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FY 1997 Development Fund for Africa: $48,030,357
FY 1997 P.L. 480 Title II: $4,387,000
Introduction.
Uganda is in the midst of completing a remarkable transformation from 20 years of chaos and violence to stability, recovery and growth. Signs of progress abound. The economy grew by 10% over the past year while limiting inflation to 3.4%. A new democratic constitution has been promulgated, general elections were held in May 1996, investment exceeded $200 million in the past year, and, significantly, the human immuno-deficiency virus (HIV) infection rate appears to be declining. The USAID program has had a major impact by assisting Uganda in creating an environment which has made these achievements possible, and which has set the stage for completing the transition to constitutional democracy accompanied by sustained economic growth. Located in the Greater Horn of Africa, Uganda is a concrete example to other nations in the area of the benefits of free-market economics combined with democratic government. Uganda has been highly supportive of U.S. policy initiatives in the region, including humanitarian operations, peace-keeping and the Greater Horn of Africa Initiative (GHAI).
The Development Challenge.
Stability and sound economic policies have brought growth which has set the stage for completing the transition to constitutional democracy. This environment is attracting large-scale private investment. Completing the transition remains an enormous challenge that will take several years, but both the government and people of Uganda are committed to finishing the job. Their achievements over the past five years strongly suggest they will fulfill their commitments.
Although economic growth has increased real per capita income by 20% since 1986, to $180 in 1994, this is still 23% below the level of 25 years ago, placing Uganda among the poorest countries in the world. Life expectancy, estimated at 37 years, is the lowest in the world as the alarmingly high prevalence of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) -- perhaps as high as 20% of sexually-active women and men -- affects every aspect of the society. Only 48% of adults are literate -- well below levels in neighboring Kenya and Tanzania -- an indication of an education system where lack of access and poor quality limit the supply of basic skills within the economy. Inadequate physical infrastructure for energy, transportation, and telecommunications has severely limited Uganda's ability to meet the demands of a growing private sector. Despite the strong liberalization of the past five years, the World Bank and International Monetary Fund (IMF) project that Uganda will continue to depend on substantial external assistance for at least the next decade. The proliferation of water hyacinth, a plant which chokes lakes and rivers, is a new environmental threat to the livelihoods of people throughout the region.
Uganda remains severely indebted; its $3.2 billion debt at the end of 1994 is equivalent to about 60% of gross domestic product (GDP). Debt service payments represent 23% of government-financed expenditures, reducing productive investments. Multilateral debt accounts for three-quarters of the debt and two-thirds of projected debt service, severely limiting Uganda's access to relief under existing international arrangements. Illustrating the confidence the international community has in how the government manages the economy, Uganda became the first nation under the Paris Club to receive permission to write off $71 million in debt; even so, the next three years' debt service will be 50% higher than Uganda has paid in the past three years. This is a staggering burden.
Effective implementation of sound economic policies has permitted Uganda to manage its debt while continuing to grow economically. A major factor in these achievements has been the leadership, technical assistance and financing which USAID has provided. Uganda's economy can point to the followingnoteworthy achievements as illustrative of what has been achieved with USAID assistance. The growth of non-traditional exports from a low base five years ago to over $100 million in 1995, the improved management of natural resources contributing to the four-fold increase in tourism over the past four years, and the groundbreaking reduction in the incidence of HIV transmission are among the visible fruits of this program.
Other Donors.
Uganda's remarkable record of economic growth over the past five years has enabled the country to finance a higher percentage of its development program, but Uganda will still be dependent on external assistance for a number of years. Approximately one-third of public expenditure is externally financed. The World Bank is the largest and most influential donor. USAID is the fifth largest bilateral donor behind Denmark, the United Kingdom (UK), Germany, and Japan. Donor coordination is good and USAID provides parallel financing for major reform programs in the health and education sectors with the World Bank. Donors collectively pledged $800 million dollars for FYs 1995/96 at the annual meeting of donors convened by the World Bank meeting in July 1995.
FY 1997 Program.
The foundation for sustainable growth now exists, and USAID will continue to build on it through investments in primary education, health, environmental management and agricultural production.
