INDIA

	FY 1998 Actual	FY 1999 Estimate	FY 2000 Request
Development Assistance	$25,631,000	$24,700,000	$28,700,000
Child Survival and Disease	$17,044,000	$17,150,000	---
P.L. 480 Title II	$94,948,000	$110,503,000	$81,650,000

Introduction

USAID's program in India responds to two key U.S. national interests: (1) global issues of population growth, infectious diseases, and climate change; and (2) humanitarian concerns of alleviating poverty and reducing malnutrition. India is the sixth largest and second fastest growing producer of greenhouse gases. Its growing population, concentrated increasingly in urban areas, contributes to the spread of communicable diseases--HIV/AIDS, tuberculosis and polio. India continues to have the largest concentration of poor in the world, more than 300 million. Despite gains in food production, half of its children are malnourished. With nearly a billion people, India's progress in slowing population growth, greenhouse gas emissions and infectious diseases and reducing poverty are vital to successfully addressing U.S. global issues and humanitarian concerns.

As a consequence of India's May 1998 nuclear tests, the United States imposed sanctions on India. Programs terminated under sanctions include financial sector reform and agribusiness development.

The United States continues to be India's largest trade and investment partner. In 1997-98, trade between the two countries was $10.36 billion; approvals of U.S. direct investment totaled $783.4 million in the first three quarters of 1998. The potential for expanded trade and investment is enormous but dependent upon a second wave of Indian economic reform. India's external debt is manageable as indicated by 1998 estimates of the stock of debt ($92 billion), foreign exchange reserves in months of imports (six months), the current account deficit as a percent of GDP (2.3%) and the debt service ratio (21.7%) which are all largely unchanged from the previous year.

Development Challenges

India's ability to achieve sustainable growth and reduce poverty depends greatly on its ability to stabilize population growth. Its population will reach one billion by the year 2000 and, not long after, will surpass China as the world's most populous country. A major contributing factor to India's rapid population growth is the lack of access to reproductive health services. Hence, USAID's program to stabilize population growth focuses on improving the quality of, and access to, family planning services in Uttar Pradesh, India's most populous state with 154 million people. In the program's pilot areas, use of contraceptives increased from 16 percent to 36 percent in three years.

Malnutrition in more than 50 percent of India's children is reflected by the death of one of every nine children before reaching age five. India has 25 percent of the world's child deaths. Under the humanitarian assistance program, P.L. 480 Title II food and development assistance resources are integrated in activities that provide supplementary feeding and basic health services to mothers and children. USAID is working with Cooperative for Assistance and Relief Everywhere (CARE) and Catholic Relief Services (CRS) to feed and deliver health services daily to seven million of India's poorest people. Overall impact of the humanitarian assistance program has been to: (a) increase the percentage of children under two years receiving supplemental food; (b) improve access to immunization in program areas; (c) increase access to iron-folate supplements by pregnant women; and (d) improve rates of timely complementary feeding for infants 6-9 months.

Food assistance helps USAID respond rapidly to natural disasters. In FY 1998, $2.4 million of food was provided to 846,571 victims of natural disasters through the CARE and CRS programs. Three times during FY 1998, USAID provided $25,000 in disaster assistance: to meet immediate needs of the victims affected by tornadoes in Orissa and Bengal, the cyclone in Gujurat, and to help those affected by the floods in various parts of north and eastern India.

India's commitment to accelerated economic growth, coupled with its massive population, has serious implications for the environment. The growing demand for power, fueled largely by high-ash coal, makes India a major, and increasingly significant contributor, to global warming. USAID is assisting the Indian power sector to adopt environment-friendly, energy-efficient technology for power generation and distribution. A USAID-funded pilot activity has already helped the National Thermal Power Corporation, which generates over 25 percent of India's thermal power, to cut carbon dioxide emissions by nearly 2 million tons annually, with a potential to mitigate another three million tons. India's three largest metropolitan cities rank among the ten worst polluted in the world. Air pollution and inadequate access to clean water and sanitation add to the incidence of chronic respiratory diseases and other communicable illnesses. USAID assistance to Indian cities aims to reduce the debilitating impacts on health from urban pollution by introducing new approaches to urban environmental planning and urban water supply and sanitation systems. Technical and capital assistance have already helped create a $200 million build-operate-transfer water and sewerage project in Tiruppur and launch a $25 million municipal bond--the first in South Asia--in Ahmedabad to finance new water and sanitation services.

