Note: This document may not always reflect the actual appropriations determined by Congress. Final budget allocations for USAID's programs are not determined until after passage of an appropriations bill and preparation of the Operating Year Budget (OYB).
JORDAN
FY 1998 Economic Support Fund .......... $25,000,000 FY 1998 Development Assistance Fund .......... $2,500,000 Introduction
Jordan is a small, Middle Eastern kingdom which has common borders with Israel, Syria, Iraq and Saudi Arabia and has historically played an important political role in the region. The signing of a peace treaty with Israel in October 1994 reinforced that role and provided a new impetus to the Middle East Peace Process. With a constitutional monarchy and a bicameral legislature, Jordan has set a democratic standard for the rest of the Arab world. But the development of Jordan's fledgling democracy, its ability to "wage peace," and its continuing efforts to promote regional peace (all key U.S. foreign policy interests) depends on future political and economic stability, which can only be achieved through sustained international donor assistance. Hence, in view of Jordan's continuing key role in attaining critical U.S. national interest objectives in the region, and especially given Jordan's investment in a peace process that recently has been shaken, there is at a minimum, the need to sustain the present levels of the economic assistance program.
The Development Challenge
About the size of Indiana, Jordan covers approximately 35,000 square miles of land. Approximately 8% is arable while 92% of the country is desert. Jordan has few natural resources, primarily phosphate and potash from the Dead Sea, and these offer limited export growth potential. Population growth has put tremendous pressure on the water supply, Jordan's most scarce resource. Water from aquifers and surface sources is extremely limited and must be conserved. A country of 4.3 million people, Jordan has an average annual population growth rate of 3.7%, one of the highest in the world.
The mainstays of the economy are donor assistance, remittances from Jordanians working abroad and tourism receipts all of which are dependent on political vagaries, e.g. all three were drastically curtailed because of the Gulf Crisis. Consequently, the challenge to Jordan has been to continue to diversify its exports, create employment, and improve management of its limited natural resources. Creating an economic environment that encourages domestic growth and international investment is vital to Jordan's long-term economic growth, political stability, and ability to reap the benefits of peace with Israel.
Overall economic indicators demonstrate that Jordan is serious about controlling problems constraining development. For example, the current account deficit declined to 3.7% of Gross Domestic Product (GDP), between 1994 and 1995 and is projected to decline further to 3.1% of GDP in 1996; external debt in 1995 was 96.6% of GDP, down from a 1990 peak of 190%; and debt service as a percentage of exports of goods and services was 31.6% in 1994, 27.0% in 1995, and expected to be 25.2% in 1996. Moreover, the government has initiated a series of policy reforms that will make Jordan "open for business." In 1995, the Government of Jordan (GOJ) focussed its reform efforts on stimulating private investment, both local and foreign. The GOJ passed a new investment law that lifts restrictions on foreign ownership and a new income tax law that makes significant cuts in corporate and business taxes. Non-Jordanian investors were permitted to repatriate their foreign capital and profits, and liquidate their projects or stocks without delay and in convertible currencies. The new income tax law reduces the maximum rate on taxable personal income from 50% to 35% and reduces the maximum corporate income tax rate from 25% to 15% in priority sectors such as mining, manufacturing, transportation, hotels, and hospitals. Similarly, the maximum tax rate on banks, financial, insurance, and brokerage firms was reduced from 55% to 35%.
In May 1996, Jordan signed a new three-year International Monetary Fund (IMF) agreement that calls for strong, sustainable growth. The GOJ also initiated a new series of policy reforms to curb monopoly practices, encourage stock market investment, and streamline the customs laws. The privatization process also gathered speed, as the GOJ added several government-owned enterprises to the 1996 privatization list.
Nevertheless, the economy struggled to maintain its position in 1996 growing at a rate of 5.2%. Preliminary GOJ data suggests an increase in the unemployment rate from 15% in 1995 to 19% in 1996; an increase in the inflation rate from 4% to 8% and a 13% decrease in the standard of living. Consequently, the economy's 1996 performance registered mixed results.