U.S. intervention has been a key factor in stimulating Uganda's remarkable transformation. However, much remains to be done, and it is in the interest of the United States to apply continued engagement in selected sectors. American investors are already benefitting from the strikingly improved investment climate. Uganda is also becoming an American customer, and imports of U.S.-manufactured goods increased sixfold between 1985 and 1996. Equally important, it is in the U.S. interest that the principles underlying Uganda's positive transition, including free-market economics, constitutional democracy and public accountability, be spread to the several troubled countries in the region. This can happen if those principles continue to be practiced, bringing benefits to Uganda and to the region. Uganda is now part of the solution, but without continued support, there is significant risk it would become part of the problem. The failure of Uganda to maintain its march toward constitutional democracy would likely add to the pool of refugees and humanitarian crisis in the area.
A reduction in resources will result in the cancellation of activities in each of USAID's four strategic areas, hurting both American and Ugandan interests. In real terms, a reduction would mean training fewer primary teachers and health workers, canceling procurement of desperately-needed equipment for schools and health centers, reducing credit for poor rural business people, and scaling back support to non-governmental organizations (NGOs) involved in HIV testing and counseling. Because most planned activities are underway, we are already engaged with, and committed to, numerous partner organizations and communities. Resource cuts will jeopardize contracts and grants with our U.S. partners and undermine the development efforts and aspirations of the Ugandan people.
Four strategic objectives (SOs) and one specific objective comprise USAID's program of assistance to Uganda. While activities under each SO target specific development problems, the SOs are mutually reinforcing and in some cases contribute to the achievement of more than one Agency goal.
Agency Goal: Encouraging Broad-Based Economic Growth
Underlying sustainable development in Uganda is continuing political stability and broad-based economic progress. The benefits of growth will have broader impact if shared, especially among the majority rural population. Two of USAID's four strategic objectives address this pressing need.
SO 1 aims to increase income from on-farm activities, primarily by promoting non-traditional exports, and from off-farm activities by encouraging the growth of micro and small enterprises, and by improving the business environment. Increasing non-traditional agriculture exports can benefit thousands of marginalized farmers. Title II resources are an integral part of the Mission's strategic objective in economic growth. Title II is used to improve rural infrastructure and expand opportunities to grow and market traditional export crops including coffee, tea, cotton and tobacco. The Title II resource is also used to revitalize the Cooperative Bank, the only formal financial institution active in agricultural credit. A successful example is a pyrethrum activity promoted by a U.S. investor and financed under a USAID-supported venture capital fund in the remote southern part of the country has tripled income for over 3,000 producers, mostly women. The Foundation for International Community Assistance (FINCA), a U.S. NGO, has organized over 1,000 women into savings groups that have borrowed, and repaid, over $400,000 during the last two years. This is a significant achievement in a country where rural credit programs have a reputation for failure.
SO 3 responds to the long-term need for literacy and other basic skills in order to boost productivity and provide an informed and responsible electorate. USAID's policy dialogue has strengthened the Government of Uganda's ability to adopt policies leading to wholesale reform of the primary education system. New policies have resulted in the construction of hundreds of classrooms, the removal of thousands of redundant, untrained teachers from the payrolls and a sixfold increase in teachers' salaries, in-service training for thousands of other teachers, and the purchase of 1.5 million textbooks. During the last year the percentage of untrained teachers in the classroom fell from 50% to 40%.
Agency Goal: Protecting the Environment
USAID selected Uganda as a Biodiversity Priority Country containing unique, essential ecosystems critical to the conservation of globally-important biodiversity. Uganda's unique biodiversity has been placed at risk by intense and increasing population pressures, poverty, unsustainable natural-resource management practices, and a history of conflict. Therefore, this Strategic Objective addresses the challenge of biodiversity conservation by assisting Uganda to maintain the integrity of targeted biodiverse ecosystems.
