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Jordan
>> Regional Overview >> Jordan Overview ACTIVITY DATA SHEET
PROGRAM: Jordan
TITLE and NUMBER: Improved Access to and Quality of Reproductive and Primary Health Care, 278-003
STATUS: Continuing
PLANNED FY 2001 OBLIGATION AND FUNDING SOURCES: $17,938,000 ESF
PROPOSED FY 2002 OBLIGATION AND FUNDING SOURCES: $17,000,000 ESF
INITIAL OBLIGATION: FY 1995 ESTIMATED COMPLETION DATE: FY 2004Summary: USAID's Improved Access to and Quality of Reproductive and Primary Healthcare objective supports U.S. foreign policy concerns affecting global issues such as world population growth and maternal and child health. Jordan's 2.4% annual rate of natural population increase is among the highest in the world. Given the pressures that rapid population growth places on a resource-scarce country, USAID's health sector strategy also supports U.S. economic and environmental foreign policy objectives. The strategy is designed to improve maternal, and child health by ensuring availability of quality reproductive, maternal and primary healthcare services and promoting effective healthcare financing. Jordanian women between the ages of 15 and 49 will benefit from USAID's initiatives. Moreover, children also will benefit from the substantial maternal health improvements that birth spacing and an improved primary healthcare system will provide.
Key Results: Under the Comprehensive Postpartum (CPP) activity, 21 CPP centers were completed in FY 2000. The annual percentage of women delivering in hospitals with CPP centers who return for postpartum/family planning services has increased to 65%, up from 6% before the activity was started. Lessons learned from this activity are being shared with USAID's Egypt and West Bank/Gaza programs. In addition, the CPP experience is helping shape implementation of the Primary Healthcare Initiatives (PHCI) activity. PHCI activities during 2000 included extensive training programs and the selection of 40 primary health centers to serve as models for high-quality reproductive health services. Support also continued for major Jordanian institutions involved in family planning, including the Jordanian Association for Family Planning and Protection (JAFPP) and the National Population Council (NPC). The NPC, which focuses on policy, was instrumental in gaining government approval for a revised national population strategy. JAFPP, which concentrates on service delivery, embarked on an institutional plan aimed at achieving sustainability.
Performance and Prospects: Performance exceeded USAID targets for improved quality and increased availability of reproductive health services. While the FY 2000 survey measure of 39.2% for the modern Contraceptive Prevalence Rate (CPR) appears to represent a decline from the 1999 CPR rate, this difference is not statistically significant.
USAID continues to be the major donor of family planning services, supplies, information, and training for physicians, nurses, midwives, and pharmacists. USAID-funded programs have contributed to a continuing decline in the total fertility rate from 5.6 children in 1990 to 3.6 in 2000, resulting in a decrease of two births per woman over the last 10 years. Seventy percent of the decline in fertility resulted from changes in marital fertility, while 30% resulted from a delayed age of marriage.
The modern CPR seems to be leveling off at around 39% over the last three years after the sharp increase from 27% to 38.7% between 1990 and 1998. However, the continuing decline in fertility rates from 3.8 in 1999 to 3.6 in 2000 and the decline in the rate of natural population increase from 2.5 in 1999 to 2.4 in 2000 is encouraging. The seeming contradiction between the apparent leveling off of CPR and the continuing decline in the total fertility rate could be the result of further counseling and expanded availability, resulting in more effective use of contraceptives on the part of those who are using them.
One encouraging event at the population policy level is the support of King Abdullah, as indicated by his attendance at the NPC's launch of the updated national population strategy in September 2000. The Prime Minister, more than 10 Ministers, and many parliamentarians and representatives from nongovernmental organizations (NGOs) and other civil society organizations also attended. The launch emphasized the pressures that rapid population growth places on economic development, including the water and health sectors. It also made the case for a drop in the total fertility rate from 3.6 in 2000 to 2.4 by 2015, a measure that will substantially reduce those pressures.
During FY 2000, USAID supported a national contest that addressed misconceptions about modern family planning methods and gender equity in order to promote greater effectiveness in the use of contraceptives. The contest had a positive impact, with more than 89% of all respondents correctly answering the questions. In addition, a survey of young people's lifestyles, including reproductive health (RH) knowledge and practices, was conducted. The findings will be used to improve young people's knowledge of RH through training and mass media communication campaigns.
The Comprehensive Postpartum activity achieved the goal of having 21 CPP centers functioning in hospitals with the highest numbers of deliveries. Because of the high quality of services offered at the CPP centers, 65% of women who delivered in those hospitals returned to visit the CPP center for family planning and other postpartum services. This is a 10-fold increase from the 6% postpartum visits in 1995 and is 5% more than the target for CPP center visits. Health experts from elsewhere in the region also visited various CPP centers in an effort to incorporate "lessons learned" with their own health and family planning programs.