Jordan has made additional progress toward establishing democratic institutions. Municipal elections were held during 1995. This was the first time that Jordanians elected mayors (except Amman). In Amman, half of the council was elected, but elsewhere, all members of the local councils were elected by the people. Two women were elected mayors of their towns.
During 1995, Jordan initiated the revision of its 1977 national water plan. The 1977 plan focused on the assessment of water resources and potential, particularly groundwater, with provisions for further studies and program formulation. It included provisions for the most efficient use of available water, required funds and manpower, delineation of the most suitable methods for development and operation, as well as calling for the reuse of waste water. The plan was geared mainly towards the development of water resources, and only limited emphasis was placed on their management. Current revisions of the 1977 plan focus on efficient management of water resources and methods by which to minimize expected water deficits. Revisions also feature programs on water management information systems, a monitoring network, increase of supply through artificial recharge schemes and demand management in all water sectors.
The GOJ continues to provide family planning services in all of its healthcare facilities. Their 1996 decision to allow a multi-media approach, including televised infomercials to better reach and to educate Jordanian couples about family planning, was a significant step forward against the backdrop of a traditionally conservative society.
Despite the noted progress, Jordan faces several serious obstacles which require our continued assistance. Even with the forgiveness of official U.S. debt in 1994 and 1995, Jordan still has over $6.9 billion in external outstanding debt and requires foreign exchange to service that debt. Jordan still imports far more than it exports; its 1995 trade deficit stood at 29.7% of GDP and is expected to be 33.8% of GDP in 1996. Its foreign exchange reserves continue to fluctuate around $620 million, an amount equivalent to two months of imports. Jordan has one of the lowest per capita water consumption rates in the world, yet even the current rate of consumption cannot be sustained. The total fertility rate, down from 5.6, is still high at 4.4 and will determine long-term water demand.
Other Donors
In 1996, Jordan received $664 million in international donor assistance. The United States provided $7.2 million in USAID-funded bilateral assistance, seventh out of eight bilateral donors. Germany, Italy, and Canada head the bilateral donor list, contributing at least $25 million each this year. The World Bank, the European Union, the Arab Monetary Fund, and the International Monetary Fund are the largest donors, whose assistance ranged from $124 million to $98 million in 1996.FY 1998 Program
A politically stable and economically secure Jordan is pivotal to achieving U.S. foreign policy objectives in the Middle East. Jordan and Egypt stand at the forefront of this region's U.S. allies in brokering peace process initiatives and practicing the virtues of moderation in a region where extremism andtumult frequently reign. During the past year, the U.S. Government has increasingly solicited Jordan's assistance in support of the peace process. Jordan's active participation and vanguard diplomacy, however, carry a political price at home. The August 1996 bread riots, chronic unemployment, and graphic examples of increasing income disparities suggest that the much anticipated economic boom resulting from Jordan's 1994 peace accord with Israel has yet to materialize. Public support for peace with Israel and more broadly for the peace process is eroding.Jordan's prospects for sustained development hinge upon improved political and economic integration in the region and the ability to spread the benefits of growth to more of its population. USAID's efforts to promote economic growth and to spread the resulting economic benefits in Jordan are, therefore, very much in our national interest. Expanding private sector-led economic opportunities through employment generation and increasing incomes is central to ensuring long-term political and economic security.
The ability to better manage increasingly scarce water resources in Jordan and in the region is also a key factor affecting Jordan's political and economic stability. The U.S. Government is placing increasing emphasis on this long-term issue as evidenced by the State Department's November 1996 decision to make Jordan home to a Regional Environmental Hub and USAID's on-going analysis regarding future water sector investments.
Meanwhile, population growth erodes economic growth and further exacerbates the country's limited and increasingly over-taxed water resources. Population pressures are, in significant part, due to a lack of family planning knowledge, services, and products. However, demographic health survey data indicates that there is a large unmet need in family planning: the desired family size is about four children and 26% of married women either want to delay their next birth or stop having children. To help stabilize population growth, our funding broadens the range of affordable contraceptives and supports an information and education campaign that targets service providers, as well as couples, who are informed about modern family planning methods. USAID is improving family planning practices using modern methods which has proven a successful approach leading to fewer births, reduced numbers of unwanted pregnancies, and improved maternal and child health.
