fiscal Year 2000	0	DA	0	DA
	0	CSD	0	CSD
	0	ESF	0	ESF
	0	SEED	0	SEED
	0	FSA	0	FSA
	0	DFA	0	DFA
Through September 30, 2000	0	DA	0	DA	0	DA
	0	CSD	0	CSD	0	CSD
	0	ESF	0	ESF	0	ESF
	0	SEED	0	SEED	0	SEED
	0	FSA	0	FSA	0	FSA
	0	DFA	0	DFA	0	DFA
Prior Year Unobligated Funds	0	DA
	0	CSD
	0	ESF
	0	SEED
	0	FSA
	0	DFA
Planned Fiscal Year 2001 NOA	4,650	DA
	11,470	CSD
	0	ESF
	0	SEED
	0	FSA
	0	DFA
Total Planned Fiscal Year 2001	4,650	DA
	11,470	CSD
	0	ESF
	0	SEED
	0	FSA
	0	DFA
			Future Obligations		Est. Total Cost
Proposed Fiscal Year 2002 NOA	4,652	DA	30,595	DA	39,897	DA
	12,803	CSD	60,327	CSD	84,600	CSD
	0	ESF	0	ESF	0	ESF
	0	SEED	0	SEED	0	SEED
	0	FSA	0	FSA	0	FSA
	0	DFA	0	DFA	0	DFA

ETHIOPIA

Activity Data Sheet

U.S. Financing