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ACTIVITY DATA SHEET PROGRAM: Morocco TITLE AND NUMBER: Reduced Fertility and Improved Health of Children Under Five and Women of Childbearing Age, 608-001 STATUS: Closed PLANNED FY 2001 OBLIGATION AND FUNDING SOURCE: None. PROPOSED FY 2002 OBLIGATION AND FUNDING SOURCE: None. INITIAL OBLIGATION: FY 1993    ESTIMATED COMPLETION DATE: September 2000 Summary: This strategic objective has exceeded impact targets to date and was the last planned bilateral program in the health and population sector. With USAID assistance, over the past several decades Morocco has achieved outstanding results in reducing fertility and mortality of children under five. Therefore, USAID completed its financial support to the sector while helping the Moroccan Ministry of Health (MOH) consolidate the gains it has achieved and assure sustainability of the program. Key Results: The program was designed to achieve the reduction in fertility and improvement in the health of women and children, and to assure sustainability of the program beyond direct USAID support for service delivery. Overall targets were reductions in the total fertility rate and infant mortality rate, and increases in the contraceptive prevalence rate. Four intermediate results were needed to achieve these objectives: 1) greater access to quality family planning/maternal and child health (FP/MCH) services responsive to client demand; 2) improved policy environment supporting expansion of FP/MCH services; 3) reinforced capacity to manage FP/MCH programs in a decentralized demand-driven mode; and 4) diversification of the resource base financing the delivery of FP/MCH services. Performance and Prospects: FY 2000 was characterized by high-paced implementation as USAID, MOH and their partners worked to consolidate gains and complete activities planned under this final bilateral agreement. The intense level of activity has directly benefited intermediary beneficiaries, especially health care workers, as well as the ultimate customers, women and children. By the completion of this objective, the MOH had in place most of the necessary elements of a fully functioning national FP/MCH program: 1) a nationwide network of service providers and facilities; 2) an adequate contraceptive logistics system and the ability to project needs and procure commodities; 3) appropriate pre?service and in?service training programs; 4) a strong national information, education and communications program; 5) the basic tools for a modern nationwide data management and health surveillance system; 6) an active private sector with two self-financing socially marketed contraceptives (oral and condoms); 7) successful local models ready for replication in both emergency obstetric care and integrated management of childhood illnesses and 8) a burgeoning non-governmental civic sector including active professional associations for physicians, nurses, and midwives. USAID assistance in the new special objective (608-007) will focus on priority interventions essential to achieve sustainability of these and other critical activities of the FP/MCH program. Possible Adjustments to Plans: None. Other Donor Programs: USAID works with the Ministry of Health to encourage funding by other donors for key population and health activities. Other donors supporting work in this sector in Morocco include the World Bank, the European Union, the United Nations Fund for Population Activities, the World Health Organization, and the United Nations Children's Fund. Principal Contractors, Grantees, or Agencies: John Snow Incorporated (JSI) is the primary institutional contractor for the bilateral program, with subcontractors University Research Corporation and Johns Hopkins University. In addition, various cooperating agencies provided technical assistance via field support to Global Bureau programs, including INTRAH; University of North Carolina with Tulane University and JSI; International Science and Technology Institute with Helen Keller International; The Partnership for Child Health; Deloitte Touche and Tomatsu with Population Services International and the Meridian Group; and Johns Hopkins University. FY 2002 Performance Table Morocco: 608-001 Performance Measures: Indicator FY97 (Actual) FY98 (Actual) FY99 (Actual) FY00 (Actual) FY00 (Plan) FY01 (Plan) FY02 (Plan) Indicator 1: Evidence of data-driven FP/MCH program action in focus regions/provinces (Agadir and Meknes). NA MET MET MET NA NA NA Indicator 2: Percent of Couple Years of Protection (CYP) from use of long-term (LT) methods in the public sector 33 36 37 0.35 NA NA NA Indicator 3: Percent of Couple Years of Protection (CYP) from use of long-term (LT) methods in the public sector 33 36 37 0.35 NA NA NA Indicator 4: Total Couple Years of Protection (CYPs) delivered by the commercial private sector as a proportion of all CYP delivered by public and private sectors 33 34 37 0.36 NA NA NA Indicator 5: Policies/regulations supportive of improved FP/MCH services: access, quality and sustainability 58 (a) 55 (b) 76 (b) 0.92 NA NA NA Indicator 6: Total Couple Years of Protection (CYPs) delivered by the commercial private sector as a proportion of all CYP delivered by public and private sectors 33 34 37 0.36 NA NA NA Indicator 7: Evidence of data-driven FP/MCH program action in focus regions/provinces (Agadir and Meknes). NA MET MET MET NA NA NA Indicator 8: Policies/regulations supportive of improved FP/MCH services: access, quality and sustainability 58 (a) 55 (b) 76 (b) 0.92 NA NA NA Indicator Information: Indicator Level (S) or (IR) Unit of Measure Source Indicator Description Indicator 1: IR Determination as to whether benchmarks signalling the use of peripheral level management information systems (MIS) as a tool in decentralized management have been met or not met. JSI Project reports from the field. A qualitative measure of the active use of management information in support of the MOH decentralization process. The SO team determines whether a benchmark has been achieved through review of project reports and validation by field visits. Indicator Data Quality: Moderate 1996 Baseline: All FP/MCH statistics from provinces entered by hand and sent to central level for computer entry and analysis. Program targets for provinces established at central level. 