US FY 1999 Congressional Presentation

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).
ACTIVITY DATA SHEET

PROGRAM: LAC REGIONAL
TITLE AND NUMBER: More effective delivery of selected health services and policy interventions;
598-S003
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1999: $4,672,000 CSD
INITIAL OBLIGATION: FY 1996; ESTIMATED COMPLETION DATE: FY 2001

Purpose: The purpose of the activity is more effective delivery of selected health services and policy interventions. This activity subsumes the activity reported in the FY 1998 CP as "Sustainable Country Health Sector Reforms in Effect." Infant, child, and maternal mortality remain high in LAC, especially among disadvantaged populations. While vaccination coverage is increasing towards the target levels, there are pockets of low coverage and programs are not yet sustainable; furthermore, the ambitious measles elimination goal adopted by the region will require substantial strengthening of service delivery and surveillance systems. The primary killers of infants and children in the LAC region are diarrheal disease and acute respiratory infections; maternal mortality is approximately seven times as high as in the U.S. Changes in health status can be made sustainable only if health sector reforms achieve more equitable access to higher quality basic health services.

USAID Role and Achievements to Date: This activity builds on successful efforts of prior activities with the Pan American Health Organization (PAHO) supporting regional vaccination activities as well as the LAC Regional Health and Nutrition Technical Services Support Project. Vaccination coverage for infants with all antigens has increased to about 80% in six of the eight target countries; tetanus toxoid coverage among fertile-age women in high risk districts has increased so that only 312 cases were reported in 1996, 78% less than 1988. The Americas have been polio-free since 1992, but there was a significant outbreak of measles in 1997, which started in an area which had not followed the eradication strategies; the surveillance system and regional assistance contained it quickly. Health authorities in six of the eight target countries made the decision to adopt Integrated Management of Childhood Illnesses (IMCI) for their child survival programs, developed national plans, and began training. The implementing agencies reached agreement on how to test coordinated community and health facility program initiatives designed to prevent maternal mortality and selected sites and local partners to do so. In collaboration with other major donors (World Bank and IDB), agreement was reached on standards for National Health Accounts and six countries were assisted to initiate analysis of health spending from all sources; a thesaurus for abstracting the health reform literature from the region so it can be easily available by internet to health authorities was developed.

Description: This activity provides assistance to LAC country programs to strengthen quality and availability of selected health services and policy interventions: 1) vaccinations; 2) essential emergency obstetrical care; 3) integrated management of childhood illness (especially acute respiratory infections and diarrheal disease); and 4) health sector reforms to increase equity of access to basic health care. These themes support the action plan from the Miami Summit of the Americas and the ongoing work of the Symposium of First Ladies in the Americas: to reduce infant mortality and eliminate measles from the hemisphere; to reduce maternal mortality; and to increase equity of access to basic health services by implementing health sector reforms in management and financing. Strategic approaches include: 1) improving service delivery; 2) improving surveillance systems; 3) increasing the sustainability of health programs; and 4) health management and financial reforms (e.g., decentralization of responsibility for health service delivery). Target countries are specific to each component; e.g., for vaccinations and integrated management of childhood illness, the eight LAC child survival emphasis countries will receive more intense support. Implementation will use PAHO's recognized regional leadership and influence on policy and national programs and the cutting edge technical leadership of USAID's worldwide partners in these health technologies. USAID missions may supplement the grants to PAHO to implement their programs and have ready access to USAID's worldwide program partners for country program implementation.

Host country and Other Donors: For the regional vaccination program, PAHO has budgeted $10 million and has pledges of $1 million from Spain and $2.2 million from the IDB. USAID missions implement programs which assist countries to improve effective delivery of vaccinations, emergency obstetrical care, and services to manage diarrhea and acute respiratory infections in children, and to identify and implement country health sector reforms; and work with other donors (principally PAHO, UNICEF, World Bank and IDB), through the Inter-Agency Coordinating Committees, to coordinate such efforts for each country.

Beneficiaries; Principal Contractors, Grantees, or Agencies: The direct beneficiaries will be host country personnel and others involved in service delivery, surveillance, and health reform programs. Ultimately, children under five and women of childbearing age in LAC will benefit from improvements in the selected health services, and from improved access to basic health services due to health sector reforms. Grantees and contractors implementing this activity include: PAHO, John Snow International, University Research Corporation, The Partnership for Child Health, Abt Associates, Harvard University School of Public Health, and Management Sciences for Health.
Major Results Indicators End-of-Activity Targets:  		Baseline (1996)	Target (1999)

Vaccination component - 

     - No. of countries with at least 90% vaccination 
coverage against tuberculosis, polio, diphtheria, 			3			7
pertussis, and tetanus (among children under one)

     - No. of countries with at least 95% measles 
vaccine coverage (among children under one)				2			6

     -  No. of countries with 90% vaccine coverage with 
tetanus toxoid (women of childbearing age in high-risk areas)	0			6
  
Integrated Management of Childhood Illness component 

     - No. of target countries with 10% of health	 		0			5
facilities delivering IMCI services.

     - No. of target countries with 90% of health facilities 		0			5
in designated districts delivering IMCI services.

Maternal Mortality component - proposed revised indicators:

Target countries with percentage of births attended by 		N/A			6
trained personnel increased by one percent over prior year; 

Target countries with 5% increase over prior year in percen- 	N/A			6
tage of reporting units with active maternal mortality committees.

Health Sector Reform component
Target countries* with in-country capability to assess 
health sector problems and to design, implement and			8 (1997)		10 (2000)
monitor reforms, demonstrated by having an entity 
responsible for reform.
^* target countries are the thirteen USAID-presence countries with PHN objectives

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