Agency Goal: Encouraging Broad Based Economic Growth
With one of the world's highest population growth rates, a small internal market, and an extremely limited natural resource base, bringing broad-based economic growth to Jordan is especially challenging. USAID's contribution to this effort addresses two major issues -- employment generation and water. The first strategic objective enhances private sector economic opportunities and the second strategic objective improves water resource management.The success of Jordan's transition to an open economy that sustains growth and achieves the rewards of peace depends on how widely the benefits of economic growth are shared. Despite a return to positive economic growth since the Gulf War, the condition of the poor and the income gap between the middle-class and the poor has widened. Many Jordanians unfortunately blame this reality on the economic reform process which exacerbates underlying skepticism regarding the peace process, the benefits of which are now considered unrealized by the vast majority of Jordanians.
After a year of protracted negotiations, USAID decided to terminate support to the culture and nature visitor industry program (tourism). USAID used this event to begin to develop a new economic opportunities strategic objective to replace tourism. The new strategic objective is being designed to help spread the benefits of Jordan's expanding economy more equitably and support the peace process by generating jobs and increased incomes for disenfranchised Jordanians.
USAID believes that the private sector is the key to providing enhanced economic opportunities in Jordan with small- to medium-size enterprises offering the best prospect for employment generationand increased incomes. Chief among the development constraints to be addressed will be access to credit, lack of productivity, and lack of integration into the regional economy.
The economic growth strategy, once developed and approved, will address areas offering the greatest potential for results and where USAID has a comparative advantage. This design of a new economic growth strategy assumes modest funding but also identifies opportunities that can be expanded should additional resources become available.
Water is the most critical natural resource in Jordan. Without improved management of existing supplies, sustainable economic growth in Jordan will become an increasingly elusive goal. USAID is addressing water quality and efficient use problems through irrigated water use technologies, wastewater treatment, and improved water management systems.
- Strategic Objective 5: Enhanced private-sector economic opportunities.
Wastewater treatment is an important element of USAID's water strategy. As the population increases, the quantity of wastewater also increases. Proper treatment can result in a steady or increasing supply of water for agriculture, replacing water of potable quality in many cases. Likewise, increased quantities of untreated or improperly treated wastewater can threaten public health, ground and surface water supplies and environmental sustainability in general. The upgrading of the wastewater treatment facility at As-Samra will be completed in the second quarter of FY 1997. At that time, some 53 million cubic meters, or all of the effluent from the Greater Amman/Zarqa area, will meet international and Jordanian standards and will be suitable for unrestricted use on irrigated agriculture. The feasibility and design of water and wastewater services for the Wadi Mousa area, locus of the famed world heritage site Petra, also will be completed in the second quarter of 1997. A master plan for wastewater services through the year 2025 for the greater Amman metropolitan area will be completed in the third quarter of FY 1997.
In the area of improved water resources management, the Ministry of Water and Irrigation (MWI) now agrees that a unified information management system is essential for proper tracking and analysis of water data. The system design is nearly complete and some elements of this long-term activity are already installed. Design of an improved water quantity and quality monitoring system is also nearing completion. Installation of approximately 50 monitoring stations will be completed by the end of 1997.
To promote the efficient use of water, over 30,000 people have received information on water use and scarcity issues. Jordanian NGOs proved an effective vehicle in reaching substantial numbers of consumers. Technical assistance in the operation and maintenance of improved irrigation systems, a change from the water delivery system to limited rate on-demand and demonstration projects involving a range of donors are all improving irrigation efficiency throughout the Jordan valley. An efficiency increase of only one percent equals 3 million cubic meters of water that can be used for other crops or other higher value purposes.
USAID's activities in the water sector are proceeding well, with most expected to be completed within the next year or two. Largely for that reason, USAID is reviewing the focus in the water sector with GOJ and other donors in order to extend and consolidate current activities and to identify additional priority areas where our assistance can have the greatest impact over the next five years.
