Agency Goal: Stabilizing Population Growth and Protecting Human Health

The GODR spends only l.7% of GNP (or 14% of its budget) on health, well below world and Latin American and Caribbean regional averages. Approximately 70,000 illegal abortions take place each year, testifying to the inadequacy of family planning services. High rates of unintended pregnancy, especially among adolescents, and lack of accessible primary health and family planning services compound the problems of lower-income groups, since scarce resources are devoted to additional children or to curing family members from preventable diseases. For FY 1997, USAID support will continue to accelerate fertility decline in the Dominican Republic. Reproductive health information and services are targeted at the male population and adolescents, as well as at women of reproductive age in general, and are closely integrated with the rest of the primary health care program.

Access to and use of maternal care services, preventive health and hygiene, and human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) prevention is an essential complement to USAID's emphasis on economic opportunities and poverty alleviation. Because of relatively good child survival indicators for the country, strong coverage by other donors, and the capability of the USAID-assisted NGO consortium to continue providing such services, USAID will no longer work directly in child survival in FY 1997. As a result of customer demand in target communities, however, and acting as a catalyst for mobilizing private, other donor, and Government of the Dominican Republic (GODR) funding, USAID intends to work with NGOs in developing community-managed potable water and sanitation systems, establishing "challenge targets" (or matching grant standards) for their increased financial participation. USAID also will continue to reinforce an incipient and highly innovative government and nongovernmental organization partnership to ensure the sustainability of such systems.

The Dominican Republic is a USAID AIDS-priority country. Approximately 250,000 Dominicans (3.5% of the population) were expected to be HIV positive by the end of 1995, according to epidemiological projections, justifying USAID's overarching priority to build national institutional and technical capacity to address AIDS issues, including substantial support by the private sector. Although HIV/AIDS is found throughout the social spectrum in the Dominican Republic, the poor and socially disadvantaged are being infected at high rates. To address this growing problem, USAID will: (1) expand its already successful program to conduct an effective public information campaign, especially targeting adolescents, (2) educate and mobilize the private sector through workplace programs, (3) strengthen and expand the participation of both public and private sector organizations in HIV/AIDS and sexually transmitted disease (STD) prevention, and (4) develop the infrastructure for greatly expanded diagnosis and treatment.

Agency Goal: Building Democracy

Establishing an effective, functioning democracy is critical to the future development of the Dominican Republic. Civil society organizations and a public better informed of, and skilled in, the nature and practice of democratic values are the mainstay of such a system. Notable grass roots success has occurred in Salcedo Province, a small but densely populated region in the fertile Cibao valley, where public and private sector organizations have joined together to identify and implement their development priorities in a non-partisan setting. However, such examples are extremely rare. The medium-term thrust of USAID activities under this strategic objective is to enhance broad-based, active participation of civil society, including Dominican NGOs, public interest groups, labor unions, foundations, community organizations, and the general public in various aspects of political life, at the local and national level. To ensure a sustainable national framework for participatory democracy, however, reform of key political institutions is essential. In FY 1997, USAID intends to support public demand for enactment of judicial reform measures stipulated by 1994 constitutional amendments. Such reforms would lessen corruption, protect civil rights, and improve the functioning of the market economy. Another priority is to consolidate the network of democracy action groups created for the 1996 presidential election to prepare for the 1998 legislative and municipal elections -- another step in this historic democratic transition.

In the event of a funding shortfall, efforts to promote truly broad-based participation in building democracy would suffer from the reduction in activities sponsored by NGOs which play a major role in strengthening democratic values and practices at the community level.

Agency Goal: Environment Managed for Long-Term Sustainability

The Dominican Republic is over-dependent on inefficient and unreliable energy sources that pollute the environment and deplete the natural resource base. Up to 50% of government-owned and contracted electric power production is often unavailable due to equipment failure or water shortages. An estimated two million rural residents live beyond the reach of the power grid. Firewood and charcoal still constitute the principal cooking fuel in most rural households. Cutting firewood is now considered the principal cause of deforestation, which causes siltation of hydropower reservoirs.

By demonstrating how known technologies can exploit untapped alternative energy resources in a cost effective and commercially viable way, NGOs, cooperatives, community groups, and private businesses can help dramatically to improve power availability for the rural poor. Better living standards will help to limit urban migration. Solar power for community potable water and domestic lighting systems; solar cooking, heating and drying ventures; pilot conservation projects in critical watersheds, one of which is already being replicated by the World Bank; and wind energy and mini-hydro pilot demonstrations for community electrification, are among the activities receiving support under this strategic objective. In FY 1995, $500,000 in Environmental Initiative for the Americas financing was made available to support the expansion nationwide of a U.S. private voluntary organization's (PVO's) solar energy program among rural households. In addition to drawing on the capability of U.S. firms in the alternative energy field, this strategic objective can have a marked impact on the use of fossil fuels. USAID technical assistance has also been instrumental in developing a new energy law proposal and will assist in preparing internationally accepted standards and norms to regulate the conventional energy sector.

