MEXICO

	FY 1998 Actuals	FY 1999 Estimate	FY 2000 Request
Development Assistance	$8,977,000	$6,882,000	$6,725,000
Child Survival & Disease Fund	$400,000	$2,050,000	$1,700,000
Economic Support Funds	$1,000,000	$1,500,000	$2,000,000
International Narcotics Control Funds	$500,000	$1,000,000	$1,000,000

Introduction

Mexico, with its 2,000 mile border, emerging democracy, and volatile economy, is central to U.S. Latin American policy. Mexico is a major transit country for illicit drugs and a source of much legal and illegal labor. As the United States’ second largest trading partner, Mexico helps shield the U.S. export market from world shocks. In Mexico, USAID facilitates hemispheric and regional cooperation between the United States and Mexico, addresses key diplomatic objectives such as counternarcotics and energy, and works in sustainable development activities such as health and the environment. Mexican partners bear more than half of the expense of programs carried out by USAID in Mexico.

Development Challenge

The challenge in Mexico is unique among USAID-presence countries. Not only does USAID deal with Mexico in a multilateral context--on hemispheric and world issues such as the Kyoto Climate Change, the Summit of the Americas, the North American Free Trade Agreement (NAFTA), trade integration, and Central American reconstruction--it also has a bilateral program that cooperates with Mexican and U.S. agencies in addressing issues in counternarcotics and crime, the environment, clean energy, and public health.

Mexico is one of the largest emitters of greenhouse gases in the world and a key country in USAID's Climate Change Action Plan, both for emissions and their potential for reduction. USAID and the Mexican Electric Commission have reduced CO₂ emissions in a way that shows that clean energy and economic development are compatible goals. Cost-effective energy-saving technology, much of which comes from the United States, is being expanded to other generating stations. Mexico is a major contributor to achievement of the second generation reforms launched at the Second Summit of the Americas in Santiago in April 1998. On the fifth anniversary of the North American Free Trade Agreement, the United States, Mexico, and Canada are moving to coordinate their development assistance programs in a spirit similar to that of NAFTA to spur increased progress against the Summit goals. USAID underpins these activities by providing concrete support to U.S. diplomatic positions. Mexico and the United States are seeking closer coordination of development activities in Central America. High among these priorities is reconstruction of the damage caused by Hurricanes Georges and Mitch. USAID will facilitate contacts in Mexico for third countries where USAID Missions are funding reconstruction activities.

The primary U.S. bilateral policy issue with Mexico is control of narcotrafficking and related crime. USAID facilitates exchanges between U.S. and Mexican federal judges to strengthen administration of justice, especially in counternarcotics, and will also facilitate contacts between state judges as well. USAID has facilitated contacts between U.S. and Mexican cities for the improvement of municipal services and maintains an active program of exchange and support for NGOs interested in improving governance at all levels.

Mexico is among the most biologically diverse countries in the world. It also has one of the world's highest rates of deforestation and natural resource degradation as a result of wildfires, agricultural clearing, and over-fishing. In June 1998, the Bi-National Commission of the two governments agreed to cooperate in the prevention and protection against wildfires. USAID will also help the GOM and Mexican NGOs to expand the system of protected areas, plan resource management for vital ecosystems; offer economic alternatives for people living in these delicate areas, and promote policy reforms and strengthening key organizations.

Mexico has the third largest HIV/AIDS-infected population in the Western Hemisphere. USAID is designing prevention programs at the state level to avoid the human consequences and high costs if AIDS were to reach an epidemic level. Tuberculosis has emerged as a threat, with its incidence and increase linked to poverty, migration and HIV/AIDS. The number of drug-resistant cases in U.S. and Mexican border states is above the average for both countries. USAID is working with the Mexican Secretariat of Health, other GOM institutions, and NGOs to better monitor and treat tuberculosis. USAID’s support to Mexican voluntary family planning programs ends in March 1999. Since 1997, the assistance emphasized quality of care issues including informed consent of persons who avail themselves of family planning services.

Other Donors

The Inter-American Development Bank (IDB) and the World Bank finance development assistance programs through the GOM, largely in the poor southern states. USAID's role has been one of breaking a path for the multilateral lenders. Mexico has development cooperation with Japan, and is negotiating technical exchanges with the European Community.