USAID successfully launched the Primary Healthcare Initiatives (PHCI) activity, aimed at improved quality, management and efficiency of reproductive and PHC services at all 380 Ministry of Health PHC centers. This new initiative is partly based on lessons learned under the CPP project. Training of a first group of trainers was completed, a quality improvement system was initiated and tested, and 40 centers from all over Jordan were selected for upgrading. USAID will fund these centers so they can serve as models for high quality RH/PHC services.
Assisting Jordan in developing an effective healthcare financing system is an important area of USAID involvement. Rapid population growth places enormous pressure on the healthcare system, especially in the area of reproductive and primary healthcare. With USAID assistance, the Ministry of Health completed a national health expenditures and facility utilization survey and provided support for strengthening the epidemiological surveillance system. The findings from these surveys will be used to design a new USAID-funded health policy reform activity in FY 2001, which will address such issues as cost recovery, health insurance schemes, financing options, improved private-public sector participation, and decentralization.
USAID is designing a new cost recovery and sustainability activity to JAFPP, a successful NGO that provides 25% of FP services in Jordan. JAFPP is still reliant on donor assistance. The goal of this five-year activity is to assist JAFPP to increase its recovery of overall costs from the current 44% to 75%, while maintaining its 25% share of family planning services in a highly competitive market. Also, a small new HIV/AIDS program has been launched, aimed at high-risk groups as a means of addressing a problem that so far has had only a modest impact in Jordan.
The information provided below is illustrative.
In FY 2001, USAID plans to-
The life-of-objective funding level for this objective will increase by $17,000,000, bringing the new funding total to $132,718,000.
- Provide $3 million to the Primary Healthcare Initiative, aimed at improving services throughout Jordan's network of primary healthcare centers. Approximately 40 health centers will also be upgraded and improved, in part through the provision of new equipment;
- Provide $2.6 million to help launch a new JAFPP initiative designed to improve service quality delivery and strengthen prospects for sustainability. The organization is the leading non-governmental provider of family planning services and plays an important role in meeting the demand for family-planning services;
- Provide $3.5 million to support the U.S. Centers for Disease Control in its ongoing cooperative initiative with Jordanian health authorities. Among other things, the activity supports Jordan's efforts to better understand, monitor, and control the spread of infectious diseases in the country; and
- Obligate $8.9 million through various contract buy-ins with funds obligated and managed by USAID's Global Bureau. Specific activities envisaged under Global buy-ins include a program on HIV/AIDS management and impact; a health policy reform program; support for demographic and population surveys; contraceptive procurements; and support for NPC on communication strategies, policy development, and other issues.
Possible Adjustments to Plans: None.
Other Donor Programs: USAID and the World Bank are the largest donors in the population and family planning sector. USAID programs are closely coordinated with those of other donors working in the population field including Japan and the United Nations Fund for Population Activities. The Ministry of Health provides necessary personnel and facilities for all program activities. Jordan Television has provided significant support for communications programs, including free primetime advertising for USAID-funded family planning "infomercials" and youth TV programs.
Principal Contractors, Grantees, or Agencies: Current contractors and grantees include Johns Hopkins University; U.S. Bureau of Census; Abt Associates; Harvard University; Pathfinder; Futures Group; Deloitte Touche Tohmatsu; John Snow; the Academy for Educational Development; the Centers for Disease Control; Access for Voluntary Surgical Contraception; and Family Health International. Major host country partners include the Ministry of Health; Jordan University Hospital; Royal Medical Services; Department of Statistics; and Jordanian non-governmental organizations
.FY 2002 Performance Table
Jordan: 278-003
Performance Measures:
Indicator FY97 (Actual) FY98 (Actual) FY99 (Actual) FY00 (Actual) FY00 (Plan) FY01 (Plan) FY02 (Plan) Indicator 1: Increased revenue generation in JAFPP clinics 50 62 89.7 NA 80 NA NA Indicator 2: Primary Health Centers achieving a minimum quality standards. N/A N/A N/A N/A N/A 17 centers 34 centers Indicator 3: 60% of MCRA correctly comprehend a given message 84, 75 96, 100 80 (1) 87 (2) 89 (3) 89 60 60 60 Indicator 4: Modern Method Contraceptive Prevalence Rate 37.8 (2) 38.7 (3) 39.8 (4) 39.2 40.8 39.7 40.2 Indicator 5: Percentage of women who deliver in hospitals with CPP centers and return for postpartum care, the proportion hopefully increasing from 6% in 1990 to 60% in 1999 35 46 65 65 60 NA NA Indicator 6: Percentage of women who deliver in hospitals with CPP centers and return for postpartum care, the proportion hopefully increasing from 6% in 1990 to 60% in 1999 35 46 65 65 60 NA NA Indicator 7: Modern Method Contraceptive Prevalence Rate 37.8 (2) 38.7 (3) 39.8 (4) 39.2 40.8 39.7 40.2 Indicator 8: Increased revenue generation in JAFPP clinics 50 62 89.7 NA 80 NA NA Indicator 9: Primary Health Centers achieving a minimum quality standards. N/A N/A N/A N/A N/A 17 centers 34 centers Indicator 10: 60% of MCRA correctly comprehend a given message 84, 75 96, 100 80 (1) 87 (2) 89 (3) 89 60 60 60 Indicator Information:
Indicator Level (S) or (IR) Unit of Measure Source Indicator Description Indicator 1: IR % of operational costs recovered JSI/R&TI reports. JAFPP clinic records Percentage of operational costs recovered annually. Indicator 2: IR Number of Primary Health Care Centers achieving a minimum quality standards Annual Quality Surveys This is a new indicator. The number of primary health care centers achieving a minimum quality standards. The standards is defined to inculde:1. Infection prevention system components in place and utilized; 2. Appropriate referral practices followed; 3. protocols snd standards available and being followed;4. health information and counseling provided at the time of the visit to PHC centers and 5. follow up care provided. Indicator 3: IR % of married couples who, having heard a method - specific message, are able to paraphrase the main idea. Results of focus group discussions on 24 women of reproductive age (1). Results of focus group discussions on 65 married individuals (2). Results of 4 pretests on 99 married individuals (3). 2 radio spots on exclusive breastfeeding and lactational ammenorrhea criteria (1). 4 method specific brochures on vasectomy, tubal ligation, LAM, spermicides (2). A contest run in local newspapers, on modern FP methods and gender equity (3). Indicator 4: IR Women 15-45: percent 1997 Demographic Health Survey. 1998 Jordan's Annual Fertility Survey. 1999 Jordan's Annual Fertility Survey. 2000 Jordan's Annual Fertility Survey Modern methods are: oral contraceptives, IUD, DMPA, Foam, Condom, Norplant and Tubal Ligation. Indicator 5: IR % of women who return for postpartum care at CPP centers CPP centers records Women who deliver in a hospital with a CPP center who return to receive post partum care in the USAID funded CPP center. Indicator 6: IR % of women who return for postpartum care at CPP centers CPP centers records Women who deliver in a hospital with a CPP center who return to receive post partum care in the USAID funded CPP center. Indicator 7: IR Women 15-45: percent 1997 Demographic Health Survey. 1998 Jordan's Annual Fertility Survey. 1999 Jordan's Annual Fertility Survey. 2000 Jordan's Annual Fertility Survey Modern methods are: oral contraceptives, IUD, DMPA, Foam, Condom, Norplant and Tubal Ligation. Indicator 8: IR % of operational costs recovered JSI/R&TI reports. JAFPP clinic records Percentage of operational costs recovered annually. Indicator 9: IR Number of Primary Health Care Centers achieving a minimum quality standards Annual Quality Surveys This is a new indicator. The number of primary health care centers achieving a minimum quality standards. The standards is defined to inculde:1. Infection prevention system components in place and utilized; 2. Appropriate referral practices followed; 3. protocols snd standards available and being followed;4. health information and counseling provided at the time of the visit to PHC centers and 5. follow up care provided. Indicator 10: IR % of married couples who, having heard a method - specific message, are able to paraphrase the main idea. Results of focus group discussions on 24 women of reproductive age (1). Results of focus group discussions on 65 married individuals (2). Results of 4 pretests on 99 married individuals (3). 2 radio spots on exclusive breastfeeding and lactational ammenorrhea criteria (1). 4 method specific brochures on vasectomy, tubal ligation, LAM, spermicides (2). A contest run in local newspapers, on modern FP methods and gender equity (3). U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 10,718 DA 8,699 DA 2,019 DA 0 CSD 0 CSD 0 CSD 30,882 ESF 14,152 ESF 16,730 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Fiscal Year 2000 0 DA 455 DA 0 CSD 0 CSD 20,000 ESF 17,074 ESF 0 SEED 0 SEED 0 FSA 0 FSA 0 DFA 0 DFA Through September 30, 2000 10,718 DA 9,154 DA 1,564 DA 0 CSD 0 CSD 0 CSD 50,882 ESF 31,226 ESF 19,656 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 0 DA 0 CSD 17,938 ESF 0 SEED 0 FSA 0 DFA Total Planned Fiscal Year 2001 0 DA 0 CSD 17,938 ESF 0 SEED 0 FSA 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 0 DA 0 DA 10,718 DA 0 CSD 0 CSD 0 CSD 17,000 ESF 36,180 ESF 122,000 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA
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Last Updated on: May 29, 2002 |