The environmentally-sound energy strategic objective is due to terminate in FY 1998 and requires only minimal funding to complete. A funding shortfall at this point would require early termination of eight NGO sub-grants, jeopardizing USAID's credibility in the sector and undermining the opportunity to demonstrate the feasibility of alternative energy options for large segments of the rural population beyond the reach of the formal energy grid. The impact would fall disproportionately on the poor. Grants for conservation activities such as community management of national parks, sponsored by The Nature Conservancy, also would have to be cut short.

USAID Mission Director: Marilyn A. Zak

Purpose: To augment the human capital of the poor and to facilitate their integration into the economy.

Background: Poverty in the Dominican Republic is the driving force behind one of the highest emigration rates in Latin America. Flawed governance, economic policies, and social injustice are the primary factors that exacerbate Dominican poverty. Coupled with chronic low and inefficient government social spending, these factors result in large numbers of Dominican poor without the requisite skills and capacity to seek and hold gainful employment.

USAID Role and Achievements to Date: USAID support includes microenterprise credit and training, primary education curriculum development and teacher training, and grants to local nongovernmental organizations (NGOs) for policy analysis, debate and consensus building. Since 1990, microenterprise loans have resulted in the creation of over 40,000 new jobs with an additional 97,000 jobs strengthened. Some 9,700 microentrepreneurs received skills training which enabled 94% of them to find new employment, to create their own businesses, or to improve their income. A landmark ten-year plan for education reform was developed by a local NGO, with country-wide consensus. Primary school desertion rates declined almost 20% for USAID- assisted schools, while the rate for other schools stagnated. Using local NGOs, USAID provoked an almost daily debate in the media on economic and poverty alleviation issues. Over the past two years, USAID support to 20 local NGOs for economic policy analysis and consensus building resulted in over 600 newspaper articles, 208 television and radio programs, and the participation of 5,550 people in training events.

Description: USAID focuses on achieving results in three key areas: (1) human capital development, through targeted business and vocational training and increased quality primary education for the poor, (2) financial services for small and microenterprises, and (3) NGO-led economic policy analysis and public debate on a favorable environment for broad-based economic growth and poverty alleviation. Funding for the first two areas is channeled through local NGOs. Emphasis is placed on the provision of services that improve the productivity of the poor, at the same time allowing for cost-recovery mechanisms to enable continued service delivery after USAID financial support ceases. Funding for the third area is channeled through a U.S. firm that works with a large number of local NGOs. FY 1997 funds will be used to expand several microentrepreneur skills training initiatives through local NGOs. A particularly innovative effort will be through a new small and microentrepreneur business support center located in a local premier business administration and engineering university. Funds also will be used to further a poverty-alleviation, policy- reform effort that will support alliances between local NGO think-tanks and specific government ministries involved with poverty alleviation.

Host Country and Other Donors: Several major donors assist the microenterprise sector, including the Inter-American Development Bank (IDB). The World Bank and IDB are collaborating on an $80 million primary education project which will pick up and expand where USAID leaves off, incorporating new curricula and testing materials in a much broader range of schools.

Beneficiaries: The focus on the Dominican majority reflects the fact that the poorest half of the Dominican population earns only 18% of the national income. While USAID policy and basic education activities are designed to impact on as many of this majority as possible, USAID training and financial services activities focus on the small and microenterprise sector which employs almost 30% of the economically active population.

Principal Contractors, Grantees, or Agencies: USAID implements activities through a U.S. firm, Stanford Research International; The American Institute for Free Labor Development; and local NGOs including the Microenterprise Fund (FONDOMICRO), the Basic Education Association (EDUCA), and the National Council of Private Business (CONEP).

Major Result Indicators:

Baseline Target
Reduction in national
poverty level 20% (1992) 18% (1997)
Reduction in unemployment
and under-employment rates 20%/30% (1995) 15%/25% (2000)
Reduction in school desertion
rates 20% (1994) 16% (1999)

PROGRAM: DOMINICAN REPUBLIC
TITLE AND NUMBER: Increased Use of Effective Primary Health Care Services by Underserved Populations, 517- SO02
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1997: $6,872,000 DA
INITIAL OBLIGATION: FY 1995 ESTIMATED COMPLETION DATE: FY 2000

Purpose: To improve access to and quality of family planning services, selected maternal and child health (MCH) interventions, including potable water and sanitation systems, and acquires immunodeficiency syndrome (AIDS) prevention practices.