As one of the world's epicenters for HIV/AIDS, India has an estimated 3-5 million persons who are HIV positive, more than any other country. USAID, through interventions in Tamil Nadu, has contributed to a measurable increase in condom use by high-risk groups. A major expansion of the HIV/AIDS initiative into Maharashtra state, which has the largest number of HIV/AIDS positive cases, is planned. To eradicate polio in India, USAID provided $4 million to the World Health Organization (WHO), United Nations Children's Fund (UNICEF) and Rotary International for an immunization campaign which in 1998 reached about 125 million children under five years on a single day. The on-going campaign has led to a 94% drop in polio cases.

The low status of women is tellingly reflected in India's 1991 census data which shows a sex ratio of 927 females per 1,000 males and a female literacy rate of 39% versus 64% for males. Data from 1994 shows 43% of eligible girls are enrolled in primary school compared to 62% of boys. USAID's programs seek to increase women's decision-making power by supporting indigenous organizations in the areas of microfinance for women, girls' school participation and combating violence against women.

The breadth and depth of development problems in India, and the U.S. national interest in progress on these problems, suggest a graduation time frame that runs beyond the medium term.

Other Donors

Seven multilateral and 13 bilateral donors provide assistance to India. The United States is the seventh largest donor after the World Bank, the Asian Development Bank, the European Union, Japan, Germany and United Kingdom. We collaborate closely with other donors on reproductive health, HIV/AIDS and other infectious diseases, population, climate change, urban environmental infrastructure and women's empowerment.

FY 2000 Program

USAID/India requests $28,700,000 of DA, $16,000,000 of CSD and $81,650,000 of P.L.480 Title II for the FY 2000 program of assistance to India. The program will stabilize population growth; cut pollution in power generation and cities; reduce transmission of HIV/AIDS and other infectious diseases; empower women and meet humanitarian needs of India's poorest populations.

INDIA

FY 2000 PROGRAM SUMMARY (in thousands of dollars)

USAID Mission Director: Linda Morse

USAID Strategic & Special Objectives	Economic Growth & Agriculture	Population & Health	Environment	Democracy	Human Capacity Developmnt	Humanitarian Assistance	TOTALS
S.O. 2. Reduced Fertility and Improved Reproductive Health in North India -DA -CSD	--- ---	17,000 4,500	--- ---	--- ---	--- ---	--- ---	17,000 4,500
S.O. 3. Increased Child Survival and Nutrition in Selected Areas of India -CSD -P.L. 480/Title II	--- ---	2,000 ---	--- ---	--- ---	--- ---	--- 81,650	2,000 81,650
S.O. 4. Increased Environmental Protection in Energy, Industry and Cities -DA	---	---	10,000	---	---	---	10,000
S.O. 7. Reduced Transmission and Mitigated Impact of Infectious Diseases, Especially STD/HIV/AIDS in India -CSD	---	8,500	---	---	---	---	8,500
Sp.O. 3. Expanded Advocacy and Service Delivery Networks for Women -DA -CSD	1,300 ---	--- ---	--- ---	400 ---	--- 1,000	--- ---	1,700 1,000
Totals - DA - CSD - P.L. 480/Title II	1,300 --- ---	17,000 15,000 ---	10,000 --- ---	400 --- ---	--- 1,000 ---	--- --- 81,650	28,700 16,000 81,650

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ACTIVITY DATA SHEET

PROGRAM: INDIA
TITLE AND NUMBER: Reduced Fertility and Improved Reproductive Health in North India, 386-SO02
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCES: FY 2000:$17,000,000 DA; $4,500,000 CSD
INITIAL OBLIGATION: FY 1995 ESTIMATED COMPLETION DATE: FY 2004

Summary: With nearly a billion people, India accounts for 16% of the world's population, and adds a further 18 million people a year - one fifth of global population growth. The purpose of this strategic objective (SO) is to reduce the current high level of fertility and improve women's reproductive health by: 1) increasing quality of, access to, and demand for a broad range of reproductive health and family planning services and 2) addressing related fertility parameters, including the status of women in north India. The direct beneficiaries are women of childbearing age (15-49) in Uttar Pradesh, totaling approximately 30 million women. Couples of reproductive age throughout India will benefit from broader commercial availability of family planning and other reproductive health products. Secondary beneficiaries are children under age five, in particular, female children whose survival will be enhanced by the program. The major intervention under this SO is the Innovations in Family Planning Services (IFPS) activity implemented in Uttar Pradesh, India's most populous state (154 million). Complementary to the IFPS activity is the Program for the Advancement of Commercial Technology/Child and Reproductive Health (PACT/CRH) activity, designed to stimulate private sector participation and commercial partnerships for the development, promotion and availability of reproductive health and child survival technologies.

