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).
WEST AND CENTRAL AFRICA REGION
FY 1997 FY 1998 FY 1999 Actuals Estimate Request Child Survival and Disease$6,295,000 $5,847,000 $4,405,000 Development Assistance$7,387,000 $8,451,000 $7,175,000
Introduction
Following years of economic decline, political failure, and widespread civil conflict, the 24 countries of West and Central Africa (WCA) appear to be making progress toward political pluralism, economic liberalization, and sustainable growth. Progress is fragile, however, and requires strong support from the donor community. Complicating the U.S. response is the fact that USAID will close The Regional Economic Development Office for West and Central Africa (REDSO/WCA) by the end of FY 1998.
The United States has vital interests in a prosperous West and Central Africa. The costs to the United States of civil conflicts in the region since 1980 have been high, more that $700 million for Liberia alone. In the health sector, professionals are convinced that the only way to effectively control the global AIDS pandemic is to gain control of it in all parts of the world, including highly infected areas in Africa and elsewhere. Problems of strong interest to the United States, such as global climate change and maintenance of biodiversity, are being aggravated in this region by population pressure on the limited natural resource base. The support of these 24 countries for U.S. positions is important in a wide range of international fora, and prospects for such support are enhanced through U.S. engagement on issues and problems vital to the region's welfare. Finally, the United States can enjoy the benefits of an increasingly productive economic and trade relationship with these countries only if economies in the region experience high growth.
The Development Challenge
Following 15 years of declining gross domestic product on a per capita basis during the 1980s and early 1990s, much of this region appears to have embarked on a path of sustainable economic growth. Most countries in the region have committed themselves to a process of economic liberalization and political pluralism, and all are expected to benefit if these processes continue. Political and economic progress in the two largest countries in the region, the Democratic Republic of the Congo and Nigeria, remains extremely tenuous. Governments and donors now need to consolidate progress on economic and political reforms, where these are already underway, and foster them where they are lagging.
Past economic policies have left a legacy of inadequate and overextended public infrastructure, low rates of investment, including foreign private investment, insufficient employment generation, and declining quality of public services in vital areas such as education and health. On a regional basis, among the most pressing problems are those related to population and the AIDS pandemic. Given the porousness of borders due in part to patterns of regional trade and migration of seasonal labor, these problems require attention on a regional basis. The extent of AIDS infection in WCA is exceeded worldwide only by certain regions of East Africa. This threatens long-term economic growth by imposing unbearable health costs on societies in the region and increased mortality among the population in its most potentially productive years. At the same time, high rates of population growth are imperiling the sustainable natural resource base for economic growth through degradation of the natural resource base, and by placing excessive pressure on all types of infrastructure including health, education, shelter and urban services.
From 18 bilateral field missions in the late 1980s, USAID will have reduced its presence in the region to five sustainable development missions (Ghana, Mali, Senegal, Benin, and Guinea), and two transition missions (Liberia and Nigeria) by FY 1999. USAID also will have closed REDSO/WCA and will be
relying on these five missions to provide the regional support services REDSO hitherto has provided.
Centrally-managed regional programs such as the Sahel Regional Program now help address certain regional problems. In addition, REDSO's existing regional program for WCA, the Family Health and AIDS (FHA-WCA) Project, will continue to operate in the region after REDSO's closure. USAID assistance under this activity supports family planning, maternal and child health, and control of AIDS, areas which imperil the region's sustained economic growth and where the U.S. has a comparative advantage. A small regional strategic analysis team will be set up in Mali to attempt to determine whether, with limited financial and human resources, USAID will be able to address other pressing regional problems.
Other Donors
West and Central Africa has an enormous need for development resources, public and private. Official development assistance to the region, including both bilateral and multilateral sources, has been running at approximately $7 billion per year, with USAID in the neighborhood of $160 million per year. As a bilateral donor in the region, the United States ranks fourth, with France supplying bilateral assistance at about eight times the level of USAID, Japan at about four times, and Germany at about 3.5 times the U.S. level.
In the health sector a large number of donors are providing regional assistance, the most important being France, the World Bank, the European Union, the African Development Bank, Germany, Canada and the United Nations agencies. These donors provide major support, primarily to the public health sector and through the provision of pharmaceuticals. While the U.S. ranks behind other donors in terms of financial effort, U.S. private voluntary organizations (PVOs) and public institutions such as the Centers for Disease Control have predominant technical capability in health and population activities in the region.
FY 1999 Program
The centerpiece of the FY 1999 regional program will be the five-year Family Health and AIDS activity. Launched in 1995, this regional health initiative addresses key transnational health and population problems through U.S. PVOs and key regional African organizations and targets approximately 40 million people. It responds to USAID's goal of stabilizing population growth and protecting human health and seeks to minimize the transmission of HIV/AIDS, improve women's health and contribute to reducing infant and child mortality. Implementation employs an innovative approach of partnership between key U.S. and African institutions and the commercial sector, all of which are committed to a performance-based delivery system. After two years of field implementation this approach has already resulted in improved quality of health services, a strengthened African regional capacity and an emerging trend of less dependence on donor resources. USAID will complement the current project activities with additional child survival activities focusing on malaria, disease surveillance and malnutrition as additional funding becomes available. Success will be measured through prevalence of modern family planning methods and child health-related products and practices in Cote d'Ivoire, Togo, Burkina Faso and Cameroon; changes in high-risk sexual behavior; and more effective institutional capacity of selected African organizations to sustain these activities into the next century.