FY 2000 Program

The program in FY 2000 will support trilateral assistance coordination in the hemisphere and work towards strategic U.S. objectives in counternarcotics, the environment, energy, health, and democracy. Specifically, USAID will:

• Implement a trilateral agreement for coordination of development assistance in the hemisphere that directly supports the Summit of the Americas objectives.
• Implement a bilateral agreement that facilitates the use of Mexican training and technical assistance for hurricane reconstruction and broader development in Central America.
• Broaden the conservation of threatened eco-systems and promote sustainable environmental protection, including microenterprise under a Development Credit Authority (DCA) guarantee.
• Co-host an international conference on the use of fire in agriculture.
• Assist the power sector to apply more efficient combustion technology to reduce costs and greenhouse gas emissions.
• Continue the judicial exchange activity with emphasis on counternarcotics and state courts, strengthen municipal governments and NGOs with an interest in improving governance.
• Expand HIV/AIDS prevention and develop guidelines for STD diagnosis and treatment.
• Launch a tuberculosis program to expand the GOM's Directly Observed Treatment training to cover the northern border and key states.

MEXICO

FY 2000 PROGRAM SUMMARY
(in thousands of dollars)

USAID Mission Director: Paul E. White

USAID Strategic and Special Objectives	Economic Growth & Agriculture	Population & Health	Environment	Democracy	Human Capacity Developmnt	Humanitarian Assistance	TOTALS
S.O. 1 Ecosystems and Biological Resources Conserved - DA	---	---	3,570	---	---	---	3,570
S.O. 2 CO2 Emissions and Pollution Reduced - DA	---	---	2,430	---	---	---	2,430
S.O. 3 Strenghtened and More Responsive Democratic Institutions/ Citizenry - DA - ESF - INC	--- --- ---	--- --- ---	--- --- ---	725 2,000 1,000	--- --- ---	--- --- ---	725 2,000 1,000
S.O. 4 Enhanced Access, Quality and Sustainability of HIV/AIDS Ser-vices and Info for Vulnerable Populations - CS	---	1,200	---	---	---	---	1,200
S.O. 5 New TB Activity - CS	---	500	---	---	---	---	500
TOTALS - DA - CS - ESF - INC	--- --- --- ---	--- 1,700 --- ---	6,000 --- --- ---	725 --- 2,000 1,000	--- --- --- ---	--- --- --- ---	6,725 1,700 2,000 1,000

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ACTIVITY DATA SHEET

PROGRAM: Mexico
TITLE: Critical Ecosystems and Biological Resources Conserved, 523-SO01
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCES: FY 2000: $3,570,000 DA
INITIAL OBLIGATION: FY 1995 ESTIMATED COMPLETION DATE: FY 2006

Summary: The focus of this strategic objective (SO) is conserving critical ecosystems and biological resources. Protected areas management, forest and wildlands conservation, fires prevention and recovery, and many other portfolio activities help to sequester carbon or avoid or reduce the emission of greenhouse gases. In this way the SO also supports Agency objectives regarding the mitigation of global climate change.

The USAID program addresses four key constraints which must be removed to permit successful on-the-ground conservation in Mexico: (1) the system of protected areas is too small and unrepresentative Most of the GOM protected areas lack funds and cannot develop or enforce management plans; (2) natural resource management on lands adjacent to protected areas is inadequate; (3) reform is needed in laws and policies; and (4) there is insufficient nongovernmental capacity to guide resource management. In addition, the wildfire disaster of Spring 1998, which sent smoke and ash over much of the southern United States, produced a unique bilateral agreement. This agreement was ratified by the two governments at the June 1998 Bi-National Commission meetings in Washington to cooperate on the prevention of such disasters.

