USAID: West Africa Regional FY 2002 Congressional Budget Justification

Program: WEST AFRICA REGIONAL
Title and Number: Increased Use of Selected, Regional Reproductive Health, HIV/STI, and Child Survival Services and/or Products in the WCA Region, 624-001
Status: Ending
Planned FY 2001 Obligation and Funding Source: $0
Proposed FY 2002 Obligation and Funding Source: $0
Initial Obligation: FY 1995 Estimated Completion Date: FY 2001

Summary: Despite significant improvements in the heath status of the population over the past thirty years, the West and Central Africa (WCA) region continues to face serious public health problems. As populations continue to grow at a rate that will see the total regional population double over the next 25 years, the health situation will worsen. Since diseases do not respect national borders, progress achieved to date can be easily overwhelmed by the impact of migration and the spread of HIV/AIDS.

The Family Health and AIDS in West and Central Africa activity (FHA) contributes to the achievement of USAID Agency goals in global health and State Department goals to improve access to HIV/AIDS prevention, health education, sanitation and the utilization of family planning and child survival services and products in this region.

Focusing on critical transnational issues, FHA tests new and innovative service delivery models mainly in the urban centers of Burkina Faso, Cameroon, Côte d'Ivoire and Togo, while at the same time promoting institutional capacity building among both public and private sector African institutions. FHA also works in close coordination with USAID bilateral programs and other bilateral and multilateral donors working in the region to promote program collaboration, the exchange of technical information and best practices, and more effective disbursement and use of available resources.

Using DA funds, FHA has supported the ongoing development of quality family planning and related reproductive health services in 206 principal demonstration sites through social marketing and community outreach programs in the service delivery countries. DA funds have also been used to support exchange of lessons learned and the replication and adaptation of key tools and approaches, such as the reproductive health pre-service training module, in the region.

CSD account funds have been used to: 1) support health systems development through improved capacity of national and regional partner institutions to plan and manage the implementation of health services; 2) support the distribution of oral rehydration salts (ORS) and all related information, education and communication (IEC) activities towards the control of infant and child morbidity and mortality associated with diarrheal disease; 3) prevent and control malaria within the context of essential obstetric care and to add to the body of knowledge in the region regarding effective malaria treatment and prevention; 4) improve maternal health through essential obstetric care; and 5) expand HIV prevention and control efforts in the region. CSD funds have also supported a concerted effort to coordinate bilateral and regional donor inputs to the health sector in WCA.

Activities funded under this SO will continue under a new SO, 624-005, Increased, Sustainable Use of Selective Reproductive Health, STI/HIV/AIDS, Child Survival and Maternal Health Services and/or Products in West Africa, beginning in FY 2001.

Key Results: Levels of knowledge and use of modern contraceptives and ORS in the activity's four focus countries have risen significantly, reaching or exceeding the activity's five-year performance targets. The contraceptive prevalence rate increased most in Côte d'Ivoire (from 5.7% in 1994 to 9.8% in 1998-99), Cameroon (4.2% in 1992 to 8.0% in 1998), and Togo (3.4% in 1988 to 7.9% in 1998). A smaller but still noteworthy increase took place in Burkina Faso (4.0% in 1993, 5.8% in 1998).

A cross-border HIV prevention activity targeting migrants, truckers and commercial sex workers achieved notable results: pre- and post-intervention surveys in Burkina Faso reported use of condoms with both regular and occasional partners increased from 49% to 67%, and from 69% to 90% respectively.

Performance and Prospects: Under FHA, couple-years protection for family planning services reached 705,000 in FY 2000, an increase of 57,000 over FY 1999. Because of 1999 policy changes in Togo and Côte d'Ivoire that granted permission to advertise brand-name oral contraceptives in the mass media, social marketing sales of oral contraceptives rose, and the number of outlets reached 1,800.

The condom social marketing program distributed 55 million condoms in FY 2000, surpassing by five million the number distributed the previous year. Integrated behavior change and communication, such as the French-language Keys to Life radio drama, appear to be increasing knowledge of family planning, ORS, and HIV prevention. Wake-Up Africa!, a campaign promoting fidelity, abstinence, condom use, and compassion toward those living with AIDS was broadcast on television and public and private radio stations, including the regional radio station Africa No. 1. The HIV sensitization campaign with truckers continues in vigor along heavily traveled routes and now includes Benin and Cameroon.

Distribution of the regional social marketing brand of ORS-Orasel-continues to exceed expectations with 2.7 million ORS sachets distributed in FY 2000. New supply approaches and market research may point to ways to further stimulate distribution and ORS sales in Togo.

Increased regional capacity for health programming and implementation is critical to the sustainability of this activity. During FY 2000, FHA made solid progress in strengthening African partners to provide support to other African institutions. Drawing on Regional African Partner Institutions (RAPIs), 350 consultant-weeks of African professional and technical expertise were deployed-well above the planned level of 240 weeks. Positive results in the areas of capacity-building and donor coordination illustrate sub-region-wide impacts of the program. Since 1995, as many as twenty countries in the region have been involved. This includes active partnerships in Mali, Senegal, Benin, and the Democratic Republic of Congo, as well as FHA's four focus countries (Côte d'Ivoire, Togo, Cameroon and Burkina Faso). Requests from other donors and from several USAID missions demonstrate sub-regional demand for FHA's technical assistance, tools, and approaches.

