NICARAGUA

	FY 1998 Actuals	FY 1999 Estimate	FY 2000 Request
Development Assistance	$14,843,000	$16,600,000	$17,810,000
Child Survival & Disease Fund	$8,717,000	$11,940,000	$7,500,000
Economic Support Funds	$1,000,000	$1,500,000	$3,000,000
P.L. 480 Title II	$5,485,000	$13,069,000*	$6,244,000
* includes emergency food aid in response to Hurricane Mitch

Introduction

U.S. assistance to Nicaragua advances our national interests and strategic goals by strengthening democracy, promoting economic growth and reconstruction, and fully integrating Nicaragua in regional and global markets. U.S. engagement in Nicaragua is an investment in regional stability and the security of our borders, particularly after the destructive flooding caused by Hurricane Mitch in November 1998. Broad-based economic growth, open markets, and more jobs in Nicaragua not only offer an expanding market for U.S. exports and investment but also help stem the flow of illegal immigration to the United States. Assisting Nicaragua achieve a healthy democracy and rule of law contributes to a more level playing field for U.S. companies and improved security for U.S. citizens in Nicaragua as well as strengthens Nicaragua as a partner in the fight against illicit drug trade and international crime. Efforts to reduce environmental degradation will protect vital hemispheric biodiversity and help prevent natural disasters in the future while assuring sustainable development. U.S. assistance to reactivate basic health and education services following Hurricane Mitch, and emergency programs to improve food security for affected families, respond to Nicaragua's humanitarian needs and will contribute to its future prosperity.

Development Challenge

Prior to Hurricane Mitch, 1998 GDP growth for Nicaragua had been projected by the Central Bank to be 5.8% led by strong performance in the agriculture sector despite the effects of El Niño early in the year. Nicaragua had considerable success in reducing its rate of inflation to 7.2% in 1997, was on track to enjoy a small fiscal surplus in 1998, and had signed an Economic Structural Adjustment Facility (ESAF) agreement with the International Monetary Fund (IMF). However, despite debt forgiveness by the U.S. and other donors before and after Hurricane Mitch, Nicaragua still has an impossibly large external debt burden. Notwithstanding recent debt relief from the United States and other Paris Club creditors, still additional debt forgiveness is required. The country's debt burden remains considerable, including a debt-to-GDP ratio that exceeds 300% and a debt-service ratio in the neighborhood of 20%. These data compare most unfavorably to those of other Central American countries such as El Salvador and Guatemala where debt-to-GDP ratios are under 30 percent and debt-service ratios stand around 10 percent. Moreover, with overall economic losses as a result of Mitch estimated at $1.5 billion, projected GDP growth for 1998 dropped to four percent. A further drop to a 2.4% annual growth rate is expected in 1999. The challenge now is to recover productive capacity, with emphasis on rebuilding damaged agriculture, shelter, water and transportation infrastructure. To deal with the requirements of hurricane reconstruction, the Government of Nicaragua (GON) estimated it needs $1.4 billion in assistance from the international community.

The USG supports the GON's post-Mitch objective to safeguard good governance and its guarantee that civil society will participate in national reconstruction programs. Before the disaster struck, Nicaragua had free and fair elections in March 1998 on the Atlantic Coast, human rights violations continued to decline, and an increase in the level of participation by civil society in the political arena. Confidence in the judicial system grew in 1998 and the Congress passed several pieces of controversial legislation. The challenge now for democracy in Nicaragua is to not regress during this difficult period of recovery, but rather to push forward on government accountability, transparency, efficiency, participation, and decentralization during the reconstruction period.

Nicaragua's growing investments in the social sectors suffered a severe setback with the damage to and loss of physical infrastructure, equipment and stocks of supplies as a result of Hurricane Mitch. Previously, all health and education indicators showed positive trends of increasing primary school completion rates while decreasing infant mortality and fertility rates, and was on track to have one of the highest immunization rates in the Americas at 90%. However, following the severe flooding, Nicaragua's first challenge is to feed the hungry and prevent outbreaks of infectious diseases, and then to rebuild water and sanitation systems, health facilities, and schools.