In FY 1998, we plan to complete the management information system and the MWI's water quantity and quality monitoring program. Increased efficiency in agricultural water use will continue as a multi-donor effort, including the World Bank, Germany and France. The construction of Wadi Mousa wastewater collection, conveyance and treatment will continue. The ultimate impact of this activity is expanded and improved wastewater services for some 15,000 people and protection of Petra, the cornerstone of Jordan's tourism industry, from further environmental degradation. New activities mightinclude coordination with other donors on water system management privatization to decrease significant water losses in Amman as well as initiatives to implement aspects of the Greater Amman Wastewater Masterplan which USAID has financed.
USAID is also considering a fourth result in the water sector more directly tied to regional peace, addressing such issues as Jordan River water quality, increased potable water conveyance capacity (e.g. the Wadi Arab-Irbid pipeline or a second pipeline from Dier Alla to Amman); and/or design and construction of additional water storage facilities in the Jordan Valley.
Throughout the development of this revised focus, we will continue to emphasize sustainability and maintenance issues as well as potential leveraging of other donor resources.
- Strategic Objective 2: Improved water resource management.
Agency Goal: Stabilizing World Population Growth and Protecting Human Health
Jordan's population growth rate of 3.7% remains one of the highest in the world. As a way to address this critical problem, USAID is concentrating on modern family planning methods--providing information and expanding the variety of products at prices most Jordanians can afford.USAID has played a major role in assisting the GOJ to establish and implement a national family planning program. As the lead donor in family planning, USAID has helped Jordan to increase the modern contraceptive prevalence rate (CPR) from 27% in 1990 to an estimated 35.8% in 1996. Total CPR is now estimated at 46.2%, while the total fertility rate has dropped from 5.6 to 4.4.
In the last year, USAID and its partners in the Ministry of Health (MOH), the private commercial sector and the non-governmental organizations (NGOs), have continued to put the pieces of a quality family planning program in place. Since the last Congressional Presentation, USAID resources have trained over 1,000 physicians, nurses, pharmacists and family planning counselors from the private and public sectors. Additionally, a management information system for NGO family planning clinics has been established and is functioning. The five clinics which were established in the NGO sector continue to successfully use quality of care protocols to ensure client satisfaction with the services provided. This year, these clinics have also concentrated on cost recovery issues. Although these clinics have only been in existence for an average of three years, they are now recovering 48% of their costs. Also in the NGO sector, couple-years of protection have increased from 21,676 (January 1994 to June 1994) to 26,861 (January 1995 to June 1995).
USAID and the MOH are cooperating to encourage women to space births at least two years apart. Although 80% of all Jordanian births occur in hospitals, only six percent return for postpartum care and family planning services. As a result of USAID interventions, postpartum family planning services will be provided in 12 hospitals where most births occur. Over the last year, six additional postpartum centers have been renovated, furnished and fully equipped, bringing the total number of fully operational centers to ten. Before the end of FY1997, all twelve centers will be operational. In the ten centers, postpartum family planning services have begun. Instituting family planning services in public hospitals represents a major advance in a traditionally conservative environment.
During the past year, USAID was instrumental in introducing an additional contraceptive in the market, working with its private sector partners in the pharmaceutical industry. With USAID technical leadership, Norplant, a long acting, reversible implant, has been registered for use in Jordan. Thus, women in Jordan are now able to easily find four modern contraceptives (oral contraceptives, intrauterine devices, injectable contraceptives and implants) at affordable prices in pharmacies throughout the country. With USAID guidance, the MOH and the pharmaceutical industry continue to offer contraceptives through the private sector at market prices.
Building on the successful television educational drama which contained birth-spacing messages, the MOH agreed to provide contraceptive method-specific information on television. In September 1996, the Jordan Television Network began to air three method-specific family planning infomercials. The infomercials are aired nightly during prime time. Although the infomercials have only been on the air for about six weeks, October 1996 contraceptive sales are showing an increase over September 1996 sales. A new TV spot is currently under production for the social marketing program.