USAID emphasizes natural-resource planning, strengthening management of protected areas and support to NGOs engaged in activities which integrate conservation and development in and around protected areas. Uganda successfully completed a National Environmental Action Plan in May 1995 with the passage of landmark implementation legislation. The new legislation defines both needs and guidelines for biodiversity conservation. Management of Uganda's protected areas, USAID's target areas for biodiversity stabilization, by the Uganda Wildlife Authority has improved markedly through strengthened management capacity, improved infrastructure, and higher revenues from ecotourism. Finally, the incentives and ability of local communities to conserve biodiversity have grown due to new revenue-sharing policies, access to resources, and ongoing conservation education.
Agency Goal: Stabilizing World Population Growth and Protecting Human Health
Uganda was among the first countries in Africa to be hit hard by the HIV pandemic. Close to 10% of the total population may be infected, and cases are mostly among adults in the prime of their economic lives and those about to enter this age group. A large, and generally unattended, problem with sexually transmitted infections is probably a significant contributor to continuing HIV incidence.
With one of the highest fertility rates in Africa, Uganda has a serious population problem. At current rates, the population will double in 21 years. This has resulted in a disproportionately large number of children dependent upon a correspondingly small number of adults. In Uganda over 50% of the population is under20 years old. Women have an average of 6.8 children each, so many that childbearing poses a significant health threat to both women and children. Although precise figures are not available, prevailing opinion is that maternal mortality is extremely high, and poor child-spacing contributes to poor nutrition, which in turn leads to sickness and physical and mental stunting. Infant mortality has been estimated at 81/1,000 live births, a surprising figure in that it is lower than most countries in Sub-Saharan Africa.
Fertility has dropped since 1989, and it appears that Uganda is entering a period of significant fertility decline. While the causes for this decline are complex, USAID's support for family planning and use of modern contraceptives has played an important role. Contraceptive use has increased from 2.5% to 7.8% since 1991. USAID's social-marketing program has helped create a robust commercial market for family planning and maternal health services. It also appears that the incidence of new HIV infection has levelled off and actually started to decline. Constraints that USAID will address include poorly trained health workers, reluctance among many Ugandans to use modern health services.
Agency Goal: Building Democracy
Uganda has made encouraging progress toward becoming a constitutional democracy. Over the past three years, the first free and fair national elections were completed, a new democratic constitution promulgated, and human rights abuses almost eliminated. USAID leadership, technical assistance and financing made a major contribution to these achievements. USAID was actively involved with the preparations for the general elections for president and parliament, held in May 1996. Although there were a few allegations of election irregularities made primarily by the opposition, the election results were validated, and the first free, peaceful and democratically-elected president has been inaugurated. Building on the foundation of the 1995 constitution, and following the 1996 elections, USAID anticipates funding activities in civic education, judicial improvement and human rights defense. These activities are aimed at assisting Uganda to spread the benefits of democracy to the grass-roots level.
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Environment |
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| USAID Strategic Objectives | ||||||
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1. Increase Rural Household Incomes - Dev. Fund for Africa - P.L. 480, Title II |
11,847,316 |
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4,387,000 |
11,847,316 |
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2. Stabilize Biodiversity in Target Areas - Dev. Fund for Africa |
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8,306,527 |
8,306,527 |
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3. Improve the Quality and Efficiency of Basic Education -Dev. Fund for Africa |
11,691,760 |
643,597 |
12,335,357 |
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4. Improve the Reproductive Health of Ugandans - Dev. Fund for Africa |
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15,541,157 |
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15,541,157 |
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Totals - Dev. Fund for Africa - P.L. 480, Title II |
23,539,076 |
15,541,157 |
8,306,527 |
643,597 |
4,387,000 |
48,030,357 4,387,000 |
USAID Mission Director: Donald B. Clark
PROGRAM: UGANDA
TITLE and NUMBER: Increase Rural Household Income, 617-S001
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1997 $11,847,316 DFA, $4,387,000 P.L. 480, Title II
INITIAL OBLIGATION: FY 1996; ESTIMATED COMPLETION DATE: FY 2001
Purpose: To increase rural household income. Increasing income will enhance food security, alleviate poverty and contribute to an improved quality of life for the majority of Ugandans.