Key Results: A revised set of intermediate results was established in FY 1998 for this SO: (1) increased quality of family planning services; (2) increased use of family planning services; and (3) increased use of reproductive health services.

Performance and Prospects: Two hundred and forty grants, including 147 to non-government groups, have been made in Uttar Pradesh. The 93 government grants are supporting improvements in health worker skills through training and provision of equipment; minor infrastructure upgrading of clinics; quality improvements in client counseling and use of better infection prevention practices; improved contraceptive logistics; and development of reproductive health camps offering family planning, antenatal care and immunization services. In the private sector, broader community participation has been stimulated through the 147 grants to NGOs and cooperatives to provide information, education and temporary family planning methods to 700,000 people. An integrated public/private sector programming approach in six districts is underway, promoting broad-based participation and decentralized management. A statewide communications campaign in Uttar Pradesh was launched, in which 10,000 health workers were trained and provided materials to educate and counsel couples on family planning. In addition, local folk troupes were contracted to provide performances at the community level on the pros and cons of family planning. Radio and TV spots have been designed and will be aired by April 1999.

To improve birth outcomes for both mother and child, traditional birth attendants have been trained in three districts in safe delivery practices. An assessment of this intervention is underway to plan for expansion. In addition, a community-based study on training of family and community members to provide care during pregnancy and assistance during delivery is underway to develop replicable models to reduce maternal mortality and improve neonatal survival.

A four-state generic campaign to promote acceptance and use of oral contraceptives was launched in north India. Complementary to this is the development of a statewide contraceptive marketing campaign in Uttar Pradesh for promotion and distribution of condoms and oral contraceptives to rural areas. These two activities will broaden access to temporary contraceptive methods, allowing couples more choice in planning their family.

The second USAID-funded National Family Health Survey for the 25 states of India is currently underway. Key health indicator data will be available by mid-1999. This data is utilized widely by the GOI, donors and others within India and internationally to track health trends over time.

Considerable progress has been made in building program momentum to reduce fertility and improve reproductive health in north India. Emphasizing improved access to quality reproductive health services, the program is rapidly expanding to 29 districts covering a population of 72 million.

Possible Adjustments to Plans: None

Other Donor Programs: The World Bank, United Nations Population Fund (UNFPA), United Nations Children's Fund (UNICEF), and the British foreign aid program provide complementary donor support in reproductive health, safe motherhood and child survival. USAID's program has introduced a number of innovative approaches to supporting both public and private sector efforts, some of which have been incorporated into a major new initiative in reproductive health being launched by the World Bank. The GOI contributes substantial resources through its existing personnel and massive infrastructure to provide health and family welfare services to the general public. GOI health and family welfare services address the needs of large numbers of extremely poor clients who are unable to purchase health services from the private sector.

Principal Contractors, Grantees, or Agencies: The major grantees are the State Innovations in Family Planning Services Agency and Industrial Credit and Investment Corporation of India (ICICI) Limited. USAID-supported cooperating agencies include: The Association for Voluntary and Safe Contraception, Cooperation for Assistance and Relief Everywhere, Center for Development and Population Activities, Johns Hopkins University/Population Communication Services, Deloitte Touche Tohmatsu, University of North Carolina, International Training in Health - PRIME Project, MACRO International Inc., Program for Appropriate Technologies in Health, Population Reference Bureau, and John Snow, Inc.

Selected Performance Measures:

	Baseline (1997)	Target (2000)	Target (2004)
* Number of public sector clinics with satisfactory quality ratings 1	4	72	361
* Annual number of public sector family planning clients by methods 1	303,000	454,000	661,000
* Annual number of private sector family planning clients by spacing methods 1	11,000	24,000	41,000
* Annual contraceptive Social Marketing (CSM) and Commercial sales of - oral pills (million cycles)2 - condoms (million pieces)2	4.2 104	6.3 127	10.4 205
* Percentage of pregnant women receiving Ante Natal Care (ANC) services 1 - two doses of Tetanus Toxid - 100 Iron and Folic Acid Tablets	43% 32%	46% 34%	50% 40%
* Percentage of deliveries attended by trained provider	17%(1995)	22%	30%
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1 in 28 priority IFPS Activity districts; 2 in Uttar Pradesh