The pilot activities that USAID supports are securing the long-term stability of parks and protected areas through increased Mexican management capability, and development of sustainable funding mechanisms. USAID is developing community-based plans, technologies and industries, for sustainable use activities in all targeted areas. USAID's partner organizations are working to develop an improved legal and policy framework. USAID's program is designed to build management capacity among NGOs, community groups and others where that capacity is insufficient. USAID expects to replicate its successful pilot experiences and develop a critical level of institutional capability that will promote sustainable biodiversity conservation in Mexico. This is the same model which the Mexico Conservation Fund (FMCN) has successfully carried out. In late FY 1998, USAID initiated a Mexico Fires Prevention and Rehabilitation Program with a new partner, the GOM's Environmental Secretariat (SEMARNAP). This activity (budgeted under the LAC Regional Program) will be implemented through the development of a grants program to be administered by the FMCN, and will be integrated into existing environmental conservation activities.

Key Results: USAID has identified four intermediate results which will lead to achievement of the SO: (1) improved management of nine target protected areas and other critical ecosystems; (2) demonstration and implementation of sustainable use activities in biologically important areas (measured by the number of men and women participating in sustainable activities; (3) improved policy framework for conservation and sustainable use of biological resources; and (4) improved professional capacity for seven Mexican NGOs to direct conservation and sustainable use programs. One of the key indicators for the fourth program IR has been achieved: The FMCN has become fully operational, and is fulfilling the biodiversity conservation mandate established for it when its funding endowment was established. This is measured by (a) the capitalization level of the FMCN, which demonstrates non USG commitment to USAID's biodiversity goals (FY 2003 target: $79 million); and (b) the number of grants for NGO projects in this area being approved and disbursed each year (FY 2003 target: 100).

Performance and Prospects: In 1998, USAID assisted its Mexican partners to implement improved management of five protected areas, while a total of eight protected areas were being managed under work plans designed by Mexican NGOs. Approximately 9,000 people living in these fragile areas directly benefit from improved management of these lands. Nongovernmental support to Mexican NGOs increased substantially, with 76 grants awarded by the FMCN. Fire emergency preparedness was increased at the community level as a result of the wildfires prevention and recovery project, begun in June 1998.

Possible Adjustments to Plans: The FMCN is now expanding its activities, to incorporate wildfire protection and restoration as an essential element of biodiversity conservation. The complex Fire Prevention activity must be successfully integrated with existing conservation activities. The GOM's Environmental Secretariat (SEMARNAP) must establish effective working relationships with environmental NGOs; and the NGOs must learn to work with the FMCN, to obtain grant funding. It may be necessary, at some point, to strengthen the structure of the fire prevention activity, in order to achieve a smooth transition to integrated activities.

Other Donors: Multinational development banks (MDBs) are important indirect partners who provide counterpart or follow-on funding for expansion of USAID-supported pilot interventions. Over the life of the SO (through FY 2006) we expect that over $100 million in MDB funds will have been contributed toward USAID's targeted results. This includes $16.5 million from the Global Environment Facility to increase FMCN's total endowment; and an estimated $20 million from the World Bank to support SEMARNAP and protected areas management.

Principal Contractors, Grantees or Agencies: The U.S. Nature Conservancy; Conservation International; The University of Rhode Island; Partners in Flight; PRONATURA; FMCN, and SEMARNAP.

Selected Performance Measures:

	Baseline (FY 1995)	Target (FY 2000)	Target (FY 2003)
Number of core areas demonstrating improved management capability	0	5	9
Number of target protected areas being managed according to NGO plans	0	8	6
Number of people in target areas participating in sustainable use activities (men/women)	0	6,420/2,795	2,742/947
Overall level of Mexican and other donor capitalization of the FMCN	0	$43 million	$79 Million
Number of new grants disbursed each year by the FMCN	0	76	100

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ACTIVITY DATA SHEET

PROGRAM: Mexico
TITLE AND NUMBER: Carbon dioxide emissions and pollution reduced, 523-SO02
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCES: FY 2000: $2,430,000 DA
INITIAL OBLIGATION: FY 1993 ESTIMATED COMPLETION DATE: FY 2006

Summary: Mexico is one of the largest emitters of greenhouse gases (GHGs) in Latin America; and ranks third among developing countries. Mexico is a key country in USAID’s global Developing Country Climate Change Action Plan, because of its contribution to net global GHG emissions, and Mexico’s potential for carrying out cost effective actions to reduce the growth in GHG emissions.