Background: USAID's development efforts must result in a better life for the 80% of the people living in poor rural areas. This depends upon higher household income through increased on and off-farm production and better use of family resources. Four on-going activities, as well as the P.L. 480, Title II Program, work to increase household income. Two activities are aimed at expanding non-traditional agricultural exports (NTAEs) in areas where Uganda has a natural comparative advantage. Title II resources are also integrated into the strategy by supporting rural infrastructure improvement and expanding opportunities to grow and market traditional exports crops including coffee, tea, cotton and tobacco. NTAEs can benefit thousands of small farmers. For example, an activity to cultivate pyrethrum, the foundation for natural insecticide, was promoted by a U.S. investor in the remote southern part of the country. It has tripled income for over 3,000, mostly women, producers. A third activity is expanding employment with off-farm activities with small amounts of credit to support agricultural-based businesses such as sunflower oil production. This credit is designed to respond to needs among small and micro enterprises. USAID is also working to build an appropriate business environment for small entrepreneurs in rural Uganda. The Foundation for International Community Assistance (FINCA), a U.S. non-governmental organization (NGO), has organized over 1,000 women into savings groups that have borrowed -- and repaid -- over $400,000 during the last two years. This is a significant achievement in a country where rural credit programs have uniformly failed.
USAID Role and Achievements To Date: USAID acts as a facilitator and catalyst to create an enabling environment in which entrepreneurs can take advantage of Uganda's natural comparative advantages, and new market opportunities emerge. This entails many diverse activities, from working with farmers to improve farming, storage and handling, to helping business people put deals together, and rehabilitating long-impassable rural roads. Our program is working. NTAEs grew at an average annual rate of 35% between 1990 and 1994. Returns to rural labor associated with NTAE production increased at an average annual rate of 25% over the 1990-1993 period, well in excess of the growth of per capita gross domestic product (GDP). These achievements translate into a better quality of life for Ugandans. For example, women in one of the NTAE-producing areas confirmed increased incomes and stated that they are now better able to pay for school fees, medical care, and food.
Description: Accomplishing this effort relies on increasing rural business activity, including farm businesses. Actions funded under four principal activities lead to this result. The Cooperative Agriculture and Agribusiness Support (CAAS) activity increases agricultural productivity and rural incomes through an increased supply of inputs, liberalized marketing and assistance to agribusiness. Resources from a P.L. 480, Title II monetization program support these objectives. The Agriculture Non-Traditional Export Promotion (ANEP) activity aims at alleviating public and private sector constraints to export of a range of NTAEs, in part by strengthening analytic and policy-making capacity. The Investment in Developing Agricultural Exports (IDEA) activity helps to diversify NTAEs by expanding food crop exports such as maize and beans to other countries of the Greater Horn, thereby enhancing regional food security, and meeting regional demands for basic food requirements. The Private Enterprise Support, Training and Organizational Development (PRESTO) activity is expanding rural credit through U.S. private voluntary organizations (PVOs) and local financial institutions and tackling policy and regulatory constraints to business development.
Host Country and Other Donors: Alleviating poverty is the Government of Uganda's (GOU) highest development priority. The GOU is committed to creating the proper enabling environment through disciplined adherence to structural reforms such as the abolition of marketing boards and liberalized trade and payments systems. Achievements realized under the SO require a primary role by the private sector. USAID's chief collaborators are the World Bank and the European Union, although most major donors address the problems under this SO with activities designed to raise income and alleviate poverty. To improve coordination, a private sector donor subgroup, chaired by USAID, meets monthly.
Beneficiaries: Fourteen million Ugandans living in rural areas are the target beneficiaries of this strategic objective.
Principal Contractors, Grantees, or Agencies: Activities contributing to the achievement of SO 1 are implemented by a number of U.S. contractors and PVOs. These include Chemonics International, Agricultural Cooperative Development International, the Foundation for International Community Assistance, Land O'Lakes, and Mississippi State University. A U.S. firm is currently being selected to implement the Private Enterprise Support, Training and Organizational Development activity.
Major Results Indicators:
Baseline Target
Average household expenditures 100 (1992) 137 (1998)1/
Increase in NTAEs $33.7 million (1990) $138 million (1998 )
Increase in savers and repeat rural borrowers 1,000 (1995) 6,000(1998)
in USAID-supported programs
PROGRAM: UGANDA
TITLE AND NUMBER: Stabilize Biodiversity in Target Areas, 617-S002
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1997: $8,306,527 DFA
INITIAL OBLIGATION: FY 1996; ESTIMATED COMPLETION DATE:FY 1997
Purpose: To maintain the integrity of globally-important biodiverse ecosystems.