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ACTIVITY DATA SHEET

PROGRAM: INDIA
TITLE AND NUMBER: Improved Child Survival and Nutrition in Selected Areas of India, 386-SOO3
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCES: FY 2000: $2,000,000 CSD; $81,650,000 P.L. 480 Title II
INITIAL OBLIGATION: FY 1995 ESTIMATED COMPLETION DATE: FY 2003

Summary: One-third of India's nearly one billion people lacks adequate food. More than half of India's young children (73 million) are underweight, and chronic maternal malnutrition is high: one of every nine children die before the age of five. Infant and child mortality rates are very high. Poor access to health care, high illiteracy rates and poor nutrition and health practices contribute to the high mortality and malnutrition. Because poor women and children, particularly in remote rural and tribal areas, have the greatest mortality risks, the purpose of this strategic objective (SO) is to reduce the high levels of child mortality and malnutrition. The major activity that contributes to this SO is the P.L. 480 Title II program being implemented by Cooperative for Assistance and Relief Everywhere (CARE) and Catholic Relief Services (CRS). The program reaches more than seven million women and children by integrating Tile II commodities and other GOI and non-governmental resources in the program. Through the GOI's Integrated Child Development Services (ICDS) program (India's equivalent of Head Start), CARE taps into a network of over 111,000 village centers. CRS, working through private registered social service societies including programs managed by Mother Teresa's and the Dalai Lama's organizations, reaches those women and children who are not served by the GOI's ICDS.

A bilateral activity, the Program for Advancement of Commercial Technology/Child and Reproductive Health (PACT/CRH), complements the Title II program by providing support at the national level for technologies aimed at improving child survival while increasing commercial marketing and distribution of quality child survival products and services such as Oral Rehydration Salts (ORS) and vaccines.

Key Results: Among the multiple factors influencing child survival and nutrition, three key intermediate results were identified by USAID as critical in the Indian context to achieve this objective: (1) increased use of key child survival interventions; (2) improved maternal and child nutrition; and (3) improved targeting of at-risk populations.

Performance and Prospects: Under the Title II activity, performance surpassed expected levels for all key results. In FY 1997, under the CARE program areas, immunization rates were 60% (planned - 31%); iron-folate supplementation of pregnant women improved from 13% to 26% (planned - 20%) despite problems in GOI supplies of the tablets; the percentage of infants receiving complementary foods at 6-9 months of age increased from 46% to 65% (planned - 50%); and the coverage of under-two-year-olds in the program rose from 40% to 63% (planned - 43%). These initial results are encouraging and the trends indicate that the strategy of using food to draw children and mothers into programs where they can receive health care services is working. The program is, thus, expected to achieve the projected improvements in nutritional status of children. A mid-term review of the CARE and CRS Title II programs planned for FY 1999 will assess the success of the strategy and recommend any mid-course corrections in strategy and activities.

Nearly one-fourth of child deaths are due to diarrhea, a substantial proportion of which can be prevented by the use of oral rehydration salts (ORS). Under the PACT/CRH activity: (i) the Industrial Credit & Investment Corporation of India (ICICI) is in the process of approving a loan to a firm with an extensive distribution network to manufacture, market and promote ORS in India. A generic promotion campaign to position ORS as the scientific, doctor-recommended, first-line product for all cases of childhood diarrhea is scheduled to be launched this year; (ii) ICICI has also entered into an agreement with the premier vaccine manufacturer in India, the Serum Institute, to produce and market a high quality Mumps, Measles and Rubella vaccine through commercial channels; and (iii) a grant has also been provided to set up an Information Center for Child and Reproductive Health and AIDS Prevention.

USAID, along with the World Bank, has funded a large Deworming and Enhanced Vitamin A (DEVTA) trial. The ongoing trial covers 8,000 villages and about 1 million children and is based on results of a smaller study that showed improved impact of Vitamin A on growth of children with concomitant deworming. The study will determine the impact of enhanced vitamin A coverage and deworming on mortality and growth of children and will also provide a sustainable model for improved delivery of micronutrients, including vitamin A. USAID plans to fund additional research that will inform government policy on vitamin A and anemia control programs.

Possible Adjustments to plans: USAID proposes to develop new activities that would strengthen its contribution to improving child survival and nutrition, particularly micronutrient status. Discussions have been initiated with key nutrition and research institutions in this regard.

Other Donor Programs: Other donors working in the nutrition and health sector include the United Nations Children's Fund, World Bank, Swedish International Development Agency, and World Food Program . In addition, the GOI funds all of the ICDS services, program personnel, infrastructure, for the CARE program and in-country transportation and storage costs for all P.L. 480 Title II commodities. CARE and CRS provide technical assistance, training and logistic support.