Energy is inexpensive, and widely available thanks to an extensive electrical grid. Partly because energy receives high GOM subsidies, there are few incentives to use electric power efficiently. Energy demand has grown very fast in the past 10 years (six to seven percent per year). Industrial pollution has also become a major problem. Mexico faces a dilemma: how to stimulate its economy and create employment through industrial growth, while remaining competitive with global producers and protective of its environment. USAID believes the solution lies in three major action areas: demonstrating that investment in proven energy efficiency, renewable energy and pollution reduction technologies will pay off for industry; increasing financing available for those who wish to adopt new energy technologies; and changing public policies to encourage efficient, non-polluting use of energy. All of these elements are necessary, in order to achieve the primary goal: widespread use of clean, efficient and renewable energy and production technologies, and reduced carbon dioxide emissions and pollution.

Key Results: This SO has one intermediate result: the adoption of resource management systems (RMS) and renewable energy technologies and practices in targeted industries and municipalities. From program inception to FY 1998, SO2 focused on three specific indicators: 1) carbon dioxide emissions prevented through adoption of more efficient combustion technology (886,000 million metric tons; 2) adoption of at least 50% of energy/environment audit recommendations by 82 firms; and 3) adoption of renewable energy technologies and practices by 52,000 beneficiaries.

Performance and Prospects: The first phase of this program focused on testing and demonstration of economically viable RMS and renewable energy technologies in selected industries. This phase, and its corresponding intermediate results have been completed successfully through demonstration projects focused on specific management measures and technologies (i.e., steam efficiency, motor rewinds, and high efficiency motors), and on the maquiladora industries (i.e., electroplating, foundry and chemical sectors).

The second phase of the program, now beginning, is aimed at achieving widespread adoption of proven energy efficiency and non-polluting production technologies. RMS activities include: design of large-scale programs based on pilot project results; replication of proven RMS methodologies (high efficiency motors and pumps), and developing computer software for energy efficiency analysis with Mexican expertise; expansion of non-polluting production techniques to a second group of plants in the electroplating industry; work on policies to encourage industrial pollution reduction; training local consultants and manufacturing plant staff to conduct energy audits resulting in increased energy efficiency, decreased pollution, and lowered operating costs. The renewable energy program, working through agricultural development and conservation organizations, has installed approximately 200 energy generating projects in 10 Mexican states. These projects are producing approximately 100KW of electric power using renewable energy methods. (This is expected to grow to 250 KW by end-FY 1999). The program has worked with more than 40 U.S. and Mexican manufacturers and suppliers of renewable energy technologies. To date, there are an estimated 10,000 direct and 40,000 indirect beneficiaries of these renewable energy systems. And a potential market of over US $1 billion has been identified for renewable energy.

To expand adoption in FY 1999 and FY 2000, the program will implement pilot projects in additional industrial sectors, to demonstrate viability of RMS technologies; develop improved policies, strengthen the institutional capacity of partner institutions, and create financing mechanisms that promote the adoption of RMS and renewable energy; and provide training for more than 1,500 engineers, suppliers, and decision-makers in renewable energy project implementation.

Possible Adjustments to Plans: Mexico's commercial banks are experiencing a liquidity crisis, and are reluctant to risk entering a new lending market. If sustainable financing cannot be developed, USAID may fall short of its goal of achieving widespread adoption. The alternative would be to encourage other international donors to provide replication funding, until the Mexican economy situation improves. The current energy subsidies are politically popular. With inflation driving all other costs up, the GOM will be reluctant to take price and other policy measures which force manufacturers and industrialists to convert to energy efficient technologies. This would affect USAID's ability to meet the objective.

Other Donor Programs: Mexico’s public power utility, the Federal Electricity Commission, provided $23 million in funding to the national Trust Fund for Electrical Savings (FIDE). The Inter-American Development Bank (IDB) has authorized a $23 million loan for promotion of energy efficiency in the power sector. The United Nations’ Industrial Development Office (UNIDO) and the Mexican National Polytechnic Institute supported the creation of a Center for Cleaner Production, which implements pollution prevention projects in conjunction with the USAID program. The World Bank is preparing a $440 million agricultural productivity improvement project which could provide up to $40 million for agricultural projects which use renewable energy applications.

