WEST AFRICA REGIONAL PROGRAM

	FY 1998 Actual	FY 1999 Estimate	FY 2000 Request
Development Assistance	$7,951,000	$6,567,000	---
Development Fund for Africa	---	---	$7,000,000
Child Survival and Disease	$5,847,000	$7,410,000	$8,800,000

Introduction.

The rapid reduction in USAID presence in West and Central Africa during the mid-1990's threatened termination of historically strong U.S. support for population and health and disruption in favorable regional trends in fertility and mortality; only five Sustainable Development missions remain -- in Mali, Benin, Guinea, Ghana, and Senegal -- with transitional/limited-presence offices in Liberia and Nigeria. Since 1996, however, a unique USAID experiment is successfully unfolding that is sustaining United States support and favorable reproductive health trends. Reflecting USAID's increased emphasis on partnerships, planning for sustainability and accountability the Family Health and AIDS Prevention activity for West and Central Africa (FHA/WCA) has fostered a unique partnership among four U.S. NGOs and universities and ten regional African organizations.

The Development Challenge.

West and Central Africa lag behind the dramatic improvements in health achieved by other developing countries over the past 40 years. For example, whereas other developing regions achieved over 50 percent declines in infant mortality between 1960-1990, in this region infant mortality remains unacceptably high at an average of 11 deaths per 1000 births. The population is growing at almost 3 percent a year and likely will double over the next 25 years. Demographic pressures are closely linked to increasing migration, which spans the region. Thirty million people likely will migrate from the interior to the coastal areas between 1990 and 2020. Immigrants make up 33 percent of the population of Cote d'Ivoire, contributing one percent to the almost 4% growth rate of the country. Cote d'Ivoire -- the most important pole of regional economic development after Nigeria -- has become the epicenter for the spread of HIV/AIDS throughout the region. The prevalence of HIV is estimated at 10% among the general population, and the combination of seasonal and permanent regional migration for work of young men and women contribute to spread of HIV and other sexually transmitted infections. To assist with these problems, USAID developed the FHA as a regional approach to foster transnational technical assistance by a newly forming network of African organizations with highly trained African managers working with U.S. NGOs with strong track records in dealing with health and population issues in the region.

Other Donors.

The largest bilateral and multilateral donors working in the region are France, the World Bank, the European Union (EU), the African Development Bank, Germany, Canada, and the United Nations agencies. These donors support construction, maintenance and operation of health centers and hospitals, and availability of essential drugs; they focus mainly on the public sector health delivery system and child survival activities. Of major international donors in this sector, the United States is among the smallest in the WCA region. The FHA, however, is linking other major donors to U.S. expertise available through USAID-supported health and population organizations. Several of the above donor agencies have collaborated closely with the regional FHA activity and have co-financed almost $6 million in activities related to social marketing, operations research, clinical training, and contraceptive supply over the past three years, and FHA products have been directly incorporated into numerous activities supported by other donors.

FY 2000 Program.

Despite the closure of USAID's regional office in Abidjan in September 1998, USAID continued the FHA activities in Burkina Faso, Cameroon, Cote d'Ivoire and Togo based on compelling human needs, strong demand for U.S. assistance in this sector, and large prior investments with positive trends and results. Three years after the launch of this regional initiative in FY 1995, the FHA-WCA has emerged as an innovative and effective approach to deliver USAID assistance in the context of a reduced USAID mission presence. Focused on key transnational problems, it promotes regional networking by exploiting comparative advantages of U.S. NGOs and builds on regional African organizations operating in seven countries. The FHA-WCA project was formulated to include service delivery support mainly in urban centers of the FHA-WCA target countries, (total population about 43 million). However, most countries of the region benefit from FHA activities and products, taking advantage of transnational educational campaigns, product marketing, training and supervision standards and systems, operations research, and shared regional "best practices." FHA includes mission activities for pre-service reproductive health medical and paramedical training in Benin, Democratic Republic of Congo (DROC) and Senegal, cross-border HIV/AIDS activities targeting "populations on the move" (migrants and truck drivers), and institutional development of ten regional African institutions. Indicators of achievement are increased use of modern family planning methods and child health-related products and practices in target areas, changes in high-risk sexual behavior, and more effective, strengthened institutional capacity of selected African organizations and more efficient utilization of host country and donor resources. Preliminary results from 1998 demographic and health surveys in Togo and Cameroon indicate a doubling of contraceptive prevalence in these countries and a dramatic increase in condom use for HIV/AIDS prevention.