1999 Target/Benchmark: Evidence of regular and accurate FP/MCH data entry and analysis. 1998 program actions reviewed for effectiveness and adjusted accordingly. At least three additional program actions per region taken based on data analysis. Indicator 2: IR LT methods include VSC, IUDs, injectables and Norplant - percent MOH Service Statistics (SNISSTAT) based on facility reports of commodities distributed Public sector CYP from LT methods is the numerator, overall public sector CYP is the denominator. All years calculated using USAID 1997 conversion factors: IUDs = 3.5 CYPs; 15 cycles pills=1 CYP; 120 condoms = 1CYP; VSC = 8 CYPs; Norplant = 3.5 CYPs; 4 injectables (depo) = 1 CYP. Data is for Fiscal Year. Retroactive cleaning operations completed on 1998 data revealed that total CYP was over-estimated by about 9% (see corrected figures below). Last year's reported proportion of long term methods (36%), however, remains accurate. Indicator Data Quality: Moderate. Mission conducted site visits confirm public sector CYP data quality improvement from last year with variances between different levels now decreased to 8% or less. Indicator 3: IR LT methods include VSC, IUDs, injectables and Norplant - percent MOH Service Statistics (SNISSTAT) based on facility reports of commodities distributed Public sector CYP from LT methods is the numerator, overall public sector CYP is the denominator. All years calculated using USAID 1997 conversion factors: IUDs = 3.5 CYPs; 15 cycles pills=1 CYP; 120 condoms = 1CYP; VSC = 8 CYPs; Norplant = 3.5 CYPs; 4 injectables (depo) = 1 CYP. Data is for Fiscal Year. Retroactive cleaning operations completed on 1998 data revealed that total CYP was over-estimated by about 9% (see corrected figures below). Last year's reported proportion of long term methods (36%), however, remains accurate. Indicator Data Quality: Moderate. Mission conducted site visits confirm public sector CYP data quality improvement from last year with variances between different levels now decreased to 8% or less. Indicator 4: IR Percent - The numerator is total commercial sector CYPs (including USAID/CSM CYP's). CMS and commercial sector data do not include CYPs from VSC or condoms. The denominator is CYPs from both the public and commercial private sectors. CMS project data, data from pharmaceutical industry on private sector sales, Moroccan Family Planning Association, and MOH statistics service See unit of measure above. Indicator Data Quality: Private Sector data: Good (international standard for determining pharmaceutical sales); Public Sector data: Moderate (see description in Indicator 1) Indicator 5: IR Percentage completion of 10 policy/regulatory reforms (see attachment). PHR, JSI, MOH Composite index of advancement in policy dialogue and implementation of measures both within the MOH and also in the wider policy arena, improving the provision of FP/MCH services. Indicator Data Quality: Moderate Indicator 6: IR Percent - The numerator is total commercial sector CYPs (including USAID/CSM CYP's). CMS and commercial sector data do not include CYPs from VSC or condoms. The denominator is CYPs from both the public and commercial private sectors. CMS project data, data from pharmaceutical industry on private sector sales, Moroccan Family Planning Association, and MOH statistics service See unit of measure above. Indicator Data Quality: Private Sector data: Good (international standard for determining pharmaceutical sales); Public Sector data: Moderate (see description in Indicator 1) Indicator 7: IR Determination as to whether benchmarks signalling the use of peripheral level management information systems (MIS) as a tool in decentralized management have been met or not met. JSI Project reports from the field. A qualitative measure of the active use of management information in support of the MOH decentralization process. The SO team determines whether a benchmark has been achieved through review of project reports and validation by field visits. Indicator Data Quality: Moderate 1996 Baseline: All FP/MCH statistics from provinces entered by hand and sent to central level for computer entry and analysis. Program targets for provinces established at central level. 1999 Target/Benchmark: Evidence of regular and accurate FP/MCH data entry and analysis. 1998 program actions reviewed for effectiveness and adjusted accordingly. At least three additional program actions per region taken based on data analysis. Indicator 8: IR Percentage completion of 10 policy/regulatory reforms (see attachment). PHR, JSI, MOH Composite index of advancement in policy dialogue and implementation of measures both within the MOH and also in the wider policy arena, improving the provision of FP/MCH services. Indicator Data Quality: Moderate U.S. Financing (In thousands of dollars)

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