Principal Contractors, Grantees or Agencies: Hagler Bailly; U.S. Department of Energy’s Sandia National Laboratories; the Mexican National Energy Savings Commission (CONAE); the Mexican Electrical Energy Savings Trust Fund (FIDE); the Mexican Center for Cleaner Production (CMPL); and the Mexican Shared Risk Trust Fund.

Selected Performance Measures:

	Baseline (FY 1995)	Target (FY 2000)	Target (FY 2006)
Carbon dioxide emissions prevented through selected uses (per year) (estimated metric tons of CO2)	0	300,000	1,254,000
Number of firms adopting energy efficient technologies and practices	0	43	165
Number of beneficiaries adopting renewable energy technologies and practices	0	1,000	32,000

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ACTIVITY DATA SHEET

PROGRAM: Mexico
TITLE AND NUMBER: More democratic processes adopted in key government institutions, 523-SO03
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCES: FY 2000: $725,000 DA; $2,000,000 ESF; $1,000,000 INC
INITIAL OBLIGATION: FY 1997 ESTIMATED COMPLETION DATE: FY 2003

Summary: Seventy years of one-party rule are coming to an end. The old political structures are breaking down, and the Mexican people are demanding open, democratic, effective and transparent government. USAID’s role has been to support the initiatives that Mexicans are taking in key areas.

A judicial exchange activity provides a unique fora for discussion between U.S. and Mexican judges of legal issues of mutual interest, and provides ideas which stimulate Mexico’s justice reform efforts. USAID proposes to start a model state court pilot (FY 1999) to test methods for improved court administration and prosecution of cases. USAID is also testing alternative dispute resolution (ADR) as a means of reducing court caseloads, making court administration more efficient, and improving access to justice for the poor. These will be important to USG counternarcotics objectives, as all narcotics cases begin at the state level in Mexico. USAID supported the National Autonomous University (UNAM) Judicial Research Institute development of a model judicial education degree program.

The pluralistic Chamber of Deputies (lower house in the federal legislature) must now update and streamline its administration, develop procedures for more pluralistic debate and consensus-building, and strengthen its ability to legislate independently of the executive branch. USAID is working with a committee of legislators to identify and assist in meeting the most urgent institutional strengthening needs for possible future assistance.

The federal government is decentralizing authority and funds to local levels. But Mexico's municipalities are ill-prepared to meet citizen expectations. USAID’s U.S.-Mexico Partnership for Municipal Development is conducting a municipal government strengthening pilot which includes technical assistance to improve municipal administration and services, coupled with a "sister cities" arrangement. If successful, this model to raise local government effectiveness and increase citizen participation may be replicated by other states and municipalities across Mexico.

After decades of corrupt elections, Mexico has made major advances toward orderly transfer of power among multiple parties. USAID helped Mexican NGOs strengthen the election observation system, and provide information to citizens about their electoral rights and obligations. A crucial test of the system's maturity will be the upcoming presidential elections in 2000, in which the opposition has a realistic chance of taking over the national government.

Key Results: Three intermediate results will help achieve the SO: more effective local governance in target areas; permanent structures strengthened to enhance Congress’ legislative function; and more efficient administration of justice in target state courts.

Performance and Prospects: In FY 1998, the municipal development activity formed working relationships between nine Arizona cities and six pilot municipalities in Jalisco. The technical assistance needs of each Mexican municipality were identified, and baseline measurements completed. Training courses in local government functioning and advocacy strategies for citizen organizations were designed. More than 100 Mexican and U.S. judges, prosecutors and legal academics from California, Arizona, Baja California and Sonora states participated in the first Judicial Exchange Border Conference to discuss major bilateral legal issues in criminal law, prosecuting and trying narcotics cases, commerce and trade, migration and environmental protection. UNAM designed and implemented a pilot master’s degree program in judicial law. The Mexican Center for Aid to Victims of Crime (CENAVID) opened two pilot centers for ADR in Jalisco; and is assisting court officials at state and federal levels and police agencies in testing mediation of less serious cases outside the court system. Commitments were obtained from a multi-party working group of congressional deputies to accept assistance through Mexican party foundations and administrative committees. An initial observation tour of legislative support services in FY 1999 will help the deputies develop a detailed work plan for future assistance.