Background: USAID has designated Uganda as a biodiversity priority country containing ecosystems critical to the conservation of globally-important biodiversity. However, this unique biodiversity is imperiled by unsustainable natural-resource management practices. USAID is assisting Uganda to maintain the integrity of targeted biodiverse ecosystems. USAID's Action Program for the Environment (APE) activity is the principal component of this strategic objective (SO).
USAID Role and Achievements to Date: At a national level, USAID supports activities designed to establish an appropriate policy and institutional framework for environmental management; and at the local (e.g., protected area) level APE activities assist the National Parks and non-governmental organizations (NGOs) to better manage protected areas. USAID's efforts have led to major improvements in Uganda's environmental policy and institutional framework. A National Environmental Action Plan (NEAP) was adopted with landmark legislation signed into law. Six new national parks have been created since 1991, bringing to 10 the number of parks within Uganda's protected area system. These parks are USAID's target areas for biodiversity stabilization, including basic repositories for in situ conservation in Uganda. Important progress has also been made outside the policy arena. Tourism has increased fivefold since 1991, with a concomitant tenfold increase in park-user fees. Privatization of state-owned tourism concessions, and numerous ecotourism ventures launched by local communities intent on capitalizing on increasing numbers of tourists, have created significant employment. The parks system has adopted a policy of sharing revenue with local communities, and sustainable multiple-use practices have allowed buffer-zone communities continued access to park resources. Finally, local communities participate in park management. USAID is also assisting the Government of Uganda (GOU) to respond to the uncontrolled spread of destructive water hyacinth plants in the countries adjacent to Lake Victoria.
Description: At the national level, assistance focuses on the development and implementation of a comprehensive strategy to address environmental issues through policy, legislation and institutional reform--the NEAP. Technical assistance and training have resulted in the adoption and implementation of the plan. At the local level, USAID-funded U.S. and local NGOs strengthen management of protected areas by creating conservation incentives for local communities; promoting conservation through revenue sharing, and by increasing public awareness. USAID also supports research aimed at improving protected-area management and increasing environmental management capacity of GOU agencies, local NGOs and community-based organizations. A U.S. firm is assisting the GOU to contain the economic and environmental damage caused by the proliferation of water hyacinths on the region's lakes and rivers.
Host Country and Other Donors: USAID works most closely with the National Environment Management Authority on broad policy and institutional issues, and with the Uganda Wildlife Authority on protected-area management issues. USAID collaborates with other donors, including the World Bank, the International Union for the Conservation of Nature, German Technical Cooperation, the European Community and Danish International Development Agency to ensure overall donor coordination in natural resource management.
Beneficiaries: Activities implemented under this SO benefit the nation as a whole through improved management of the country's natural resources and increased foreign exchange and employment from an expanding ecotourism industry. Activities implemented by NGOs in the buffer zones of protected areasbenefit rural communities surrounding national parks. USAID efforts to control water hyacinth benefit riparian communities around Lake Victoria.
Principal Contractors, Grantees or Agencies: Activities contributing to the achievement of SO 2 are implemented by U.S. contractors, private non-profit companies, and U.S. and host-country private voluntary organizations (PVOs) and NGOs. These include Tropical Research and Development, Aquatics Unlimited, Volunteers in Overseas Cooperative Assistance, Agricultural Cooperative Development International, Consortium for International Development, Cooperative for American Relief Everywhere (CARE), World Wide Fund for Nature, and African Wildlife Foundation.
Major Results Indicators:
Baseline Target
% current surface areas maintained2/ 40% (1986) 100% (1997)
Annual park user fees revenues $74,000 (1991) $1 million (1997)
Increase in buffer zone employment 0 (1989) 12,000 (1997)
Increase in % park staff trained 0% (1989) 60% (1997)
PROGRAM: UGANDA
TITLE AND NUMBER: Improve the Quality and Efficiency of Basic Education, 617-S003
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1997: $12,335,357 DFA
INITIAL OBLIGATION: FY 1996; ESTIMATED COMPLETION DATE: FY 2001
Purpose: To improve the quality and efficiency of basic education.