Other Donors

The international community responded immediately and generously to Nicaragua's emergency needs following the devastation of Hurricane Mitch. Indications are that major infrastructure repair and reconstruction in the transport, housing, electric and communications sectors will be covered by multilateral financial institutions, the European Union, and bilateral donors including Japan, Spain and Taiwan. The World Bank, United Nations agencies, and numerous bilateral donors are expected to reorient and increase their funding for school and health center reconstruction and equipping as well as for new water and sanitation programs. Though there are many donors financing agriculture and environmental recovery, the funding needs are overwhelming given the extent of the damages. The Inter-American Development Bank (IDB) has two large programs in financial sector reform and capital markets which will soon come on line. Nicaragua plans to continue with its ESAF program with the International Monetary Fund (IMF) in hope of early entry into a Highly Indebted Poor Country (HIPC) initiative. The United States ranks as the largest single bilateral donor to Nicaragua.

FY 2000 Program

USAID plans to continue with the core of its development program in Nicaragua in the areas of democracy, economic growth, health and education. The country strategic framework will, however, be revised to accommodate the strong USG response to the humanitarian and development needs resulting from Hurricane Mitch. USAID's ongoing program is already focussed on the geographical area most affected by Mitch, which also coincides with the area of highest level of poverty. Based on its comparative advantage vis à vis other donors, USAID proposes to focus reconstruction assistance over the next two years in agricultural recovery and natural disaster mitigation, public health promotion and disease prevention, public works, and microenterprise financing, all within a framework of promoting transparent and effective governance. USAID has reprogrammed some FY 1998 funds to jumpstart rehabilitation of basic grain crops and agricultural infrastructure, provide emergency supply of medicines to flood victims, support to food-for-work programs, and refinance microenterprise loans.

In addition to the regular funding levels requested for FY 2000 and non-emergency P.L. 480 Title II requirements, a full reconstruction strategy would require supplemental funding of over the next two years. The program would finance seeds, fertilizer, tools, grain and seed storage facilities, technical assistance and agricultural credit for the zones devastated by Mitch. Disaster mitigation activities such as watershed management, reforestation and stabilization of hillsides would benefit small farmers whose farms were washed out by flood waters. USAID plans to invest in reconstruction of water and sanitation systems in approximately 200 small communities not targeted by other donors. In addition to ongoing health activities with the Ministry of Health, USAID would fund PVO activities in health education and disease prevention in communities at high risk of malaria, dengue, cholera and leptospirosis as a result of hurricane damage. A centerpiece of USAID's FY 1999/2000 program would be the combination of P.L. 480 Title II development and emergency food commodities with supplemental funds to mount an ambitious food-for-work program to restore basic community infrastructure through disaster-related reconstruction projects. USAID proposes to capitalize microfinance partners in order to refinance loans of small producers affected by Mitch. Finally, USAID's good governance and rule of law activities will continue to build the systems, institutions, and attitudes required to assure competent and honest implementation of national reconstruction programs during the next two years.

NICARAGUA

FY 2000 PROGRAM SUMMARY
(in thousands of dollars)

USAID Mission Director: Marilyn Zak

USAID Strategic and Special Objectives	Economic Growth & Agriculture	Population & Health	Environment	Democracy	Human Capacity Developmnt	Humanitarian Assistance	TOTALS
S.O 1. More Political Participation, Transparency and Com-promise - DA - ESF	--- ---	--- ---	--- ---	4,360 3,000	--- ---	--- ---	4,360 3,000
S.O. 2 Sustainable Growth of Small Producers Income and Employment - DA - P.L. 480/II	7,450 ---	--- ---	2000 ---	--- ---	--- ---	--- ---	9,450 ---
S.O. 3. Better Educated, Healthier, Smaller Families - DA - CS - P.L. 480/II	--- --- ---	4,000 4,000 ---	--- --- ---	--- --- ---	--- 3,500 ---	--- --- 6,244	4,000 7,500 6,244
Totals - DA - CS - P.L. 480/II - ESF	7,450 --- --- ---	4,000 4,000 --- ---	2000 --- --- ---	4,360 --- --- 3,000	--- 3,500 --- ---	--- --- 6,244 ---	17,810 7,500 6,244 3,000