Principal Contractors Grantees or Agencies: USAID implements the P.L. 480 Title II India program through U.S. PVOs, namely CARE and CRS. The PACT/CRH is implemented through ICICI, with U.S. technical assistance from Program for Appropriate Technology in Health.

Selected Performance Measures:

	Baseline1	Target1	Target1
	CARE: 1996 CRS: 1997	2000	2001
Percent of children fully immunized by age one CARE: CRS:	28 28	40 43	44 48
Percent of pregnant women who Received 90-100 iron-folate tablets During their pregnancy CARE: CRS:	13 13	30 28	35 33
Percent of infants who received Breast-milk and solid-mushy foods At 6-9 months of age CARE: CRS:	46 64	62 78	65 78
1 Population covered lies within CARE and CRS serviced catchment areas.

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ACTIVITY DATA SHEET

PROGRAM: INDIA
TITLE AND NUMBER: Increased Environmental Protection in Energy, Industry, and Cities, 386-SO04
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCES: FY 2000:$10,000,000 DA
INITIAL OBLIGATION: FY 1995 ESTIMATED COMPLETION DATE: FY 2002

Summary: This strategic objective (SO) funds work which increases efficiency and reduces pollution in the electric power and industrial sectors to reduce greenhouse gas (GHG) emissions, and improves urban environmental planning and infrastructure. India is the sixth largest and second fastest growing producer of GHG in the world. Electric power generation is the major source of GHG emissions in India, accounting for 48% (or 71 million tons) of India’s carbon emissions from fossil fuels. The activity supports the adoption of GHG reduction technologies and practices by the electric power sector. The activity also assists adoption of environmental management systems and clean technology practices by high energy-intensive industries, directly benefiting the firms, their workers and the local community. In addition, the activity improves living conditions in urban areas by assisting local governments in providing commercially viable basic services (water, waste collection and sewerage) to the fast growing urban population, especially to low income groups. The rapid growth in India’s urban population has put urban environmental infrastructure, including water supply, sanitation, and sewerage systems, under tremendous strain. Close to 40% of the urban population live in slums and squatter settlements without any significant access to these basic services, causing severe health problems to the most vulnerable groups of the population.

Key Results: Achievement of three key results by 2002 will indicate the successful attainment of this SO: (1) increased access to improved drinking water, waste water and solid waste services through commercially viable systems; (2) increased avoidance of emission of carbon dioxide equivalents; and (3) increased number of firms that meet international environment quality standards in selected industrial sectors.

Performance and Prospects: USAID helped the Ministry of Power draft the Energy Conservation Act to be approved by the Indian Parliament in early 1999. In the state of Haryana, USAID identified and developed projects worth $40 million for the World Bank to improve low-tension electricity distribution. USAID technical assistance to the states of Punjab, Haryana and West Bengal is helping establish State Electricity Regulatory Commissions to improve power sector efficiency. USAID recommendations have led to the reduction of two million metric tons of carbon dioxide by power plants of the National Thermal Power Corporation and by the Gujarat Electricity Board.

USAID’s support for renewable energy technologies has resulted in the installation of nearly 200 MW of sugar co-generation power plants using bio-mass fuels and domestic lighting for nearly 2500 rural homes using solar photovoltaic technology. The signing of new partnership agreements between leading Indian and U.S. power utilities and regulatory agencies under the USAID-funded Utility Partnership Program provides a long-term mechanism for transfer of U.S. non-nuclear technology and experience to Indian organizations, while opening the door for U.S. exports. The USAID Energy Training Program provides training for ongoing regulatory reform and energy efficiency in India.

USAID’s Clean Technology Initiative is providing assistance to Indian industry to adopt certified environmental management systems and is enhancing the capacity of industry to incorporate best technologies and practices into their operations to enhance productivity and profitability. Energy intensive sectors of cement, thermal power and steel were targeted for assistance. Nine firms will achieve ISO 14000 certification under a pilot phase.

USAID’s achievement in improvement of urban environmental infrastructure in India is well recognized. The Ahmedabad Municipal Corporation (AMC) succeeded in issuing a $25 million municipal bond, the first one in South Asia, to help finance the city’s environmental infrastructure projects including provision of basic services to slum communities. Thereafter, USAID assisted AMC to prepare commercially viable water supply and sanitation projects. USAID’s Urban and Environmental Credit Loan Guaranty of up to $25 million to AMC has also been an important "confidence builder" for this innovative package of changes. In the state of Tamil Nadu, the negotiations for the first build-operate-transfer project on water supply and sewerage in Tiruppur has been completed and is nearing financial closure and the commencement of construction.