Background: A May 1995 World Bank report estimates that one in five Dominicans live in poverty and one in ten in extreme poverty. Data from 1992 indicates that half the families living below the poverty line consume less than 75% of required protein and 61% consume less than 75% of the required calories. Twenty-five percent of the households are headed by women. Broad-based participation, innovative nongovermental organzation NGO service delivery methods, and expanded social marketing have made a positive impact on the Dominican Republic's health status. Infant mortality has been cut almost in half over the past seven years, with the current rate at 43 per thousand. Diarrheal diseases and acute respiratory infections, aggravated by poverty and low birth weight, are among the main causes of under-five deaths. A new growing threat to child survival is human immunodeficiency virus (HIV)and AIDS, especially for 26,000 children and women engaged in prostitution. Twenty-five percent of AIDS cases are people under 25 years of age. Fertility rates among the rural population remain high at over four births per woman. On average, only 65% of the population has access to potable water, with much lower coverage in rural and marginal urban barrios.

USAID Role and Achievements to Date: USAID resources are channeled primarily through NGOs for service delivery and U.S. private voluntary organizations (PVOs) for technical assistance in such areas as training, supervision, sustainability, information and financial systems management, and quality of care. Over one million couple years protection (CYPs) have been achieved by USAID-supported agencies during the past five years. Annual targets have more than doubled since 1989 (139,000), and nearly 60% of married women use contraceptives. The program is increasing its focus on rural women, as well as on adolescents and men. Behavioral change communication is a major component of the HIV/AIDS strategy which targets specific high-risk and at-risk audiences. Recent data show significant HIV seroprevalence decrease among high risk groups from 13% to 8% between 1991 and 1994. Between 1993 and 1995, rates of breastfeeding in project areas more than doubled, from 12.7% to 26.1%. During the same time period, oral rehydration therapy use in project areas increased from 40% to almost 60%. Water and sanitation projects are focusing increasingly on promoting community-based ownership and management of water and sanitation systems. Fifty-six community water organizations have been formed.

Description: Of the total funding requested for population and health, $4,735,000 is planned for population activities and $2,137,000 is planned for health activities. USAID works in four major areas: family planning, including maternal health and breastfeeding; reducing the risk of sexually transmitted diseases (STD) and HIV infection; increasing access to potable water and sanitation systems; and policy dialogue for health sector reform. Interventions in STD and HIV prevention target both the general population and core populations at increased risk of transmission and infection. Both urban and rural low-income populations are reached through family planning and water and sanitation activities. USAID seeks an increasing involvement from the private sector in AIDS prevention. USAID also supports health policy reform to improve access and the utilization of services and to modernize the health sector. During FY 1997, USAID will continue to play a catalytic role in the health sector. USAID is actively building partnerships with other donors and fostering such liaisons between NGOs and the government. Support for community-managed water and sanitation projects will incorporate "challenge targets" to secure increased investments from the NGOs, the government, and the communities themselves. Maternal health issues will continue to be addressed through the reproductive health component of the family planning project. All of USAID's health and population interventions will reflect the cross-cutting concerns of health sector reform, donor coordination, and NGO organizational strengthening, service delivery capacity building, and financial sustainability. USAID's termination of support for direct child survival interventions comes at a time when immunization coverage rates are high, infant mortality has steadily declined, otherdonors are providing technical and financial resources to the neediest areas, and the capacity of NGOs to work in this sector has been substantially strengthened.

Host Country and Other Donors: The United Nations Children's Fund provides assistance to the GODR and a limited number of NGOs to control diarrheal diseases and acute respiratory infections. Primary emphasis continues to be the promotion of breastfeeding through certification of baby friendly hospitals. The rights of children in especially difficult circumstances also will be a major initiative. The European Union supports maternal and child health activities in an underserved region of the west and medical curriculum assistance, medicines and AIDS interventions. Japanese assistance consists of construction of and equipping a gastrointestinal facility and water/sanitation infrastructure. Spanish International Cooperation sponsors training and an epidemiology program. The Pan American Health Organization has a range of activities in water and sanitation, integrated community development, food and nutrition, epidemiological programs, diarrheal control, acute respiratory infections medicines and health sector reform. The World Bank and the Inter-American Development Bank are joint partners in the design of a health care reform blueprint.

