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SENEGAL
Activity Data Sheet
>> AFR Regional Overview >> Senegal Overview PROGRAM: SENEGAL
TITLE AND NUMBER: Increased and Sustainable Use of Reproductive Health (Child Survival, Maternal Health, Family Planning, and Sexually Transmitted Infections/AIDS) Services in the Context of Decentralization in Targeted Areas, 685-003
STATUS: Continuing
PLANNED FY 2001 OBLIGATION AND FUNDING SOURCE: $3,255,000 (DA); $9,466,000 (CSD)
PROPOSED FY 2002 OBLIGATION AND FUNDING SOURCE: $3,162,000 (DA); $8,302,000 (CSD)
INITIAL OBLIGATION: FY 1998 ESTIMATED COMPLETION DATE: FY 2006Summary: Social services in Senegal remain extremely limited, particularly in the rural areas where access to health structures is especially difficult for women and children. Maternal mortality is high (510 per 100,000 live births), and use of family planning is low (only 7.1% of women use modern contraception. Senegalese women bear an average of five children each. Although significant improvement has occurred in survival rates of children over the past two decades, recent studies indicate a slight increase in child mortality. This alarming reversal is likely linked with decreased vaccination coverage before the first birthday, from a peak of 61% in 1995 to 51.8% in 2000. With Senegal's success in holding HIV prevalence to 1.4%, life expectancy has remained steady at 52 years, with half of the population under 18 years old.
This general description does not reflect the vast difference in health status between urban and rural populations in Senegal. In 1999, child mortality in the rural areas was twice that in the urban areas and contraceptive prevalence of modern methods among married rural women was only 3.3% as opposed to 17.5% in urban areas.
Implemented in the context of Senegal's decentralization policy, USAID's program focuses on increasing the participation of local communities in planning and financing health services and on developing more effective and innovative approaches to improving the quality of health care. It seeks to improve reproductive health (RH) services through increased local participation in setting priorities and in financing activities, through more effective and innovative approaches, with the ultimate goal of increasing demand for, and use of, these services. SO activities directly benefit (a) persons of reproductive age; (b) children under five; (c) groups with high-risk sexual behavior; (d) health care providers; and (e) local communities, grassroots organizations, NGOs, and political and religious opinion leaders. The SO intends to cover 29 health districts whose residents comprise 60% of Senegal's population. The program contributes to the Mission Performance Plan's health and population goals.
In FY 2001, $1,683,000 in child survival and maternal health funds under the Child Survival and Diseases (CSD) account will be used to reinforce vaccination programs (EPI) and to expand the Integrated Management of Childhood Illnesses (IMCI) and Minimum Integrated Nutrition Package (MINPAK). $4,302,000 in HIV/AIDS funds within the CSD account will be used for condom social marketing, information, education, and communication and policy dialogue, sero-surveillance and sexually transmitted infection (STI) prevention and treatment. $3,481,000 in infectious diseases funds will support malaria prevention targeted at children and pregnant women and TB treatment linked to HIV/AIDS prevention and care. $3,255,000 in population funds under the Development Assistance (DA) account will be used to increase access to and use of family planning (FP) and prenatal services. CSD and DA funds contribute proportionately to local level matching funds used to support integrated health plans and capacity building in targeted districts.
In FY 2002, $8,302,000 in CSD is requested to target care and support activities for families affected by AIDS; increase efforts to integrate health financing, child survival, maternal health, FP, and STI/AIDS at the local level; and expand the health care financing program to all 29 health districts in the country. $3,162,000 in DA is requested in support of family planning activities.
Family planning agreements under this notification will incorporate clauses that implement the President's recent directive reinstating the Mexico City Policy.
Key Results: The key results achieved through this strategic objective during FY 2000 include: improved access to quality reproductive health (RH) services; increased demand for quality RH services; and increased financing of health services from internal sources.
Decentralization reforms are intended to increase resources for local-level health services and improve the efficiency of their use by transferring the responsibility for managing health funds to local governments and encouraging local financing to augment health facility budgets. With the incentive of USAID matching funds, local governments' contributions of their own tax revenue to health activities have increased steadily since 1998 and exceeded the 2000 target. Local government units (LGUs) in the first group to receive matching funds contributed tax revenues equaling 7.7% of the health district's annual operating budget in 1998 and 11.7% in 2000; and LGUs in the second group contributed 13.1% in 2000. The relatively rapid adoption of this new concept is a result of increased awareness among LGUs that providing better quality health services for their constituents can pay political dividends.