Responding to the needs of both city governments and NGOs working on community based environmental improvements, USAID provided technical assistance to develop a "tool kit" of improved environmental management approaches and helped five cities to prepare environmental status reports/workbooks, comparative risk assessments, and environmental management plans.

Possible Adjustments to Plans: New funding for energy activities under this Strategic Objective was suspended in May 1998 as a part of the response to India's nuclear tests. Limited energy activities are currently being implemented with "pipeline" budgets from years prior to FY 1998. If there is no change in the suspension by mid-1999, the target achievements will have to be revised. Results and benefits will decrease significantly.

Other Donor Programs: USAID works closely with the World Bank (WB), the British Department for International Development and Asian Development Bank (ADB) on power sector reform and restructuring. A proposal for funding to improve the low-tension distribution system in the energy sector is under review by the WB. USAID is working with the WB and ADB to provide complementary grant-funded technical assistance to the states of Haryana, Punjab and West Bengal for power sector regulatory reform. Negotiations for WB assistance to augment the resources of the Tamil Nadu (TN) Urban Development Fund for financing environmental infrastructure projects in the state, have reached the final stages. The WB project paper has been developed in consultation with USAID and draws heavily from the work experience of USAID in TN. USAID will complement the WB’s effort in the institutional strengthening component of the project.

Principal Contractors, Grantees or Agencies: Current grantees and contractors include: International Resources Group; Federal Energy Technology Center of U.S. Department of Energy; Winrock International; Institute of International Education; United States Energy Association; Hagler Bailly Services Corporation; and Community Consultants Inc. Indian partners include: Ministry of Power; Central and State Electricity Regulatory Commissions; State and private sector power utilities; Ministry of Environment and Forests; Power Finance Corporation; Industrial Development Bank of India; ICICI Limited; National Thermal Power Corporation Limited; Confederation of Indian Industry; Federation of Indian Chambers of Commerce and Industry; National Institute of Urban Affairs; Housing and Urban Development Corporation; and Infrastructure Leasing and Financial Services.

Selected Performance Measures:

	Baseline (1995)	Target (2000)	Target (2002)
Increased access to improved drinking water, waste water and solid waste services through commercially viable systems (population in million)	0	.70	5
Emissions of carbon dioxide equivalents avoided (in million tons)	0	12.0	22.4
Increased number of firms that meet international environmental quality standards in selected industrial sectors (number of firms)	0 (1998)	15.0	25
1 cumulative CO2 avoided

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ACTIVITY DATA SHEET

PROGRAM: INDIA
TITLE AND NUMBER: Reduced Transmission and Mitigated Impact of Infectious Diseases, especially STD/HIV/AIDS in India, 386-SO07
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCES: FY 2000: $8,500,000 CSD
INITIAL OBLIGATION: FY 1995 ESTIMATED COMPLETION DATE: FY 2005

Summary: In FY 1992, USAID responded to early evidence of a growing problem of Human Immuno Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) in India by developing the AIDS Prevention and Control (APAC) activity in the south Indian state of Tamil Nadu - one of India's three recognized epidemic epicenters. APAC activities aim to prevent and control sexual transmission of HIV among groups engaging in high-risk behavior by: 1) using proven strategies of education for behavior change; 2) expanding access to and utilization of high quality condoms; and 3) expanding access to and utilization of quality treatment for sexually transmitted diseases (STD). In addition, the Program for Advancement of Commercial Technology/Child and Reproductive Health (PACT/CRH) aims to stimulate the private sector to improve access to and quality of health products and services, especially condoms.

In FY 1998, USAID/India expanded its program to include the state of Maharashtra, which accounts for over 50% of all reported HIV and AIDS cases in India, with a $41.5 million funding effort. In Maharashtra, comprehensive prevention programs will focus on the urban areas of Mumbai, Pune, Thane and Sangli, where more than 80% of Maharashtra’s sex workers live and work. The activity will also help strengthen the capacity of the state government to respond to the epidemic.

While commercial sex workers and their clients are the immediate direct beneficiaries of HIV/AIDS prevention programs, women and children represent 50% of all beneficiaries.