Beneficiaries: Children under five years and women of reproductive age; high-risk groups and youth at-risk for HIV and sexually transmitted diseases; and families in the areas of project water and sanitation provision will benefit from these activities.

Principal Contractors, Grantees, or Agencies: USAID implements activities through Development Associates, a U.S. firm; U.S. PVOS such as Catholic Relief Services and Food for the Hungry; and local NGOs including the Dominican Association for Family Well-being (PROFAMILIA), the Dominican Family Planning Association (ADOPLAFAM), Women in Development (MUDE), the Basic Education Association (EDUCA), and the National Health Institute (INSALUD).

Major Results Indicators:
Baseline Target
Women 15-49 using a contraceptive method 36.8% (1991) 46% (2000)

Target high-risk population using a condom
High-risk population 51.5% 77.0%
Adolescents -- male 29.0% 40.0%
-- female 6.0% 15.0%
Hotel/tourism workers 18.0% 25.0%
(1990/93) (1998)

Target population with appropriate waste water systems 4% (1994) 30% (1998)
Target population served with potable water systems 8% (1994) 50% (1998)

PROGRAM: DOMINICAN REPUBLIC
TITLE AND NUMBER: Increased Participation in Democratization, 517-SO03
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1997: $1,600,000 DA
INITIAL OBLIGATION: FY 1995; ESTIMATED COMPLETION DATE: FY 2001

Purpose: To enhance broad-based, active participation of Dominican nongovernmental organizations (NGOs), public interest groups, foundations, labor unions, community organizations, and the general public in building true democracy in the Dominican Republic.

Background: Clientelism, combined with weak democracy, has constrained the country's political development for decades. Corruption within the public sector is widespread. An independent, effective judiciary is almost non-existent. Vigorous, broad-based, non-partisan pressure by Dominican civil society institutions and groups is needed if democratic development, political reform, and modernization of the state is to be achieved.

USAID Role and Achievements to Date: In implementing the USAID democracy strategy, USAID works in close partnership with its Dominican civil society counterparts. This close consultative and collaborative relationship with its partners starts at the design stage of each of the activities and is maintained through their implementation. USAID's consistent efforts during the last year and a half in inducing Dominican civil society to play an active role in favor of a free and fair electoral process in 1996 is paying off. Observers of the local political scene are starting to recognize a new and totally different attitude by civil society organizations and groups regarding their participation in electoral processes. Breaking away from the traditional concentration of NGO and private voluntary organization (PVO) activities in the capital city, 24 out of 33 subgrants active during the period under the Democratic Initiatives project either have a nationwide outreach or their activities take place totally or partially outside Santo Domingo. The beneficiaries of 23 of these subgrants are barrio or rural community groups. Also under the Democratic Initiatives project, Fundación Siglo 21 provided technical assistance to a majority of political parties, the Central Electoral Board, and the Association of Dominican Municipalities in reaching consensus on two important political reform measures: a new electoral reform bill (subsequently enacted into law by Congress) and a municipal reform agenda. The Action Group for Democracy, formed in early 1995, is spearheading efforts to mobilize citizen participation in upcoming elections, including the creation of a nationwide network of local election observers.

Description: In response to the transitional nature of the current Dominican political scene, USAID has adapted its approach to both the near- and long-term priorities agreed upon between USAID and its civil society partners. The near-term emphasis is to support strong civil society pressure for a free and fair electoral process in 1996. However, USAID intends to build on the momentum gained in this process, following the inauguration of a new government in August 1996, to continue strengthening civil society's capacity for active participation with a view toward the legislative and municipal elections scheduled for 1998. The longer-term emphasis is to support efforts to more actively engage the government and the public in promoting and shaping various democratic reforms and in practicing democratic values. A new activity in 1997 will respond to strong public demand within Dominican society for the establishment of an independent, well-trained, merit-based judiciary. Current efforts to establish a nationwide public defense system to increase access to the judicial system by the disadvantaged will continue.

Other Donors: USAID includes working with other donors as an important component of its democracy strategy. Other international donor support has been unrelentingly solicited in favor of the democratic initiatives undertaken by Dominican civil society, as well as political reforms mainly in the fields of rule of law and modernization of the state. The Inter-American Development Bank (IDB) and the European Union (EU), Canada, and Spain have responded by funding program areas related to democracy, such as the 1996 election, administration of justice, modernization of the state, and decentralization.