A key component of Senegal's HIV/AIDS prevention program has been condom promotion targeting high-risk groups. USAID's social marketing program ensures that "PROTEC" condoms are widely available, affordable, and conveniently accessible as an easy choice for HIV and STI prevention. The 17.5% increase in the number of private sector sales points between 1998 and 2000 denotes impressive growth in the accessibility of and demand for condoms. Traditional sales points, i.e. pharmacies, continued to sell the majority of condoms, whereas the non-traditional sales points showed significant growth in their market share of condom sales: while their number of sales points increased by 13%, their condom sales rose by 47%.
Family planning (FP) has suffered from a three-year strike by health workers on data collection and dissemination that compromised contraceptive logistics management and led to frequent stock-outs. During the same period, USAID's program was in transition and FP activities were significantly reduced. For FY 2000, the indicator on couple-years of protection (CYP) is presented as a baseline figure, since USAID is now aggressively implementing FP activities. Despite the challenging circumstances of the data strike and decreased activities during the transition period, overall CYP levels increased by 6% in 2000. The largest increases came from condoms and Norplant. During the last three years, condoms' contribution to overall CYP levels has been significant.
In 1999, the Ministry of Health (MOH) initiated for the first time a series of micro-nutrient activities in conjunction with the third campaign of National Immunization Days against poliomyelitis, at which time children received the first dose of Vitamin A supplementation. Six months later, in June 2000, the MOH organized a subsequent round of micro-nutrient days to administer the second dose. During both events, USAID financed information and education activities at national and district levels to encourage participation. During the second round, USAID actively supported the development and implementation of operational plans at the district level with medical teams and community groups. The indicator on Vitamin A supplementation from UNICEF's multi-indicator cluster survey showed that 80.4% of children 6-59 months had received two doses within the previous six months.
Performance and Prospects: Overall, the use of reproductive health services is increasing. Family planning has continued its slow but steady ascent, particularly in urban areas: 18% of women in urban areas were using modern contraceptive methods in December 1999, representing a 48% increase within five years. During FY 2000, USAID's child survival activities generated intense demand for two new key areas of prevention - malaria protection and vaccinations - for which interventions are planned beginning in FY 2001. HIV/AIDS prevalence in Senegal remains remarkably low in relation to neighboring countries. Successful HIV/AIDS prevention activities are being reinforced by an expanded network of voluntary counseling and testing centers that are key to sustaining Senegal's low prevalence rate. USAID is also supporting targeted care and support services for families affected by AIDS.
Because many health reforms dictate that planning and financing of health services take place at the community level with locally elected officials, medical personnel, and community groups, USAID interventions must operate in the same context in order to have sustainable impact. As such, USAID's four partners in health financing, child survival, maternal health, FP, and STI/AIDS coordinated their activities in community outreach and technical training with their common counterparts. This offered both a time- and cost-efficient approach to local level interventions and also reflected more closely the integrated nature of health care service delivery at the periphery.
Future success of the strategy depends upon both management and programmatic factors. On the management side, effective collaboration among all partners is essential as they work towards integrating activities at the local level. USAID will continue its efforts to build the foundation for sustainable and productive collaboration. On the program side, more effort must be made to include women in local level planning, implementation, and evaluation. To overcome the cultural, economic, and political barriers to real participation by women, USAID's ENABLE project is identifying selected cross-cutting activities to reinforce and empower women to truly engage in and benefit from the health program.
The ultimate program goal is ownership by community, health, political and special interest groups of sustainable activities at the local level. In 2000, eight health districts were enrolled in the health care financing program; by 2003, all 29 health districts will be participating. The MOH has recommended that USAID share its health financing approach with other donors to encourage them to adopt it in their respective intervention zones. Any reduction in budget allocations will compromise USAID's ability to effectively cover the targeted intervention area, thus preventing the achievement of program results. In addition, continued financing will be key to providing a national response to reinforce HIV/AIDS prevention and support in order to maintain Senegal's low HIV prevalence.
Possible Adjustments to Plans: No adjustments to this program are foreseen at present.
Host Country and Other Donors: About twenty other bilateral and multilateral donors, including the World Bank, Japan, France, and the European Union also contribute to the health sector in Senegal. Over the 1998-2002 period, it is estimated that the Government of Senegal will cover about 60% of the planned health budget by providing human and material resources, while donors will fund about 30% of the budget, mostly for preventive health and family planning. Cost-recovery systems are expected to contribute the remaining 10%.