WEST AFRICA REGIONAL

FY 2000 PROGRAM SUMMARY
(in Thousands of Dollars)

USAID Mission Director, James Hradsky

USAID Strategic and Special Objectives	Economic Growth & Agriculture	Population & Health	Environment	Democracy	Human Capacity Development	Humanitarian Assistance	TOTALS
S.O.1. Increased Regional, Sustainable Use of Selected Reproductive Health AID/STI, and Child Intervention in WCA - DFA - CS	--- ---	7,000 8,800	--- ---	--- ---	--- ---	--- ---	7,000 8,800
Totals: - DFA - CS	--- ---	7,000 8,800	--- ---	--- ---	--- ---	--- ----	7,000 8,800

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ACTIVITY DATA SHEET

PROGRAM: FAMILY HEALTH AND AIDS (FHA)
TITLE AND NUMBER: Increased Regional, Sustainable Use of Selected Reproductive Health, AIDS/HIV, and Child Survival Interventions in WCA, 624-S001
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 2000: $7,000,000 DFA, $8,800,000 CS
INITIAL OBLIGATION: FY 1995; ESTIMATED COMPLETION DATE: FY 2002

Summary: Despite significant improvements in the heath status of its population over the past thirty years, West and Central Africa 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. The rapid reduction in USAID presence in West and Central Africa during the mid-1990's threatened termination of historically strong U.S. support for population and health and disruption in favorable regional trends in reproductive health and family planning, HIV/AIDS control and child survival. Since diseases do not respect national borders, progress achieved in past and ongoing bilateral efforts can be easily overwhelmed by the impact of migration and the dissemination of HIV/AIDS. FHA addresses this health and family planning predicament with a transnational approach and supplements USAID and other donor bilateral efforts.

Key Results: USAID focus is on key interventions which are complementary to those of other major donors in the region. These interventions–often regional in nature--address limited access to and use of modern family planning methods, high risk births that have direct impact on child morbidity and mortality, HIV/AIDS and diarrhea control through the expanded use of oral rehydration salts (ORS; commercial and/or home preparations). USAID promotes institutional development of African regional partners by fostering and supporting their long-term partnerships with U.S. NGOs. The project has promoted greater choice of more effective methods of contraception through expansion of the social marketing product line and strengthening of logistics management and information systems. The project has implemented cross-border and trans-national interventions targeting migrant populations, developed, tested, and extensively used generic regional information, education, communication and training materials with adaption within countries. The project is improving the institutional capability of 10 African regional partners, as demonstrated by their increased capability to attract other donor funding. One regional African partner based in Senegal was able to diversify its funding base, attracting $400,000 from various sources including the Government of Senegal, World Bank, UNFPA, and EU. In Cote d'Ivoire, Burkina Faso, Togo, and Cameroon, the FHA project has continued to support critical interventions in family planning, HIV/AIDS, and child survival and has maintained investments and momentum achieved over the past decade. As examples, FY 1998 sales of condoms increased 19.0% over FY 1997; FY 1998 sales of the regional brand of ORS increased 27% increase over FY 1997. Preliminary results of 1998 demographic and health surveys conducted in Togo and Burkina Faro indicate significant achievements in family planning with a doubling of contraceptive prevalence, comparatively rapid declines in fertility in urban aeas, and improved infant/child morbidity and mortality.

Possible Adjustments to Plans: USAID will complement the current project activities with additional child survival activities likely including malaria, disease surveillance, and malnutrition as additional funding becomes available. Increased attention and resources will be shifted to making U.S. technical assistance available and accessible to other major donors of the region to supplement their implementation Partnerships programs with selected regional African organizations will be strengthened through the establishment of a regional African fellowship program to attract and mentor best African expertise.

Other Donors: The largest bilateral and multilateral donors working in WCA are France, the World Bank, the European Union (EU), the African Development Bank, Germany, Canada, and the United Nations Agencies. These donors support construction, maintenance and operations of health centers and hospitals, and availability of essential drugs; they focus mainly on the public sector health delivery system and child survival activities. Donor leveraging and complementary programming are a major emphasis of this regional initiative, as exemplified by the mobilization of a complementary amount of $6.0 million from other donors to support FHA-WCA initiatives.

Principal Contractors, Grantees or Agencies: USAID implements activities through four U.S. PVOs: Population Services International, Johns Hopkins University, Tulane University, the Johns Hopkins Program in International Education and Gynecology/Obstetrics (JHPIEGO), and 10 regional African partner institutions.

Selected Performance Measures:

Major Results Indicators:	Baseline (FY 1997)	Target (FY2000)
Contraceptive prevalence in project target areas	5.9%	9.0%
Proportion of sexually active men of reproductive age who consistently use condom in target areas	13.6%	22.8%
Increase in number of condoms sold in target countries	34.2 million	49.0 million
Increase in number of ORS packets distributed in target countries	1.8 million	3.6 million
Cumulative amount of financial resources leveraged from other donors	$4.4 million	$10 million
Technical and managerial capacity strengthened for Regional African partners	0	11
Demonstration training sites developed in the region	0	20
WCA research training institutions incorporates operations research modules	0	3
Preservice training institutions incorporate reproductive Health curriculum	0	11
Regional distance-learning program in public health Operational in collaboration with Tulane University and Payson Center	0	1

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