By the end of FY 2000, three additional judicial exchange border conferences will be held. CENAVID will expand its ADR training for judicial and police officials in Jalisco; and obtain passage of legislation to install ADR in the court system in Jalisco. The Congress and Model State Court programs will be designed (including baseline, performance measures and workplans) in FY 1999. Both programs will be in full implementation by FY 2000. In FY 2000, improved service delivery and increased citizen input targets in the Jalisco municipalities will be met; and replication will begin in other municipalities. Citizen organizations trained by the Movement for Citizen Democracy (an NGO) will work with municipal authorities on key city policy issues. Progress will be made towards federal and state reforms which advance decentralization and promote municipal development.

Possible Adjustments to Plan: In the event of limited counternarcotics funding, judicial activities that contribute to this overriding U.S. objective will be slowed.

Other Donor Programs: USAID's local governance goals are advanced by Ford Foundation support for municipal associations. IDB and World Bank support municipal infrastructure development in Mexico’s southern states. The National Democratic Institute (NDI) works with the congress, and the U.S. Department of Justice, State Department and the U.S. Drug Enforcement Agency work with law enforcement and prosecutors which is an essential complement to USAID’s ROL activities. Many private international and Mexican foundations support improved access to justice and human rights in Mexico.

Principal Contractors, Grantees or Agencies: International City Managers’ Association (ICMA); Mexican NGO, Citizens’ Movement for Democracy (MCD); The Research Foundation of the State University of New York (SUNY); U.S. National Center for State Courts; the Mexican Center for Aid to Victims of Crime; and the Mexican Society for Womens’ Rights (Semillas).

Selected Performance Measures:

	Baseline	Target (2000)	Target (2003)
Local Governance: increased average municipal capacity to deliver services and increased citizen input in local governance decision-making.	.5277 on a 0-3 scale	1.25	2.5

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ACTIVITY DATA SHEET

PROGRAM: Mexico
TITLE AND NUMBER: Enhanced access, quality and sustainability of HIV/AIDS and STD services and information for vulnerable populations in targeted areas, 523-SO04
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCES: FY 2000: $1,200,000 CS
INITIAL OBLIGATION: FY 1998 ESTIMATED COMPLETION DATE: FY 2003

Summary: The GOM is currently reforming its health system, and transferring authority to the states for health policy and budget allocation. The states must tailor their programs to local realities; and health authorities and citizens must take responsibility for policy and quality of services. GOM health services and expenditures for HIV/AIDS at the national level are mostly oriented toward treatment and care than toward prevention. Decentralization forces states to determine what type and level of HIV/AIDS services they can afford. Most will not be able to support an increasingly costly treatment program. USAID's new SO will support CONASIDA in helping states pick up responsibility for funding and management of HIV/AIDS and STD programs. USAID assistance will help CONASIDA and the states to assess their current and projected situations with respect to HIV/AIDS and STDs; identify the most vulnerable populations; and design financially viable programs and information campaigns aimed at prevention, rather than treatment. The emphasis will be on institution-building and strengthened linkages between the public and private sectors.

While government is responsible for establishing a national strategy and guidelines for combating HIV/AIDS, private sector collaboration is needed in formulating the strategy and implementing programs, especially among hard to reach populations outside the reach of government services. Taking into consideration number of cases, current level of response and socio-economic conditions in each state, CONASIDA selected the states of Yucatan, Guerrero, Mexico (along with the Federal District), Puebla, Veracruz, Jalisco, and Oaxaca to initiate activities. Effective collaboration will require political will on the part of decision-makers, and full participation by civil society, as well as coordinated actions between governmental and NGO partners. Effective decision-making is also dependent on increased availability, and use of reliable data for policy development, program design, and advocacy. The USAID program will support development of cost-effective data collection and evaluation systems at the state level and within CONASIDA.

Key Results: Two key intermediate results were identified as leading to achievement of the SO: improved HIV/AIDS/STD policy environment at the national level and in targeted states; and increased capacity of governmental and nongovernmental partners to deliver HIV/AIDS/STD prevention, information and services.

