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).

TURKEY



FY 1997 FY 1998 FY 1999
Actuals Estimate Request
Economic Support Funds.............$22,000,000 -- --
Development Assistance..............$4,400,000 $4,000,000 $4,000,000

Introduction

Turkey is a close and valued ally of the United States. It occupies a strategic location between Eastern Europe, the Middle East and the New Independent States, and is a key member of NATO. Since 1980, Turkey has moved its formerly state-directed economy toward increasing reliance on market forces. Decentralization, export-led development, lower taxes, foreign investment, and privatization has been the basis for the new economic philosophy. Prior to FY 1998, Turkey received Economic Support Funds............. (ESF) for balance of payment support. In FY 1998, this assistance was discontinued.

The Development Challenge

Present USAID assistance to Turkey supports a focused population assistance program, which is guided by a five-year strategy. The strategy calls for a rational transfer of activities to the Government of Turkey (GOT) and the private sector by the end of the century. The strategy supports the U.S. Embassy's interest in broadening the bilateral U.S.-Turkey relationship beyond military cooperation.

Population issues are developing into a major priority of the GOT, given that its current population of almost 61 million is expected to double by the year 2025. Surveys show that a majority of Turkish couples use less reliable, traditional family planning methods. Modern contraceptive prevalence, while increasing, is just approaching 35%, which is below countries like Bangladesh and Egypt. USAID donates approximately 26% of GOT contraceptive commodities. Recently, the Government of Turkey has demonstrated a sense of commitment to reducing the population growth rate. Together USAID and the GOT have developed a plan for enhancing the ability of private and public sectors to meet consumer contraceptive demand independent of USAID support. Thus in FY 1995 USAID began implementing this agreed upon plan for enhancing contraceptive availability as part of a 5-year phase down strategy ultimately promoting Turkish private and public resources to take USAID's place as the main provider.

The USG-approved Population Strategy for Turkey 1995-99 contemplates the following activities. The USAID program is strengthening the GOT policy environment, forging ties among private firms and facilitating increased non-governmental organization (NGO) participation. The program works to train counselors and service providers to improve their quality of services and depth of knowledge. It seeks to expand access to services by integrating them into existing health care delivery networks. Finally, on a decreasing scale, USAID provides funding for contraceptive commodities.

The program, implemented by a number of U.S. Cooperating Agencies, has seen many gains. Family planning training has been integrated into eight university teaching programs, midwifery and nursing schools, as well as the Ministry of Health (MOH) in-service family planning sites. The MOH adopted the first-ever national family planning guidelines and operates model family planning clinics throughout the country. The MOH and social security organization agreed to begin purchasing contraceptives. The USG is working with the cooperating agencies to promote more synergistic implementation and sustainable impacts. The strategy, which includes a five-year phase down approach, will provide important guidance and impetus for results.

Other Donors

The UN Fund for Population Activities and the International Planned Parenthood Federation support activities in less developed areas and with indigenous organizations respectively. The Japanese International Cooperating Agency plays a limited role in funding the establishment of a high-tech studio for the development of audio-visual materials for the MOH. In addition, the European Union and the German Technical Cooperation Assistance have recently committed small grants to local non-governmental organizations (NGOs) to carry out small scale family planning service delivery projects.

The International Monetary Fund (IMF) and World Bank have provided standby and project loans to the GOT to encourage and reward major economic reform measures. These resources, in conjunction with those provided by other donors and private lenders, enable Turkey to continue servicing its large debt, and help support its economic reform program and structural adjustment efforts.

FY 1999 Program

As a result of the country program assessment of October 1997, FY 1999 funding will concentrate on: 1) assisting in the implementation of the national strategy for family planning; 2) full achievement of contraceptive self-reliance; 3) expanding private sector involvement in provision of services; 4) integrating the provision of family planning into hospital-based services, including postpartum services; and 5) continuing to improve the quality of family planning services.

In 1998 a Demographic and Health Survey (DHS) will have been undertaken to assist in determining progress since the 1993 DHS. Findings are expected to be available by November 1998 and will further inform and guide USAID's FY 1999 program.

TURKEY

FY 1998 PROGRAM SUMMARY

(in thousands of dollars)



Strategic Objectives   		Economic Restructuring   Democratic
Transition   		Social Stabilization   Cross-cutting / Special Initiatives   Total  
Social Benefits  
--  
--  
4,000 a/  
--  
4,000  
Cross-cutting / Special Initiatives  
--  
--  
--  
--  
--  
TOTAL  
--  
--  
4,000a/  
--  
4,000  

a) Development Assistance

Director, Office of European Country Affairs: David Cowles

ACTIVITY DATA SHEET

PROGRAM: TURKEY
TITLE: Social Benefits, 000-S003.2
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1998: $4,000,000 DA
INITIAL OBLIGATION: FY 1995; ESTIMATED COMPLETION DATE: FY 1999

Purpose: Improved sustainability of social benefits and services.