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ACTIVITY DATA SHEET

PROGRAM: Nicaragua
TITLE AND NUMBER: More Political Participation, Compromise, and Transparency, 524-S001
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCES: FY 2000: $4,360,000 DA; $3,000,000 ESF
INITIAL OBLIGATION: FY 1995 ESTIMATED COMPLETION DATE: FY 2000

Summary: The USAID program aims to strengthen democracy through more responsive government, consolidation of the rule of law including protection of human rights, and an empowered civil society. The four branches of government--slowly modernizing and becoming more open--are not coequal in power, capabilities, and accountability. The judicial system operates under obsolete codes, inefficient systems, and arbitrary decision-making. Human rights abuses, while diminishing, are still of concern. Civil society grows stronger, but must provide more constructive avenues of expression for people's interests. Nicaragua needs to decentralize power and strengthen local governments while promoting improved management of public finances and greater transparency.

The devastation caused by Hurricane Mitch has affected the development agenda of the government and civil society. National recovery and rehabilitation must involve not only the central government and international community, but also Nicaragua's local government representatives and civil society. Overall, broad and informed citizen participation will help decentralize power and lead to an effective, representative government.

Key Results: Five key results are necessary to achieve this objective: (1) a measured increase in public support for the political system from a 1995 survey base of 43% to 55% in the year 2000; (2) a measured increase in public confidence in the judicial system from 35% in 1995 to 50% in 2000; (3) 75% of households have access to basic services such as garbage collection, sewer and water by the year 2000 compared to 52% in 1996; (4) naming of the Ombudsman for Human Rights in 1999; and (5) publication of a minimum of 20 independent audits of public institutions by 2000.

Performance and Prospects: Recent public opinion polls indicate growing confidence in the democratic system, in particular the judiciary and municipal governments. The National Assembly has become a more functional, representative body, witnessed by its dealing with a number of important and controversial bills during the 1998 session such as the judicial organic law, the code for the treatment of adolescents and children, and the executive branch organic law. USAID contributed to strengthening the Supreme Electoral Council by assisting with completion of registration and voter cards for the Ad Hoc and Atlantic Coast municipalities, as well as the preparation of the March 1998 Atlantic Coast regional elections. The USAID democracy program has spurred the formation of human rights committees at the community level, which encourage reporting/ mediation of human rights violations.

USAID-supported activities trained hundreds of judges, prosecutors, court administrators, and improved the capabilities of the Attorney General's Office. USAID is part of a multi-donor effort to reform governmental financial management systems to reduce fraud, waste, abuse and corruption. USAID, working through local NGOs, has improved civil society participation in public decision making, fostered dialogue on civil-military relations, and supported domestic election monitoring. In addition, civil society organizations have organized themselves to provide direct assistance to the victims of Hurricane Mitch, and to involve them in community rehabilitation initiatives. Municipalities receiving USAID assistance demonstrate improved service delivery.

To upgrade the efficiency, improve access, and promote equity of the judicial system USAID will finance the reform of the penal and criminal procedure codes, plus the training to assure their implementation and that of the new administrative procedures code. USAID will support a public defender's office, strengthen the attorney general's office, and improve court administration with a view to address unique problems affecting the Atlantic Coast. USAID will continue to pursue a comprehensive system to protect human rights, by strengthening peace commissions in towns and cities, improving the capabilities of human rights NGOs, and assisting the government's Human Rights Ombudsman. Finally, USAID will continue to help improve the bond compensation mechanism for compensating owners of confiscated properties and support case resolution.