Background: Basic education is fundamental to sustainable development, and is one of the essential elements in USAID's strategy of encouraging broad-based economic growth. Primary education has a decisive impact on all four of USAID's Strategic Objectives in Uganda. There is a strong correlation between investments in education and increased productivity and life expectancy, reduced fertility and poverty, improved income and distribution, and democracy. A recent study in Uganda demonstrated a strong correlation between education and the adoption of behaviors to avoid human immuno-deficiency virus (HIV) infection.
One critical precondition for Uganda's long-term success in social and economic reforms is the availability of people with appropriate training and skills in a broad range of technical, professional and commercial areas. The skill level of primary school graduates must increase dramatically to provide the basis for this training. Uganda's education system is constrained by limited access, poor quality and dilapidated physical infrastructure. USAID assistance supports the Government of Uganda's (GOU) priority policy goals within a cohesive education reform program.
USAID Role and Achievements to Date: USAID finances key elements of the GOU's education reform program. After three years significant results have been achieved. Some 5,000 principals, teachers, and tutors, representing 7% of the primary teaching force, are currently enrolled in USAID-sponsored inservice training programs. As a result of policy dialogue, the GOU has committed itself to increasing teachers' salaries to a minimum living wage of $70 per month. Since 1992, the GOU has increased teachers' salaries from the equivalent of $8 per month to $51 per month in 1995. For the first time in two decades, primary schools have been given a budget and permitted to select and order a total of 1.5 million textbooks. During the last two years, communities have been mobilized to build an additional 1,000 classrooms.
Description: USAID's education program targets four policy objectives as precursors to establishing an environment in which education can once again flourish. The first is to help re-establish teaching as a respected profession--by bettering salaries and working conditions, upgrading skills and certification through in-service training, and improving school management. The second is to work with the GOU to increase the level of resources available for primary education by improving resource allocation and budgeting. A related objective is to increase availability of instructional materials by allocating more resources and liberalizing the procurement process. Decentralization is an important principle in this activity. Prior to USAID's involvement, a corrupt and monopolized market for school supplies was in place. Finally, USAID's program is encouraging local communities to become more involved and responsible for meeting students' educational needs. At the same time, the school systems are encouraged to become more accountable to parents and students.
Host Country and Other Donors: USAID's resources complement those of other donors in the education sector. USAID funds educational reform alongside the World Bank's efforts by financing agreed-upon activities from the GOU's reform agenda. Other participants in the primary education sector include the United Nations Children's Fund (UNICEF), the Danish International Development Agency (DANIDA), and, on a smaller scale, non-governmental organizations (NGOs) such as World Vision, ActionAid, InterAid and the Aga Khan Foundation.
Beneficiaries: Two and a half million primary school pupils and 75,000 primary teachers directly benefit.
Principal Contractors, Grantees, or Agencies: Activities contributing to the achievement of SO 3 are implemented by a number of U.S. institutions. These include the Academy for Educational Development (AED), the Institute for International Research (IIR), Creative Associates, the University of Massachusetts, and the Research Triangle Institute.
Major Results Indicators:
Baseline Target
Increased efficiency of basic education: 72% (1990) 85% (2002)
% of pupils passing grade 7
Number of years of school provided 32 yrs+ (1990) 12 yrs+ (2002)
per primary school graduate3/
Increased number of students using 1:6 (1990) 1:3 (2002)
relevant educational materials:
Book-pupil ratio increased to a minimum
of one set of four core books for every three
pupils
Increased number of effective teachers:
% of qualified Grade III teachers 49% (1990) 90% (2002)
Increased girls' persistence
% of girls enrolled in grade 7 as a % 24% (1990) 40% (2002)
of girls who start school
PROGRAM: UGANDA
TITLE AND NUMBER: Improve the Reproductive Health of Ugandans, 617-S004
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1997: $15,541,157 DFA
INITIAL OBLIGATION: FY 1996; ESTIMATED COMPLETION DATE: FY 1999
Purpose: To reduce fertility and the transmission of human immuno-deficiency virus (HIV).