Principal Contractors, Grantees or Agencies: Long-term technical assistance partners for the next five years are: Management Sciences for Health for FP and maternal health activities; Family Health International for prevention and treatment for AIDS; Development Associates Inc. for decentralized health financing; and Partnership for Child Health Care for child survival activities.
FY 2002 Performance Tables
Performance Measures:
Indicator FY97 (Actual) FY98 (Actual) FY99 (Actual) FY00 (Actual) FY00 (Plan) FY01 (Plan) FY02 (Plan) Indicator 1: Contribution of local governments in the first cohort to the annual operating budget of health districts NA 7.7 8.7 11.7 9.5 10.5 11.5 Indicator 2: Number of private sales points of PROTEC condom-brand NA 1746 1915 2052 2000 2114 2175 Indicator 3: % of children 6-59 months receiving vitamin A supplementation in the previous six months NA NA NA 80.4 NA N/A 85 Indicator 4: Couple-Years of Protection 186600 192362 190322 201521 196084 216546 234345 Indicator Information:
Indicator Level (S) or (IR) Unit of Measure Source Indicator Description Indicator 1: IR Percent of the annual operating budget of health districts PHR [1998-1999]; Development Associates Inc. (DA) [2000]; USAID [00-02] The operating budget includes the recurrent expenses for telephone, drugs, electricity, fuel, water, training, supervision, office supplies, maintenance, personnel, and miscellaneous. The health district is defined as an administrative and technical structure that groups together a set of satellite health huts and heaalth posts around a health center to provide services to a defined geographical area of roughly 100,000-150,000 population. The actual 2000 figure is greater than the planned contributions for 2001 and onward. Yet, it might be wise to keep them one year more to ascertain that the process is institutionalized. Indicator 2: IR Number of sales points Activity Reports from the Agency for the Development of Social Marketing (ADEMAS) PROTEC is a condom brand that was introduced in the national network of pharmacies in April 1995. In June 1997, its distibution system was extended to non pharmaceutical sales points in the private commercial sector. These non pharmaceutical sales points are in urban and peri-urban areas throughout Senegal. They include coffee shops, bars, restaurants, bus stops, hotels, night-clubs, supermarkets, hair salons, cosmetics shops, telephone kiosks, and gas station-based minimarkets. Indicator 3: SO Percent of children 6-59 months old UNICEF, Multiple Indicator Cluster Survey (MICS) "To measure vitamin A supplementation coverage, every other year, USAID will track the percentage of children 6 - 59 months of age receiving vitamin A supplementation in the previous six months." Indicator 4: SO Couple-Years of Protection Ministry of health [1997-1999] Contraceptive Procurement Tables (CPTs) and Contraceptive Logistics Reports from DELIVER [2000 - 2002] Estimated number of couples protected against pregnancy for one year, based on contraceptive distribution to MOH facilities, Non Government Organizations (NGOs) such as ASBEF and SANFAM, social marketing, and AIDS program. Estimations are based on the current CYP conversion factors: IUD (1 unit = 3.5 CYP); Condoms (120 distributed = 1 CYP); Depo (4 injections = 1 CYP); Vaginal Foaming Tablets (120 units = 1 CYP); Norplant (1 unit = 3.5 CYP); and Oral pills (15 units = 1 CYP).
U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 16,609 DA 9,345 DA 7,264 DA 12,641 CSD 6,392 CSD 6,249 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 27,270 DFA 26,895 DFA 375 DFA Fiscal Year 2000 2,700 DA 5,434 DA 6,780 CSD 5,342 CSD 0 ESF 0 ESF 0 SEED 0 SEED 0 FSA 0 FSA 0 DFA 97 DFA Through September 30, 2000 19,309 DA 14,779 DA 4,530 DA 19,421 CSD 11,734 CSD 7,687 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 27,270 DFA 26,992 DFA 278 DFA Prior Year Unobligated Funds 0 DA 120 CSD 0 ESF 0 SEED 0 FSA 0 DFA Planned Fiscal Year 2001 NOA 3,255 DA 9,466 CSD 0 ESF 0 SEED 0 FSA 0 DFA Total Planned Fiscal Year 2001 3,255 DA 9,586 CSD 0 ESF 0 SEED 0 FSA 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 3,162 DA 9,546 DA 35,272 DA 8,302 CSD 12,761 CSD 50,070 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 27,270 DFA
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Last Updated on: May 29, 2002 |