USAID will be able to reach significantly more women with family planning information and services by contacting women in hospitals where most deliveries occur. In addition, the private sector distribution system will become an increasingly important means of providing contraceptives, while market-oriented prices will constitute an important step toward sustainability. To spur political will in this sensitive area, USAID initiated several information disseminating activities this year to encourage support for the national family planning program among parliamentarians, academics, physicians, and NGOs.
Strategic Objective 3: Increased practice of family planning with an emphasis on modern methods.
JORDAN
FY 1998 PROGRAM SUMMARY
Encouraging Economic Growth Stabilizing Population Growth and Protecting Human Health Protecting the Environment Building Democracy
Total
USAID Strategic Objectives *
2. Improved Water Resource Management. ESF
$9,000,000
$9,000,000
3. Increased Practice of Family Planning with an Emphasis on Modern Methods ESF
Dev. Assistance
$6,000,000
$2,500,000
$6,000,000
$2,500,000
5 . Enhanced Private-Sector Economic Opportunities ESF
$10,000,000
$10,000,000
Total Dev. Assistance
ESF
$19,000,000
$2,500,000
$6,000,000
--
--
$2,500,000
$25,000,000
Note: Strategic Objective 1 and 4 are closing, no additional funds will be added.
USAID Mission Director: Lewis W. Lucke
ACTIVITY DATA SHEET PROGRAM: JORDAN
TITLE AND NUMBER: Enhanced Private Sector Economic Opportunities - 278-SO05
STATUS: New
PROPOSED OBLIGATION AND FUNDING SOURCE: $10,000,000 ESF
INITIAL OBLIGATION: FY 1997; ESTIMATED COMPLETION DATE: FY 2002
Purpose: To generate private sector-led employment opportunities and increase incomes in Jordan. To more equitably spread the benefits of Jordan's recent economic growth, this activity is being designed to overcome problems of access to credit by a focussed range of private-sector borrowers, enhance the productivity of small- and medium-size enterprises, and facilitate increased private-sector investment in Jordan.
Background: Prospects for sustainable economic growth hinge on Jordan's ability to productively engage all facets of the economy. The economic growth rate, fueled by large-scale manufacturing, agriculture and related service industries, has risen over the last three years and is expected to exceed 6.3% in 1996.
Though the pace of economic reform continues at an acceptable rate, as evidenced by the new three-year IMF accord signed in May 1996, benefits of economic growth have not accrued to all Jordanians. The unofficial GOJ unemployment rate for 1996 is estimated to be 19%, up four percent from 1995. (In some areas of Jordan, the unemployment rate is over 45%.) Inflation increased to eight percent, up four percent from 1995. Finally, the standard of living, the most tangible economic barometer, decreased 13% during the year. The economy's 1996 performance has not maintained the momentum established in the preceding two years. Rising unemployment and under-employment suggests that additional private-sector interventions are warranted to strengthen Jordan's prospects for continued economic growth and expansion.
USAID Role and Achievements to Date: USAID/Jordan is developing a strategy to achieve its private sector-led employment and income generation objectives which USAID/Washington will evaluate during the Spring 1997. In developing the new objective, we will carefully consider the place of limited on-going, private-sector focussed activities presently being financed by USAID, such as micro-enterprise finance support, export credit guarantee programs and investment promotion activities.
Description: Though now under active development, the program will likely focus on removing three primary impediments to private-sector growth in Jordan: (1) lack of access to credit; (2) inefficient production; and (3) the need to increase international investment in Jordan's productive economy. By addressing these constraints, USAID will help create jobs and increase incomes within Jordan's productive private sector.
Micro-finance programs will be considered for support in light of successful on-going models in rural and urban Jordan and the expectation of limited available funding that would limit any major new micro-finance initiatives. A program to enhance private-sector productivity would likely target small/medium enterprise bottlenecks to production as well as other measures to increase efficiency. Investment promotion would help strengthen Jordan's capacity to attract international investment in Jordan -- thus creating employment -- by helping the existing investment promotion organization function more effectively.