USAID will also undertake efforts to improve public sector transparency as well as provision of more cost effective and better quality services, and to promote greater citizen participation in community affairs. Activities will emphasize municipal development and decentralization by improving the capacity to deliver public services, helping local governments to increase revenue and encouraging citizen participation in local decision-making. USAID will assist citizens and municipalities affected by Mitch to prioritize needs, formulate solutions, obtain financing, and monitor implementation of basic reconstruction projects, and ensure that municipal priorities are reflected in the national reconstruction effort. USAID will fund activities to improve the National Assembly committees' ability to research and draft legislation, train staff, foster better constituent relations, automate the information system and provide orientation to new deputies.

USAID will continue working with civil society groups to improve civilian-military relations, enhance citizen participation, address women's rights, and stimulate citizen participation in community rehabilitation efforts. Work on integrated financial management will continue, but emphasizing anti-corruption and ethics awareness, and independent audits of government programs. USAID envisages small levels of technical assistance for the Electoral Council for the 2000 municipal and 2001 Presidential/Legislative Assembly elections.

Possible Adjustments to Plans: USAID has already increased funding for the reconstruction and rehabilitation of municipalities affected by Hurricane Mitch and has begun to work with civil society organizations to develop projects that respond to the needs of hurricane victims. More programmatic adjustments are likely as a revised strategy is developed.

Other Donor Programs: USAID takes the lead role in the rule of law, while Sweden, the United Nations (UN), and the European Union (EU) continue to support courthouse construction and penitentiary system reform. Spain, the UN, the IDB and World Bank fund complementary activities in police training, legal reform, statistics, and judicial administration. The Danes and Swedes have worked on improving municipal administration in towns other than those USAID covers, while the World Bank, IDB and EU finance construction and rehabilitation projects. USAID has taken the lead on the modernization of the National Assembly, the IDB on internal regulations, and Taiwan on building construction. The World Bank, IDB, and USAID joined in a multi-donor effort to carry out financial management reform. Almost all donors have provided assistance to the election process.

Principal Contractors, Grantees, or Agencies: Local organizations: women's and human rights organizations, advocacy and research NGOs, Association of Nicaraguan Municipalities, Supreme Electoral Council, Ministry of Finance, Supreme Court, Attorney General's Office, the Comptroller General, and Human Rights Ombudsman's Office. U.S. organizations: State University of New York, Casals and Associates, the Planning Associates Development Collaborative, Interamerican Institute for Human Rights, National Center For State Courts and Florida International University.

Selected Performance Measures:

	Baseline (1995)	Target (2000)
Political system support	43%	55%
Public confidence in judicial system	35%	50%
Households access to basic services	52% (1996)	75%
Human Rights Ombudsman named (yes/no)	No	yes (1999)
Independent audits of public institutions made public (cumulative)	0	22

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ACTIVITY DATA SHEET

PROGRAM: Nicaragua
TITLE AND NUMBER: Sustainable Growth in Small Producer Employment and Income 524-S002
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCES: FY 2000: $9,450,000 DA
INITIAL OBLIGATION: FY 1995 ESTIMATED COMPLETION DATE: FY 2000

Summary: The goal of this Strategic Objective is to sustain the growth of incomes and employment opportunities of small producers. USAID finances technical assistance to small farmers through PVOs, NGOs, and producer associations. It also supports the national seed improvement program and a program to provide land titles to small farmers. USAID's microenterprise program provides technical assistance and training to strengthen 28 credit unions that provide financial services and savings mobilization in rural areas. It also supports value-added activities, including post harvest processing and storage, foods processing, equipment manufacture and repair, and commercial services. USAID funds initiatives to protect biologically important ecosystems by strengthening protected area management and by introducing resource-conserving technologies in buffer zones.