Performance and Prospects: USAID's activities over the past year were directed toward defining the goals and planning for implementation. Workplans were developed with Mexican partners; and baseline data and targets are being set. Workshops in state-level strategic planning were held in two states with the active participation of NGOs and civil society organizations. In the state of Yucatan, the participants organized a multi-sectoral planning group, and obtained private sector funding to conduct a training workshop for 150 participants. Workshops in skills building, planning and external relations were held with key NGO partners, who will replicate the workshops for smaller NGOs in selected states. In FY 2000 workshops in strategic planning will be held in three additional states, while tailored technical assistance continues in states where multisectoral strategic planning groups have already been formed. A Mexican local institution will be selected and strengthened, to provide training on new STD and revised HIV/AIDS national guidelines to health workers in target states.

Possible Adjustments to Plans: Although it was originally planned to work with additional states in strategy planning in FY 1999, the schedule has been changed in order to provide continuing technical assistance to the multisectoral planning groups in the three original states. This was deemed necessary to ensure their sustainability and technical competency.

Other Donor Programs: In the area of prevention, various donors have supported efforts which complement USAID’s. These include the World Bank-funded regional project for Latin America; the joint United Nations Programme on HIV/AIDS (UNAIDS); the Pan American Health Organization (PAHO); and the MacArthur Foundation which supports a small program for prevention of AIDS among women in Mexico and other Latin American countries.However, USAID continues to be far and away the largest donor in this field.

Principal Contractors, Grantees or Agencies: Current contractors and grantees include the International HIV/AIDS Alliance, Family Health International, The Futures Group, Macro International, CONASIDA, the Mexican Health Foundation and local NGOs.

Selected Performance Measures: A performance monitoring plan, including intermediate results, indicators and baseline data for the new, expanded program in HIV/AIDS/STDs will be finalized by May 1999. Baseline data on policy environment and NGO capability was gathered by the end of 1998, and a facility-based survey against which to measure quality of services will be conducted in the Spring of 1999.

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ACTIVITY DATA SHEET

PROGRAM: Mexico
TITLE AND NUMBER: Combatting Infectious Diseases (Tuberculosis), 523-SO05
STATUS: New
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 2000: $500,000 CS
INITIAL OBLIGATION: FY 1999 ESTIMATED COMPLETION DATE: FY 2004

Summary: Tuberculosis (TB) has recently re-emerged as a major threat to global heath. Numbers of cases are increasing in Mexico, due to a combination of poverty and large migrating populations; demographic and economic pressures which limit availability and access to health services for these highly vulnerable groups; and an upsurge in the related diseases, HIV and AIDS. Of particular concern are the large numbers of drug-resistant cases of TB along the U.S.-Mexico border. Studies show that the TB rate for the U.S. and Mexican border area is above the average for both countries. Many of these cases originate in the southern states of Mexico where poverty and out-migration are greater than in the north of the country.

Key Results: USAID will field a team of specialists in February 1999 to define the causes of TB incidence and spread in greater detail; and develop a proposed strategy for combatting this threat in collaboration with the GOM, border states on both sides, and key NGOs which are working in this area along the border. This strategy will identify key results which USAID will seek to achieve under a new Infectious Diseases (TB) SO.

Performance and Prospects: Prospects for U.S.-Mexico collaboration in combatting TB are good. Mexican President Zedillo has pledged GOM support for the effort. The Mexican Health Secretariat has indicated interest in working with USAID to address specific TB-related problems, and identify means of controlling its spread. There are a number of U.S. organizations working to combat TB along the border at present, among them: Ten Against TB (a coalition of six Mexican and four U.S. border states), Project Concern International and Project Hope. These organizations will serve as important sources of data; and assist in identification of ways to reach the most vulnerable -and most inaccessible- populations.

Possible Adjustments to Plans: None

Other Donor Programs: PAHO is assisting the Mexican Health Secretariat in implementing a program for treating identified TB victims with a method call DOTS, which is considered most effective because it assures that TB patients take medication for the period of time required for a cure.

Principal Contractors, Grantees or Agencies: USAID proposes to work initially with NGOs on the Mexican side of the border, to develop model programs which could be replicated more broadly by the Mexican Secretariat of Health.

Selected Performance Measures: Preliminary results indicators will be identified in the course of developing the new Strategic Objective and Strategy for TB.

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