Activities under the new economic opportunity objective will be designed so as to be tightly focussed, take advantage of successful existing programs, complement programs funded by other donors, consistent with USAID comparative advantages, and able to produce demonstrable results with what will most likely be modest initial funding.
Host Country and Other Donors: The GOJ's contribution will total an estimated 25% of the strategy's budget. The strategy will be consistent with the GOJ's development program as approved at the 1996 Consultative Group meeting, including the World Bank's Social Productivity strategy. Existing or planned donor-financed programs in the micro-finance and formal financial sectors will be carefully considered during the design of the new activities.
Beneficiaries: The primary beneficiaries will be (1) Jordan's unemployed and under-employed population; (2) small- and medium-size enterprise employees; and (3) investors in Jordan's productive private sector.
Principal Contractors, Grantees, or Agencies: To be determined.
Major Results Indicators: To be determined.
ACTIVITY DATA SHEET
PROGRAM: JORDAN
TITLE AND NUMBER: Improved Management of Water Resources - 278-SO02
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: $9,000,000 ESF
INITIAL OBLIGATION: FY 1995; ESTIMATED COMPLETION DATE: FY 2001
Purpose: To improve water resources management with special emphasis on increased water use efficiency and effective wastewater reuse.
Background: Water scarcity in Jordan is a serious problem. Without vigorous interventions, Jordan faces a national crisis within the next decade. Virtually all economically viable sources of fresh water have been tapped. Water scarcity is exacerbated by rapid population increase, weak government institutions, inefficient water management and use, insufficient wastewater treatment capacity, and inappropriate pricing policies. The Government of Jordan (GOJ) is fully aware of the impending crisis and is committed to making the difficult reforms required, as evidenced by new measures taken in 1996. To reduce water wastage and recover operation and maintenance costs, the GOJ doubled prices for agricultural water and increased municipal water prices by 12 percent this year. The GOJ is also pursuing privatization of key administrative, operation, and maintenance functions in the water sector, a very progressive position for a water authority in the developing world.
USAID Role and Achievements to Date: USAID's water sector contributions include developing critical water management infrastructure, increasing GOJ capacity to design and implement new water projects, improving water quantity and quality monitoring, facilitating open discussions on water policy reform, increasing public awareness, and improving cooperation between Jordan and its neighbors on water issues. With water a key factor in regional peace, and with the strong U.S. commitment to promoting that peace, continued involvement in the water sector is essential.
Description: By the beginning of FY 1998, several major activities will have been completed. An emergency upgrade of Amman and Zarqa's wastewater treatment facility, which serves 80% of Jordan's population, will be on line and will significantly improve the quality of treated wastewater available for irrigation use. A comprehensive greater Amman area master plan, feasibility study, and preliminary engineering design for wastewater services through the year 2025 will be completed and financed. Final design of new water supply and wastewater treatment facilities for Wadi Mousa, which serves Petra, Jordan's premier tourist destination, will have been completed and construction begun. Approximately 50 new monitoring stations for water quantity will be installed and operational.
Design of new activities could include co-financing implementation of parts of the greater Amman wastewater master plan; institution of an Irrigation Advisory Service to assist farmers to fully utilize modern irrigation technologies; and activities designed to implement aspects of the peace treaty's water provisions (e.g., the Jordan River clean-up or construction of new storage facilities).
Host Country and Other Donors: Other major donors include Germany, Canada, Britain, the European Union, and the World Bank. USAID is cooperating closely with Germany in a number of key areas, including emergency upgrades of the existing Amman wastewater treatment system, preparations for construction of facilities envisioned under the wastewater master plan, and development of data management systems. USAID coordinates activities with World Bank efforts in institutional restructuring, reducing unaccounted-for water, and water policy reform. The World Bank is likely to finance key aspects of the wastewater master plan; the Arab Development Fund recently financed the construction of a USAID-designed diversion channel to separate saline springs from irrigation water. The Ministry of Water and Irrigation (MWI) is the host country counterpart in USAID's activities. The MWI has invested significant financial and personnel resources in implementing USAID-funded activities.