Key Results: Under this activity, USAID is aiming for an annual seven percent growth rate in the agriculture sector by helping farmers produce more and diverse crops. Another key result expected is the expansion of small businesses and microenterprises in rural and urban areas by providing 58,000 microenterprise loans over a five-year period ending 2000. A third critical result targeted for this activity is to assure natural resources are being used more rationally, and especially that protected areas are under effective management as measured by the Parks in Peril protected areas management index. Nicaragua is expected to average 45 points on the index which would be slightly above the average for nine rated areas in Latin American in 1996.

Performance and Prospects: Despite a serious drought in early 1998 caused by El Niño, Nicaragua's agriculture sector was projected to grow 10.3% in 1998. Hurricane Mitch left extensive damage in the north and northwest regions of the country, causing widespread soil erosion and deforestation and destroying agricultural infrastructure, including soil and water conservation works, storage facilities, wells, and irrigation systems. The hurricane hit at the worst time for Nicaragua's agriculture sector, just prior to the harvest of the second and largest crop, and just before the coffee harvest and the third planting season for basic grains. The rain, flooding, and landslides severely damaged standing crops in the north. Maize and red bean production, two of the staples of the Nicaraguan diet, fell by 50% and 40%, respectively. Non-traditional agricultural exports, a focus of USAID’s program, were even more seriously hit. Vegetable and sesame production, important non-traditional agricultural exports, were wiped out. The destruction of seed stocks, and damage to farm infrastructure and the transportation network sharply reduced prospects for successful coffee and third planting grain crop harvests. Though USAID microfinance programs had been successful in opening access to credit for nearly 90% of targeted micro-entrepreneurs while generating savings of $400,000 in participating rural credit unions, many farmers and rural entrepreneurs are now unable to repay outstanding loans, threatening the viability of USAID-supported micro-finance credit institutions. Population displacement and the permanent loss of cropland due to flood damage (some 25,000 acres of cropland has been permanently destroyed and another 700,000 acres seriously damaged) threatens a new wave of settlement into tropical forests and environmentally fragile lands despite the replication of the successful management models for protected areas.

Possible Adjustments to Plans: As a result of Hurricane Mitch, USAID plans a substantial revision of activities undertaken to implement this strategic objective.

For example, USAID procured nearly $1 million in agricultural equipment and $700,000 in grain and vegetable seeds to replace losses resulting from the flooding after Mitch. To ensure that farmers will regain their livelihood, USAID has redirected nearly $800,000 in local currency generations from P.L. 480 Title III into an emergency program to support the November planting of basic grains. Investments must be made to repair and replace farm infrastructure, post harvest processing facilities, and transportation network. The destruction caused by the flooding has sensitized farmers to the problems of erosion and soil degradation, presenting USAID with an opportunity to promote soil and water conservation practices and organic agriculture. With additional resources, USAID will support the Ministry of Natural Resources, non-governmental organizations and community tree nurseries in the immediate planting of ground cover to stabilize hillsides and soils to mitigate against a repeat of the Posoltega disasters which took over 2000 lives.

Temporary measures, such as loan rescheduling, will be needed to ensure the survival of USAID-supported microfinance institutions and maintain the "repayment ethic" that USAID has worked to instill. Shortly after the hurricane, USAID programmed $450,000 in microenterprise funding to recapitalize one of its key partners, the Foundation for Microenterprise Support (FAMA).

Other Donor Programs: Among other donors working in the agriculture sector, the EU and Japan are working on broad rural development and agriculture support activities through the Rural Development Institute. Some donors have joined USAID in supporting the GON’s emergency basic grains planting program. Others are expected to contribute to GON agricultural rehabilitation programs.

USAID partners have benefited from a basic grains marketing project financed by the EU. A joint IDB/USAID Microenterprise Recovery Fund has been created to help microenterprise credit institutions recover from Hurricane Mitch. The European Community and Central American Bank for Economic Integration (CABEI) have projects for small and microenterprises. USAID and its partners have been working closely with the World Food Program in helping farmers obtain access to emergency food supplies and will be providing assistance to complement food-for-work efforts. The Danish and German governments are providing a significant amount of aid for environmental conservation. The World Bank is designing a $6.4 million forestry program.