USAID Role and Achievements to Date: USAID has provided funds for population programs in Turkey since the 1960s. Today's USAID assistance focuses on sustaining a reduced rate of population growth and a financially sustainable program, able to continue in the absence of donor resources. To achieve this end, USAID and the U.S. Embassy in Ankara, developed a five-year strategy for 1995-1999. According to the strategy, the assistance budget will be phased down significantly by the end of 1999. The program focuses on policy, management development, training, communication and service delivery. Twenty-six percent of the 1997 USAID population assistance budget was earmarked for contraceptive commodities for the public sector. The strategy also includes a phase-out plan for commodities, whereby the GOT will assume full responsibility for procurement of contraceptives by the year 1999. The convergence of a number of factors have created ideal conditions for impact in Turkey. The most salient factor is the GOT's elevated sense of commitment to population and family planning issues and the willingness to develop the role of the commercial and non-government sectors -- an endeavor seen to promote program sustainability. The GOT, commercial sector, and non-governmental organizations have all requested technical assistance in reaching their individual and mutual goals -- contributing to the increasingly productive partnership between USAID and Turkey. The coordination of the program rests with a Joint Programming Team comprised of USAID/Washington and U.S. Embassy representatives.

The program, implemented by a number of U.S. Cooperating Agencies, has seen many gains. Family planning training has been integrated into eight university teaching programs, midwifery and nursing schools, as well as the Ministry of Health (MOH) in-service family planning sites. The MOH adopted the first-ever national family planning guidelines and operates model family planning clinics throughout the country. The MOH and social security organization agreed to begin purchasing contraceptives. The USG is working with the cooperating agencies to promote more synergistic implementation and sustainable impacts.

Description: USAID's activities focus on increasing the availability and effective use of quality family planning and reproductive health services; improving Turkey's self-reliance in family planning and reproductive health by enhancing the public and private sector ability to meet consumer demand for these services independent of USAID support. There are three USAID strategic approaches for achieving the program's strategic objectives: 1. Strengthen policy and GOT budgetary support for the family planning program; 2. Improve the quality of family planning and reproductive health services in the public and private sectors; 3. Expand access to family planning and reproductive health services in the public and private sectors.

Host Country and Other Donors: Turkey's Ministry of Health, the Social Insurance Organization (SSK), NGOs and the commercial sector collaborate with USAID programs. With USAID as the lead donor both in financial and programmatic terms of the program, several other donors contribute to the program. The United Nations (UN) endorses an integrated approach to improve maternal, child and family planning services and focusses on undeserved populations, covering the most remote 28 provinces in eastern and southeastern Turkey. The International Planned Parenthood Federation (IPPF) supports the Family Planning Association of Turkey (FPAT), its local affiliate, in supporting various small projects, mostly educational activities, aimed to religious leaders, adolescents, men, and policy-makers. The Japanese International Cooperating Agency (JICA) plays a limited role, in funding the

establishment of a high-tech studio for the development of audio-visual materials for the MOH. In addition, The European Union (EU) and the German Technical Cooperation Assistance (GTZ), have recently committed small grants to local NGOs to carry out small scale family planning service delivery projects. Finally, the World Bank supports a large five year health sector loan, however, it does not focus on population and family planning.

Beneficiaries: This effort seeks to directly benefit women of reproductive age, their husbands and children through helping them meet their desired family size and improving the health status of women and children. Indirectly, this effort seeks to benefit the entire population of Turkey by reducing the population pressures on the economy, environment, housing and social services.

Principal Contractors, Grantees, or Agencies: Cooperating groups are: the Johns Hopkins Program for International Education in Reproductive Health (JHPIEGO), the Johns Hopkins Population Communication Services (PCS), the Futures Group International through the Social Marketing Project (SOMARC) and the Policy Project, Access to Voluntary and Safe Contraception (AVSC) International, and Management for Sciences for Health through the Family Planning Management Development Project (FPMD).

Major Results Indicators:*  
							Baseline		Targets

National strategic plan for family planning		None (1994)		Implemented (1999)

Modern contraceptive prevalence  			35%  (1993)		45%  (1999)

Discontinuation rates of modern contraceptives	55%  (1993)		30%  (1999) 

Abortion rates (per 100 pregnancies)			19  (1993)		reduced (1999)

Family planning line item in MOH annual budget	No (1994)		Yes  (1999)

Percentage  of modern contraceptives provided 	25% (1996)		45% (1999)
by private sector

*Progress on many of these indicators will be provided by the Demographic and Health Survey (DHS) to be undertaken during 1998. The last DHS was conducted in 1993.

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