Beneficiaries: The direct beneficiaries will be water users (municipal, industrial, and agricultural) in the greater Amman area, in the Jordan River Valley, and in the Wadi Mousa area. These beneficiaries constitute approximately 75% of Jordan's population.
Principal Contractors, Grantees, or Agencies: Camp, Dresser & McKee is supervising the construction of the new wastewater facilities at Wadi Mousa. Development Alternatives, Inc. is establishing the Irrigation Advisory Service. Activities scheduled to begin in 1998 are currently under design and service providers will be selected at a later date.
Major Results Indicators Baseline Target Increased efficiency in irrigation water use (drip): Open field, winter 56% 70% Plastic houses, winter 42% 60% Open field, summer 80% 80% Plastic houses, summer 61% 75% Number of USAID-funded
technical assistance
activities that lead to
infrastructure financing
by the GOJ or other donors. . . . . . . . . . . . . . . 1 (1997) 2 (1999) Increase in wasterwater treated to
design criteria at Wadi Mousa. . . . . . . . . . . . . . . 0 (1997) 1 million cubic meters Decrease in unaccounted-for water . . . . . . . . . . . . . . . 55% (1996) 25% (2002)
PROGRAM: JORDAN
ACTIVITY DATA SHEET
TITLE AND NUMBER: Improved Practice of Family Planning, With an Emphasis on Modern Methods -278-SO03
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1998: $2,500,000 DA - $6,000,000 ESF
INITIAL OBLIGATION: FY 1995;
ESTIMATED COMPLETION DATE: FY 2001Purpose: To improve maternal and child health by reducing the number of unwanted pregnancies and to promote the continued use of modern family planning methods by improving knowledge of family planning, making services in the public and private sectors more accessible, and making products more affordable.
Background: The 1990 demographic and health survey (DHS) revealed that there is substantial unmet demand for family planning services. Close to one-half of the women surveyed had reached their desired family size and wanted no more children. An additional 25% wanted no more children within the next two years. The survey also revealed that if all unwanted births were avoided, each woman would have an average of only 3.9 children instead of the 5.6 revealed in the survey. The DHS revealed that 95% of the women in Jordan could name a contraceptive method and 94% of women actually know where to obtain services. However, 15% of women did not use one because of myths and rumors about the efficacy and safety of these methods and 21% discontinued use for the same reasons.
To address the challenges associated with the strategic objective, USAID and its partners are focusing on a package of activities which will promote the acceptance and continued use of modern family planning methods. There are several constraints toward achieving this objective. First and foremost is the lack of a reliable and predictable contraceptive distribution system in the public sector. Additionally, in spite of positive reactions toward improved service delivery and the use of mass media to promote services and products, the Ministry of Health (MOH) continues to fear a negative reaction by Islamic fundamentalists toward promotion of family planning services.
USAID Role and Achievements to Date: In 1996, the climate for family planning and population activities in Jordan experienced a new openness. In March 1996, the GOJ approved the National Population Strategy which has special significance because it underscored the linkages between economic development, health and rapid population growth. With USAID-supported technical assistance the MOH sponsored a National Contraceptive Technology Up-date Conference. USAID's technical leadership helped launch Norplant. The MOH elected to introduce DMPA and Norplant contraceptives in the public-sector healthcare system. USAID also gained approval from the Director of the Directorate of Pharmaceuticals (the Jordanian equivalent of the Food and Drug Administration) to include low-literacy instructions in all four products marketed under the social marketing program.
In 1995, the MOH agreed to use television and radio for family planning information. In 1996, three method-specific spots aired for six weeks on prime time television, with no negative publicity to date. A fourth informercial is under production. Additionally, "Dear Doctor" columns, which provide additional information about contraceptives and reproductive health issues, run weekly in Arabic language newspapers. A series of advocacy tools to foster population awareness are underway. RAPID, a computer simulation model to be used with parliamentarians, is in the final stages of development. A national information, education and communication (IEC) task force for family planning and population has been formed and a national IEC strategy is underway. In the only model maternal health center that has been operating for one year, family planning acceptance has doubled; thereby again proving that a well equipped and stocked facility which has trained personnel and offers quality counselling will increase acceptance of family planning. Nine centers will be operational before the end of the year.