Principal Contractors, Grantees or Agencies: Winrock International, Development Alternatives Inc., World Relief, Cooperative League of the United States of America, Nicaraguan Agricultural Producers Association, Association of Non-Traditional Producers, and the GON P.L. 480 Secretariat; World Council of Credit Unions, Foundation for Microenterprise Support, and Promujer; Cocibolca Foundation, Alistar Foundation and Environmental Law and Development Center.

Selected Performance Measures:

	Baseline (1994)	Target (2000)
Growth rate of agriculture sector (GDP)	3.6%	7%
Farmers accessing USAID services	7500	28,000
Cumulative number of microentrepreneurs receiving loans under USAID projects	0	58,000

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ACTIVITY DATA SHEET

PROGRAM: Nicaragua
TITLE AND NUMBER: Better Educated, Healthier, and Smaller Families, 524-S003
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCES: FY 2000: $4,000,000 DA; $7,500,000 CS; $6,244,000 Title II
INITIAL OBLIGATION: FY 1995 ESTIMATED COMPLETION DATE: FY 2000

Summary: The purpose of the Better Educated, Healthier, and Smaller Families Strategic Objective is to develop human capital through basic education, health, and family planning. USAID has supported educational reforms, which have led to fundamental changes in the curriculum, teaching practices, and instructional materials. Our objective is to increase access to quality education and to improve student achievement. Direct beneficiaries include students in 165 urban, rural and bilingual schools and 20,000 teachers.

Women and children are particularly vulnerable segments of the Nicaraguan population. Primary and preventive health care are critical to mothers' and children's survival, full realization of their potential, and a more efficient, cost effective social support network. An unrestrained population growth rate can quickly reverse the gains achieved in other sectors. Family planning is an important ingredient in improving maternal health and child survival, and directly affects economic growth, environmental preservation, and poverty reduction activities.

Key Results: Key results expected under this activity are: 1) Women and children are better nourished; 2) Use of child survival services and practices is increased; 3) Comprehensive reproductive health services are more used; and 4) More students learn more and complete primary school. The first two results will contribute to lowering the infant mortality rate from 58 deaths per thousand in 1993 to 38 deaths per thousand in the year 2000. Total fertility rates should decrease from 4.6 children born to each woman in 1993 to 3.6 in 2000 is the third result is achieved. Finally, primary school completion rates are expected to increase from 23% in 1993 to 28% by 2000.

Performance and Prospects: Before the devastation caused by Hurricane Mitch in November 1998, Nicaragua was making rapid advances in education and health. Primary school completion rates rose from 22.8% in 1993 to 27% in 1997. Repetition rates have dropped sharply from 26% to 22%. Infant mortality dropped from 59/1000 to 40/1000 since 1993. Child immunization coverage rates sustained levels of close to 90%. Fertility rates dropped from an average of 4.6 in 1993 to 3.9 children per woman in 1997. Nicaragua's population growth rate dropped from 3.1% in 1993 to an estimated 2.3% in 1998.

In FY 1998, USAID began implementing second phases of its maternal/child health, reproductive health, and basic education programs. Curriculum reform, training in modern teaching methods, and increased community participation in the school system are the goals of the new nationwide program. The program will provide special emphasis on multi-grade schools and bilingual education on the Atlantic Coast. Because of damage to schools, the 1998 academic year ended early, and some program resources were diverted to disaster relief. Despite these setbacks, USAID will maintain performance targets for 1999.