Another objective of the SO is to help eradicate polio. USAID, through the Global Bureau, provided $4 million to UN organizations and Rotary International to help implement the Government of India's (GOI) polio eradication program. Also, the Global Bureau provided $2 million through the World Health Organization to the GOI's tuberculosis research center in Chennai and for development of integrated national disease surveillance systems. Another $2.2 million has been provided to the International Clinical Epidemiology Network (INCLEN) for research on infectious diseases in India.

Key Results: Critical to HIV/AIDS prevention programs is moving those engaged in high-risk behavior beyond knowledge about methods of preventing sexual transmission to actual adoption of safe practices.

Performance and Prospects: In the last three years, 102 non-governmental organizations (NGOs) in Tamil Nadu have been funded to carry out prevention programs for high risk groups such as truck drivers and their helpers and women in prostitution and their clients. At least six NGOs have received grants to serve each of these groups. In 1997, 66% of truck drivers and their helpers reported condom use during their last sexual encounter with a female commercial sex worker – up from 55% in 1996. Also in 1997, 79% of truck drivers and their helpers reported that they sought care from qualified medical practitioners for STD symptoms - up from 64% in 1996, while 83% of male factory workers reported similar health-seeking behavior, an improvement over the previous year’s 58%. To improve the quality of care for STDs, 615 (480 males and 135 females) physicians have been trained using a module developed by APAC. To improve the availability of and demand for high quality condoms for disease prevention, APAC entered into a collaborative effort with a manufacturer to expand the retail sales network from 25,000 to 65,000 outlets in Tamil Nadu. 2,125 retailers in Tamil Nadu will be trained over the next 12 months to motivate them to more actively promote condoms at point of purchase.

PACT/CRH has provided loans to private-sector manufacturers to expand the marketing and distribution of condoms and to manufacture and market condom vending machines. PACT/CRH has assisted manufacturers to improve their internal quality control procedures, an issue of central importance to HIV/AIDS prevention. PACT/CRH technical experts are also assisting the Drugs Controller of India to strengthen the Government's quality control monitoring capacity and work with manufacturers to improve condom packaging in India. PACT/CRH has provided a grant to the Confederation of Indian Industry to develop and market educational packages for prevention of HIV/AIDS in industrial workplaces.

Under the polio eradication activity, the support of USAID, the GOI and other donors resulted in a large-scale campaign which inoculated 125 million children under five years on a single day in 1997-98. Reported polio cases have dropped by 94% from 24,257 cases in 1988 to 1,477 in 1997. India's contribution to the worldwide burden of polio cases has been significantly reduced.

Possible Adjustments to Plans: It is expected that the Maharashtra activity will be signed with the GOI and that implementation will begin by April 1999.

Other Donor Programs: The GOI's World Bank-funded $100 million, seven-year National AIDS Control Program (NACP) assists the government health system in Indian states to work on HIV/AIDS prevention. A second phase $200 million, five-year program is presently being negotiated for an April 1999 start. The British Department for International Development is currently negotiating with the GOI to launch an $80 million assistance program that will encompass a country-wide intervention with truck drivers to promote behavior modification and STD treatment, and also behavior change programs in the Indian states of Andhra Pradesh, West Bengal, Kerala, Gujarat, and Orissa. The European Union supports NGO activities in several Indian states. UNAIDS coordinates the response of the UN agencies to HIV/AIDS in India. All donor programs, including USAID's, have been carefully coordinated to complement the World Bank-assisted NACP.

Principal Contractors, Grantees, or Agencies: Voluntary Health Services and Industrial Credit and Investment Corporation of India have been the central organizations implementing the Tamil Nadu and PACT/CRH activities. Family Health International, a U.S. organization that collaborated in the Tamil Nadu activities, and Deloitte Touche Tohmatsu are collaborators under the PACT/CRH activities.

Selected Performance Measures (in Tamil Nadu):

	Baseline	Target (2000)	Target (2002)
Percentage of individuals belonging to specified high-risk groups who report condom use in most recent sexual encounter with a non-regular partner.	37% (1996)	57%	62%
Percentage of population seeking care from qualified medical practitioners for symptomatic STDs.	52% (1996)	72%	77%
Cumulative number of APAC grants for AIDS prevention.	0 (1995)	75	100

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ACTIVITY DATA SHEET

PROGRAM: INDIA
TITLE AND NUMBER: Expanded Advocacy and Service Delivery Networks for Women, 386-SP03
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCES: FY 2000: $1,700,000 DA; $1,000,000 CSD
INITIAL OBLIGATION: FY 1996 ESTIMATED COMPLETION DATE: FY 2002