Description: The program will continue its emphasis on improving the quality of services it provides to the customer. As a component of quality of care, USAID and the MOH will develop a new Intermediate Result under the Strategic Objective which will address cost recovery issues in the reproductive health sector. This design necessitates that we analyze a wide range of issues which may include, but not be limited to health insurance, fee structures and resource allocation and uses. By the end of FY1997, USAID will have established twelve CPP centers offering comprehensive services for mothers and infants, using quality assurance protocols. A national family planning curriculum is almost finished and will be used by the MOH to train all of its personnel working in family planning, regardless of the source of funding. Activities to evaluate the quality of care being provided and to help program managers improve service delivery are underway. Evaluation instruments to document improvements in clinical and counselling skills have been developed and are in use.
Although delayed, Jordan will participate in the DHS in March 1997 to verify the results achieved toward this objective. A series of activities are either underway or planned to disseminate information for MOH and other GOJ planners and opinion leaders. In addition to working with the traditional family planning NGOs, USAID and its partners will expand their outreach to include NGOs that work to improve the quality of the lives of women overall. Training of health care providers will continue in the public and private sector. The contraceptive social marketing activity will continue with an emphasis on increasing sales and improving information to customers and providers as new products and/or new methods enter into the program. The pharmaceutical companies are forecasting a 10% increase in sales. It is estimated that total CPR will increase to 48% from the 1996 level of 46.2% and modern CPR will increase to 38% from 35.8%.
Host Country and Other Donors: USAID continues to be the lead donor in family planning in Jordan. The United Nations Population Fund (UNFPA), through its fourth country program, has provided $7 million from 1995 to 1997. USAID and UNFPA are collaborating on the provision of contraceptives to the national family planning program. USAID is providing technical assistance to develop the national contraceptive distribution system and USAID and the UNFPA are sharing the cost of provision of contraceptive supplies to ensure that Jordanian women have a wide variety of contraceptive choice available to them. USAID and UNFPA meet regularly to make sure that activities undertaken in support of this strategic objective are not duplicative but mutually reinforcing. UNICEF, through its safe mother hood initiative is also providing support to the national family planning program.
Beneficiaries: This objective has three distinct sets of customers. The customers, or beneficiaries, are: the 418,840 currently married women 15-49 who are at high risk of conceiving a child and who risk dying due to age and number of children already born; the 346,368 currently married women of reproductive age who have a demand for family planning services; and, the men who are married to these women.
Principal Contractors, Grantees, or Agencies:
* Host Country: MOH; Jordan University Hospital; Jordan University for Science and Technology; Royal Medical Services; Department of Statistics; Jordan Association for Family Planning and Protection; National Population Commission; Soldiers' Welfare Society, Pharmaceutical Companies, Publi-Graphics and Cubeisey Advertising Agencies, and Market Research Organization
* Cooperating Agencies: University Research Corporation, Brown University, Pathfinder International, The Futures' Group, Family Health International, Johns Hopkins University Population Communication Services, Johns Hopkins Program for International Education in Obstetrics and Gynecology (JHPIEGO), Association of Voluntary and Safe Contraception International; Georgetown University Institute for Reproductive Health, U.S. Bureau of the Census (BUCEN) and MACRO, International.
Major Results Indicators Baseline Target1Total contraceptive prevalence rate established in the 1990 Demographic Health Survey* Total Contraceptive Prevalence Rate 40.0(1990)1 53.6 (2000)
* Modern Contraceptive Prevalence Rate 27.0(1990)2 41.5 (2000)
2Contraceptive prevalence rate (CPR) for modern methods is predicted according to a regression equation on the relationship between total fertility reate and CPR based on 1990 Demographic Health Survey.
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