WEST AND CENTRAL AFRICA REGION FY 1999 PROGRAM SUMMARY
(in thousands of dollars)
USAID
Strategic and Special
ObjectivesEconomic
Growth & Agriculture
Population &
Health
Environment
DemocracyHuman Capacity Development
Humanitarian Assistance
TOTALSS.O. 1.
Improve Access to Selected Health and Family Planning Services in the Region
- CSD
- DA
---
---
4,405
7,175
---
---
---
---
---
---
---
---
4,405
7,175Totals
- CSD
- DA
---
---
4,405
7,175
---
---
---
---
---
---
---
---
4,405
7,175
USAID Mission Director, Willard J. Pearson
ACTIVITY DATA SHEET
PROGRAM: WEST AND CENTRAL AFRICA REGION
TITLE AND NUMBER: Improve Access and Use of Health and Family Planning Services in the Region, 624-S001
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1999: $4,405,000 CSD, $7,175,000 DA
INITIAL OBLIGATION: FY 1995; ESTIMATED COMPLETION DATE: FY 2000
Purposes: To increase the availability and use of quality family planning/reproductive health, HIV/AIDS and child survival services in concert with other donor, regional and host country efforts, while building on successful USAID-funded initiatives in West Africa.
USAID Role and Achievements to Date: In concert with the major donors in the region, USAID supports key regional initiatives. Specifically, USAID support is targeted at the limited use of modern family planning products, high-risk births that have direct impact on child morbidity and mortality, HIV/AIDS and the use of Oral Rehydration Salts (ORS) for diarrheal control. USAID supports the development of indigenous institutional capacity through a participatory process for facilitating working partnerships with U.S. PVOs in all aspects of program implementation. The project is successfully promoting access to a wider choice of contraceptive methods through increasing social marketing programs and strengthening contraceptive logistics management information systems. The project has intervened transnationally by targeting migrant populations and has developed critical generic IEC (information, education and communication) and training materials for further adaptation at the country level. Currently, the project is reinforcing the institutional capability of eleven African regional partners. Equally important, the project has developed regional networking around "best practices." While achievements in family planning have been less impressive, there are encouraging signs of progress with urban areas increasing their contraceptive prevalence to approximately 10%. Also, actual condom use to prevent the spread of HIV is increasing throughout the region at a level of about 10% and 30% among all men and unmarried men respectively in Cote d'Ivoire, Burkina Faso, Mali and Ghana. In the USAID non-presence countries targeted by the Family Health and AIDS (FHA)-WCA project (Cote d'Ivoire, Burkina Faso, Togo and Cameroon), USAID has continued to support critical activities in family planning, HIV/AIDS and child survival; and maintained the investments and momentum achieved over the past years. For example, FY 1997 sales of condoms increased by 19.4% over the FY1996 sales figures. Similarly, FY 97 sales of ORS increased by 85% over FY 1996 sales in two of the host countries supported by the FHA-WCA project.
Description: The USAID Family Health and AIDS initiative provides a new response to the challenges facing West and Central Africa. It uses a regional approach to support U.S. PVOs that work closely with key African regional implementing partners and major donors. In the first two years of implementation the FHA-WCA project has: i) promoted networking on issues and problems common to the region such as pre-service training and HIV/AIDS, and assured a sustainable supply of ORS and contraceptives/condoms; ii) developed cross-border interventions which target migrant populations and help build the capacity of eleven regional African institutions including increasing their role in program implementation; and iii) supported programs in USAID non-presence countries (Cote d'Ivoire, Burkina Faso, Togo and Cameroon) and Benin.
Host Country and Other Donors: France, the World Bank, the European Union, Canada, Germany, the U.N. Children's Fund, the U.N. Population Fund, and the World Health Organization provide support in health and family planning throughout the region. Leveraging of donor resources and joint programming are emphasized under this activity. As a result, $4.4 million has been mobilized from other donors to expand FHA-WCA interventions. Activities are planned and implemented in consultation with host governments and in accordance with their national strategies and action plans.
Beneficiaries: Children under five years and sexually active adults and adolescents are major beneficiaries. Others are eleven African partner institutions.
Principal Contractors, Grantees, or Agencies: USAID implements activities through four U.S. PVOs: Population Services International, Johns Hopkins University, Tulane University, the Johns Hopkins Program in International Education and Gynecology/Obstetrics, and African partner institutions.
Major Results Indicators: Baseline (FY 1997) Target (FY 1999)
Contraceptive prevalence in project target sites 5.9% 8.0%
Proportion of sexually active men of reproductive
age who consistently use condom 13.6% 17.8%
Number of condoms distributed
in target countries 34.2 million+ 37.5 million
Increase use of ORS by an average of 5%
per year in target countries 21% 31%
Increase in number of ORS packets
distributed in target countries 1.8 million 2.9 million
Cumulative amount of financial resources leveraged
from other donors 4.4 million 10 million
Technical and managerial capacity strengthened for
regional African partners 0 11
Training sites developed in the region 0 20
Research training institutions incorporating operations
research modules 0 3
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