Summary: Women are the most disadvantaged members of the Indian population and comprise the largest section of the population living in absolute poverty. The low status of women is reflected in indicators such as a low literacy rate, a significant gender gap in primary education, high prevalence of a number of forms of violence against women, and lack of access to financial services. India’s most recent census figures (1991) indicate that there are 927 females for every 1000 males, and a 1992-93 study of literacy identifies literacy rates of 43% for females and 69% for males. Activities under the strategic objective (SO) seek to expand women’s role and participation in decision making through the areas of micro-finance for women, greater school participation for young girls, and the prevention of violence against women. The program is based on extensive consultations with women’s groups, grassroots organizations, research institutions, government, media groups, and other donors. This special objective benefits the school-going girls in Rae Bareilly district of Uttar Pradesh (UP), low-income women in rural areas who will have access to financial services as a result of USAID intervention and women who are, or potentially may become, victims of violence.

Key Results: The special objective has three intermediate results: (1) increased number of women clients receiving financial services as a result of improved business planning of participating institutions; (2) increased number of local institutions and their constituencies collecting data and advocating against violence against women; and (3) increased enrollment and retention of girls in primary schools in one district in UP.

Performance and Prospects: Through USAID assistance, Friends of Women's World Banking (FWWB) trained 31 NGOs in strategic business planning. The first group of trained NGOs, who were serving a total of 26,578 low-income women, were able to achieve a 70% increase in coverage following a training exercise in strategic business planning. FWWB expects a similar increase in the remaining year of the activity.

By the end of 1998, draft reports had been completed on effective responses to domestic violence in the States of Maharashtra, Madhya Pradesh, Gujarat and Karnataka. A case study on violence against women from the Kheda District of Gujarat was also produced in 1998. The analysis of records from local police offices and hospitals is nearing completion and should be ready in time for the dissemination conference scheduled for April 1999. While studies of institutional records will give insights into trends, patterns, and responses to domestic violence, there is a need for more rigorous empirical data to establish prevalence, identify risk and protective factors, and determine the health and economic outcomes. To meet this need, the International Clinical Epidemiology Network (INCLEN) is undertaking a large, multi-site, population-based survey in seven different geographical sites of India, and it is expected to be completed by December 1999. The emphasis in 1999 will be on placing all research studies (and the INCLEN survey) in the larger context of generating awareness around the issue of domestic violence, sensitizing the stakeholders to the nature of the problem, and advocating programs and policies to address the problem. Dissemination conferences are scheduled for April and November 1999, and these will be aimed at researchers, medical practitioners, policy makers, bureaucrats, police, judiciary and human rights groups.

Under this special objective, USAID is also implementing an activity to increase enrollment and retention of girls in primary schools in one district of UP. The girls’ education activity focuses on in-class variables, particularly on the pattern of classroom interaction between teacher and girls. In 1998, the action research phase was successfully concluded and resulted in a draft teacher-training module and a gender handbook. The plan now is to implement the training module in the remaining 19 blocks of Rae Bareilly district.

Possible Adjustments to Plans: Technical assistance was sought to analyze existing girls' education programs, to identify a niche for an expanded USAID activity and to set up an effective performance monitoring system for all USAID-supported education activities.

Other Donor Programs: The UN, World Bank, Swiss, Dutch and Canadian Governments all support credit and enterprise programs for women. However, most of these programs focus either on the formal banking system or on women's self-help group formation and development of home-based enterprises. USAID focuses instead on upgrading the technical and managerial capabilities of non-traditional financial institutions, which, by operating on a sound, sustainable basis, will increase the quality and outreach of non-formal financial services they provide to women.

In primary education, the World Bank, UN agencies, European Union and the British Department for International Development (DFID) are providing assistance to the Indian Government’s District Primary Education Program (DPEP) to improve coverage and quality of primary education, including provision of assistance in several states for school construction, teacher training and decentralized management of schools. The USAID activity complements this comprehensive program by focusing specifically on gender training for teachers to improve community and classroom environments for girls’ enrollment and participation in schools.

Principal Contractors, Grantees and Agencies: Center for International Education, University of Massachusetts, International Center for Research on Women and sub-grantees, The Center for Development and Population Activities, Friends of Women's World Banking and other local institutions.

Selected Performance Measures:

	Baseline (1996)	Target (1999)	Target (2000)
Improved business planning process established in participating institutions	0	50
Increased number of local institutions and their constituencies creating data and informed advocacy on violence against women	0	30
Training module being used in 'X' blocks in Uttar Pradesh	0 (1996)	6	20

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