USAID supports improved quality and availability of services at public health centers and posts, focusing on women and children under five years of age. Activities include the introduction of Integrated Management of Childhood Illnesses and expanded program of immunizations. USAID activities will lead to increased prevalence of exclusive breastfeeding for the infant's first six months, improved intake of micronutrient through increased consumption of fortified foods, and expanded community health education through private voluntary organizations. Other expected results are improved monitoring and prevention of infectious diseases, and public and private sector AIDS prevention programs established. USAID finances the expansion of Profamilia, a family planning NGO; training for Ministry of Health and Profamilia personnel in contraceptive technology and patient counseling techniques; and a major contraceptive social marketing program. Though USAID-supported local NGOs and US PVOs active in family planning and reproductive health services redirected resources and program priorities as a result of Hurricane Mitch disaster relief needs, program design and performance targets remain valid. To respond to emergency needs, the P.L. 480 Title II program also shifted from targeted feeding of malnourished groups to food distribution and food-for-work for disaster victims.

Several new grants have been awarded to PVOs and the Ministry of Health to improve the health, water supply, and sanitary conditions of communities affected by Mitch and in new settlement areas for refugees. Over $800,000 worth of emergency medicines and other medical supplies destined for flood victims were purchased through a grant to the Pan American Health Organization (PAHO).

USAID has worked closely with the U.S. Army Task Force Build Hope and Task Force New Horizons to repair schools and health facilities damaged by Hurricane Mitch. Despite considerable loss of infrastructure, equipment, and supplies, the Ministry of Education plans to open schools on schedule; and although it faces an overload of disaster victims and heavy damages to health facilities, the Ministry of Health has prevented major outbreaks of infectious, vector-transmitted, and water-borne diseases. With additional support, USAID plans to help reequip and resupply schools and health posts damaged by the Hurricane.

Possible Adjustments to Plans: As a result of the hurricane, P.L. 480 Title II has expanded more than eight-fold (in terms of tonnage) with emergency allocations. Over the short-term, traditional maternal child health feeding programs will be converted to food-for-work programs to repair and rehabilitate small community infrastructure such as foot bridges, wells, rural access trails, retaining walls and drainage ditches. USAID will conduct periodic assessments to determine appropriate timing for a return to supplemental feeding for children.

Ministry of Health and PVO grantees, involved initially in full-time disaster relief, have now returned to their child survival programs, adjusted to give priority to prevention of cholera, malaria, and other infectious diseases. Health interventions planned in the event of supplemental funding focus on reconstruction of water supply and sanitation programs. USAID will concentrate on peri-urban and rural areas unlikely to be covered by the environmental health initiatives of other donors.

Other Donor Programs: International response to the hurricane disaster has been rapid and significant. Much of the relief effort has focused on health interventions, including food and medicine distribution and water supply. In addition to disaster relief, several donors have increased their existing primary health care programs. The Swedes fund regional health departments complementing USAID's activities. The World Bank and Japan finance hospital construction and renovation, other health infrastructure projects, and larger municipal water and sanitation projects. PAHO supports the immunizations program, while the UN funds limited reproductive health activities. The World Bank and Japan invest in school construction. The Dutch support education planning and curriculum development. At the secondary level, the EU funds teacher training, curriculum development, and school construction. Finland finances bilingual education on the Atlantic coast.

Principal Contractors, Grantees, or Agencies: U.S. partners include: Management Sciences for Health, the Adventist Development and Relief Agency, Academy for Educational Development, Save The Children, Project Concern International, CARE, Wisconsin-Nicaraguan Partners of the Americas, Project Hope, and Development Associates. Nicaraguan partners include Ministry of Health, Ministry of Education, and the Nicaraguan Association for the Promotion of Family Welfare (PROFAMILIA). International Agency Partner: PAHO.

Selected Performance Measures:

	Baseline	Target (2000)
Total fertility rate (children/woman)	4.6 (1993)	3.5
Infant mortality rate (deaths per thousand)	58 (1993)	38
Immunization coverage for children under one year of age	65% (1994)	90%
Primary school completion rates (6th grade graduate)	23% (1993)	28%

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