Background: Uganda's current fertility of 6.8 is among the highest in Africa. Although 67% of married women either want no more children or want to delay their next pregnancy by at least two years, only 7.8% are currently using modern family planning. Estimates of maternal mortality range from 600 to 1,000/100,000 live births. Uganda also has one of the highest rates of HIV prevalence in the world. Approximately 1.9 million Ugandans have been infected, and over 400,000 have died. Estimated prevalence is as high as 20% of the adult population of some urban populations. Poorly trained and paid health staff at insufficient health facilities, popular misconceptions about family planning and HIV, high prevalence of sexually-transmitted diseases (STDs), traditional sexual norms and the status of women, and low condom utilization are major constraints.
USAID Role and Achievements to Date: Since 1989, when USAID involvement in family planning and Acquired Immune-Deficiency Syndrome (AIDS) began with modest support, fertility has begun to drop and the use of modern family planning has more than tripled. A 1995 Demographic and Health Survey (DHS) concluded that "...Uganda is witnessing a period of rapid fertility decline." The DHS also indicates that knowledge of AIDS is nearly universal and that knowledge that AIDS can be prevented is on the order of 90%. The country is witnessing a decline in the number of new HIV infections (measured among women who attend pre-natal clinics) after years of steady increases, with clear indications of important changes in sexual behavior and steadily increasing use of condoms. Evaluation data clearly indicate that USAID projects have been effective contributors to these trends. USAID project beneficiaries report reductions in multiple and casual partners and increased condom utilization.
Description: USAID-supported activities seek to reduce fertility and HIV transmission by increasing the utilization of basic reproductive health services (family planning and maternal health, STDs/HIV), improving the quality of those services and changing behaviors in selected areas of Uganda. The SO 4 portfolio includes six sets of activities intended to: (1) increase availability of good-quality services in health facilities; (2) increase availability of good-quality services at the community level; (3) provide the public with correct information and motivation to use available services and adopt preventive behaviors; (4) increase availability of contraceptives through the private sector; (5) increase revenue generation in health facilities; and (6) strengthen private-sector provider organizations.
Host Country and Other Donors: USAID is the largest bilateral donor in reproductive health, followed by the British Overseas Development Agency. Among the multilaterals, the World Bank is the largest donor, with substantial investments in controlling sexually transmitted infections and improving district-level health services. The United Nations Population Fund (UNFPA) is also a major actor in family planning. The Government of Uganda has encouraged these donors to work in different districts to spread resources evenly around the country and avoid overlap, with the Ministry of Health assuming an overall coordination role. USAID has closely coordinated with the World Bank in reproductive health, with the Bank agreeing to finance commodities to complement USAID's provision of technical assistance. The United Nations Children's Fund (UNICEF) is a major source of funds for child survival activities. The United Nations Development Program (UNDP) and the Danish International Development Agency (DANIDA) are significant sources of AIDS funding.
Beneficiaries: USAID-funded programs are active in 13 of Uganda's 39 districts, which include about 35% of Uganda's population of around 20,000,000. Thus, about 7 million people are potential beneficiaries of activities in the SO 4 portfolio. Women from 15 to 45 years of age in these districts total about 1,500,000 and are the direct beneficiaries of family planning and maternal health services. In addition, the social-marketing program has created commercial markets for condoms and oral contraceptives throughout the country.
Principal Contractors, Grantees or Agencies: Pathfinder International, Johns Hopkins University, University of North Carolina, E. Petrich and Assoc., Futures Group, African Medical and Research Foundation, Cooperative for American Relief Everywhere, AIDS Information Center, AIDS Support Organization, Association for Voluntary Safe Contraception, and John Snow International.
Major Results Indicators:
Baseline4/ Targets5/
Total Fertility Rate 6.8 (1995) 6.0 (1999)
Contraceptive Distribution to be set 1996
HIV prevalence, 15 - 19 year 12.5% (1995) 3% decrease (1998)
old women
Condom Distribution TBD (1996) TBD