Donor collaboration and complementary use of resources are a major emphasis of this regional initiative. Currently, FHA works with a broad range of partners in the health sector and enjoys sound relationships with relevant United Nations agencies, international development programs of the Government of Germany, and the World Bank. FHA takes a lead role in fostering joint programming at the national and regional levels and urges more effective collaboration among donors by building on their comparative advantages and pressing more effective utilization of available resources. The FHA program has linked other major donors to expertise available through USAID-supported health and population organizations working in the region. Several of the above donor agencies have collaborated closely with the regional FHA activity and have co-financed over $6 million in activities related to social marketing, operations research, clinical training, and contraceptive supply over the past three years.

A key focus of the FHA program is the exchange of information across the region and sharing lessons learned and best practices with donor partners and USAID bilateral missions. A number of donors have incorporated into their program activities FHA tools and approaches, such as quality assurance models and the FHA supervisory approach for family planning service delivery. USAID bilateral programs in Benin, Guinea, Mali, Senegal, Ghana and the Democratic Republic of the Congo have each adopted and replicated for use at least one of the key FHA tools, such as the Information, Education and Communication (IEC) kit. Using both DA and CSD funding, FHA has moved this effort forward with a more concerted approach disseminating operations research findings, highlighting lessons learned, supporting exchange workshops and more active dialogue with donors and USAID bilateral missions.

Possible Adjustments to Plans: In FY 2001 this activity will be subsumed by the West Africa Regional Program (WARP) and implemented under new SO 624-005, Increased, Sustainable Use of Selective Reproductive Health, STI/HIV/AIDS, Child Survival and Maternal Health Services and/or Products in West Africa. USAID will complement current activities with an increased focus on HIV/AIDS and selected activities in emergency obstetrical care and prevention of malaria as an infectious disease as additional funding becomes available. Increased attention and resources will be shifted to networking with USAID bilateral missions and making U.S. technical assistance available and accessible to other major donors of the region. Partnership programs with regional African organizations will be strengthened by increasing the involvement of selected RAPIs in the development and management of FHA program implementation. FHA will continue to work for the establishment of a regional African fellowship program to attract and mentor African expertise in RH, HIV/AIDS and child survival.

Other Donor Programs: The largest bilateral and multilateral donors working in the region are France, the World Bank, the European Union (EU), Belgian Cooperation, the African Development Bank, Germany, Canada, and the United Nations agencies. These donors support construction, maintenance and operation of health centers and hospitals, and the procurement of essential drugs and other health commodities. Assistance is primarily focused on the public sector health system. Canada and the EU provide significant support for sexually transmitted infection and HIV/AIDS prevention and mitigation. Overall development assistance to the health sector in the four FHA service delivery countries is approximately $75 million per year.

Principal Contractors, Grantees or Agencies: USAID implements activities through five U.S. private voluntary organizations: Population Services International, Johns Hopkins University, Tulane University, the Johns Hopkins Program in International Education and Gynecology/Obstetrics, Family Health International and ten Regional African Partner Institutions.

FY 2002 Performance Tables

U.S. Financing

(In thousands of dollars)

	Obligations		Expenditures		Unliquidated
Through September 30, 1999	25,912	DA	23,668	DA	2,244	DA
	19,434	CSD	13,783	CSD	5,651	CSD
	0	ESF	0	ESF	0	ESF
	0	SEED	0	SEED	0	SEED
	0	FSA	0	FSA	0	FSA
	13,525	DFA	13,498	DFA	27	DFA
Fiscal Year 2000	6,900	DA	6,965	DA
	9,721	CSD	6,242	CSD
	0	ESF	0	ESF
	0	SEED	0	SEED
	0	FSA	0	FSA
	0	DFA	0	DFA
Through September 30, 2000	32,812	DA	30,633	DA	2,179	DA
	29,155	CSD	20,025	CSD	9,130	CSD
	0	ESF	0	ESF	0	ESF
	0	SEED	0	SEED	0	SEED
	0	FSA	0	FSA	0	FSA
	13,525	DFA	13,498	DFA	27	DFA
Prior Year Unobligated Funds	0	DA
	0	CSD
	0	ESF
	0	SEED
	0	FSA
	0	DFA
Planned Fiscal Year 2001 NOA	0	DA
	0	CSD
	0	ESF
	0	SEED
	0	FSA
	0	DFA
Total Planned Fiscal Year 2001	0	DA
	0	CSD
	0	ESF
	0	SEED
	0	FSA
	0	DFA
			Future Obligations		Est. Total Cost
Proposed Fiscal Year 2002 NOA	0	DA	0	DA	32,812	DA
	0	CSD	0	CSD	29,155	CSD
	0	ESF	0	ESF	0	ESF
	0	SEED	0	SEED	0	SEED
	0	FSA	0	FSA	0	FSA
	0	DFA	0	DFA	13,525	DFA

WEST AFRICA REGIONAL PROGRAM

Activity Data Sheet

FY 2002 Performance Tables

U.S. Financing