Beneficiaries While many activities under this strategic objective target the poor, their reach is truly nationwide. The overall aim of consolidating democracy in the Dominican Republic benefits all citizens and furthers the global interests of the United States.

Principal Contractors, Grantees, Agencies: USAID implements the programs through the local Pontificial Catholic University, the Costa Rica-based Inter-American Institute for Human Rights (IIDH), and the National Democratic Institute.

Major Results Indicators:

Baseline Target
Eligible voters who voted 66% (1990) 80% (2000)
(male and female) M= 71%
F = 62%

Eligible voters intending to vote 88% (1994) 85% (2000)
(male and female) M= 91%
F = 85%

Citizens involved in lobbying N/A (1994) 25% (2001)
for democratic reforms

Citizens active in NGOs and 16% (1994) 25% (2001)
community groups (male and female) M= 21%
F = 11%

PROGRAM: DOMINICAN REPUBLIC
TITLE AND NUMBER: Increased Availability and Use of Environmentally Sound Energy Sources, 517-SO04
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1997: $ 500,000 DA
INITIAL OBLIGATION: FY; 1995 ESTIMATED COMPLETION DATE: FY 1999

Purpose: To ensure that environmental concerns are given full consideration in the restructuring of the energy sector, to improve conservation in critical watersheds, and to develop and disseminate innovative renewable energy alternatives in rural areas.

Background: The Dominican Republic is over-dependent on inefficient and unreliable energy sources that pollute the environment and deplete the natural resource base. Power shortages are frequent, and an estimated two million rural residents live beyond the reach of the power grid. Firewood and charcoal still constitute the principal cooking fuel in the majority of rural homes. Cutting firewood is now considered the principal cause of deforestation, which causes siltation of hydropower reservoirs.

USAID Role and Achievements to Date: USAID financed a baseline environmental assessment for the Dominican power sector that provided the initial guidelines for siting, design and management requirements for two proposed new plants to be financed by the World Bank. USAID also supports nongovernmental organization (NGO) renewable energy initiatives and associated conservation activities that protect key watersheds to demonstrate how the lives of the rural poor can be dramatically improved. Active community involvement is the hallmark of this approach. By demonstrating how known technologies can exploit untapped alternative energy resources in a cost-effective and commercially viable way, USAID assists NGOs, cooperatives, community groups and private businesses to address the power needs of the rural poor. In FY 1995, $500,000 in Environmental Initiative for the Americas financing was made available to support the expansion nationwide of a U.S. private voluntary organization's (PVO's) solar energy program among rural households. Environmental guidelines were developed for minihydro activities, and a local NGO has designed the first community-based minihydroelectric plant in the country. An innovative, community-managed, water and soil management program was chosen for replication by the World Bank in a key watershed, leveraging an additional $ 2.5 million. The Parks in Peril project is protecting two major national parks, using volunteer guards from surrounding communities and building a partnership among national and international organizations.

Description: In FY 1997, USAID will assist the government in setting standards for new investments and establishing a regulatory unit for the power sector, to help direct power development along environmentally sound paths. The final tranche of grants to eight NGOs will support ongoing development of solar power for community potable water and domestic lighting systems, solar cooking heating and drying ventures, wind energy and minihydro pilot demonstrations for community electrification, and conservation projects in critical watersheds.

Host Country and Other Donors: Modest USAID assistance has had a catalytic effect on the design of a coordinated overall donor-government effort to restructure, rehabilitate and expand the electric power sector. USAID's environmental assessment was integral to the joint World Bank and the Inter-American Development Bank energy sector restructuring loan proposal. The standards and norms work has been carefully integrated into their larger efforts. Unfortunately, legislation required to meet key conditionality has been stalled in the Congress. The donors remain in agreement on the need to privatize the sector, even though USAID's assistance has shifted to emphasize alternative renewable energy.

Beneficiaries: Off-grid, rural communities without energy or water, and the rural poor in watersheds with hydroelectric power potential are the direct beneficiaries.

Principal Contractors, Grantees, or Agencies: USAID implements activities the Pan American Development Foundation, the Nature Conservancy, the Center for Marine Conservation, and several local NGOs including the Association for the Development of San Jose do Ocoa, the Association for the development of Espaillat Province, Foundation for the Development of the Southwest, and the Center for the Ecological Development of the Samana Bay. .

Major Results Indicators:
Baseline Target

Project rural households using solar 0 (1995) 1,200 (1998)
energy
Viable rural community-based 0 (1995) 9 (1998)
electrification and water systems
with alternative energy
Area under sound soil management 100 (1994) 2,000 (1998)
practices in project areas (hectares)