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Central American Regional
>> Regional Overview >> Central American Regional Program Overview Activity Data Sheet
PROGRAM: Central American Regional
TITLE AND NUMBER: Enhanced Central American Capacity to Respond to the HIV/AIDS Crisis, 596-003
PLANNED FY 2001 OBLIGATION AND ACCOUNT: $1,120,000 (CSD)
PROPOSED FY 2002 OBLIGATION AND ACCOUNT: None
STATUS: Continuing
INITIAL OBLIGATION: FY 1995 ESTIMATED COMPLETION DATE: FY 2001Summary: The spread of HIV/AIDS is a severe and growing problem in Central America, propelled as it is by growing economic interaction and mobility along the region's highways and industrial corridors. Central America has a history of intra- and extra- regional migration due to past civil unrest, the demand for seasonal labor, more open border policies, improved regional transportation routes, and proximity to the United States. The unstable economic environment provoked by Hurricane Mitch and uneven growth and employment prospects in individual countries have resulted in increased mobility. Despite increased awareness of HIV/AIDS, it is still not a sufficiently high-profile problem for many senior policy-makers, making difficult the integration of HIV/AIDS prevention into ongoing policy and programmatic activities and restricting the effectiveness of national and donor programs.
As of May 2000, 21,251 cases of AIDS had been reported in Central America (Work Group Report by the Pan American Health Organization-PAHO, World Health Organization-WHO, and the Joint United Nations Programme on HIV/AIDS-UNAIDS). "Second Generation Surveillance" focuses on HIV seroprevalence levels and behavioral information to better characterize the problem. Only in areas of the north coast of Honduras, and Belize can HIV/AIDS be classified as "Generalized," i.e., seroprevalences of more than one percent in the general population. Limited data on the rest of the region places Honduras, Guatemala, Panama, Belize and El Salvador into the "Concentrated," and Nicaragua into the "Nascent" categories. There has been a steady increase in the proportion of female cases although males continue to be more affected than females. As the disease becomes well established in the heterosexual population, transmission from mother to unborn/newborn child clearly increases. Prostitutes generally have the highest rates of infection (as high as 20%) and play a key role in the spread of the disease because they are a highly mobile population.
The regional strategy focuses on areas and high-risk groups not normally covered by bilateral programs. It works to improve the regional political environment by strengthening policy formulation and developing a broad cadre of public and private leaders who actively acknowledge HIV/AIDS as a growing and serious problem, support effective policies and programs and formulate responsive public sector reforms. The program also strengthens the capabilities of Central American organizations to deliver HIV/AIDS services and information to target groups, and develops a condom social marketing (CSM) strategy that modifies risky sexual behavior in target populations. Primary beneficiaries are Central Americans at risk of infection by HIV/sexually transmitted diseases.
Key Results: 1) Improve regional policy environment by strengthening policy formulation through sound research and information dissemination, develop a cadre of public and private leaders who actively support effective policies and programs, and formulate public sector reforms responsive to the HIV/AIDS challenges; 2) Improve NGO capacity by developing their programmatic and management skills and structures, establishing effective linkages among NGOs providing HIV/AIDS prevention services, and promoting the implementation of supportive HIV/AIDS policies; and 3) Safer sex practices by assisting in efforts to increase consistent and correct condom use, especially among high-risk groups, and by supporting strategies to make condoms more affordable and widely available.
Performance and Prospects: The Regional HIV Program has continued to improve the legal regulatory environment and has played a catalytic role in supporting national and regional efforts to develop, implement, and monitor national HIV/AIDS strategic plans in close collaboration with UNAIDS and other partners. In promoting HIV/AIDS policies, the program achieved new positive policy changes at the regional and national levels. These include: The Guatemalan Congress approved the AIDS Law in March 2000; the President of Panama sanctioned the AIDS Law in January 2000; and the Ibero-American Presidential Summit in Panama in December 2000 declared HIV/AIDS a regional emergency.
The Regional Program has successfully strengthened NGOs, policy, advocacy, and prevention networks; developed local technical capacities; and established a regional contraceptive social marketing (CSM) activity. A key result of the NGO and policy components is the constant exchange of information among all sectors of the HIV prevention community. Digital data and manuals for quality HIV prevention programming for NGO sustainability, advocacy, monitoring, evaluation, and lessons learned have been distributed and are in use by decision-makers and NGOs for improved programming. The consultant network of Central Americans has provided over 1,852 person-days of services in a wide range of areas to NGOs, national programs, and international donors.
FY 2001 funds are being used to carry out Phase I activities to improve the regional policy environment, develop a leadership cadre of public and private leaders for reforms ($340,000); improve NGO networking and information sharing for HIV/AIDS prevention services ($416,000); and develop a CSM strategy that modifies risky sexual behavior in target populations ($364,000).
Increasing emphasis now is being given to strategic alliances, networking, and information dissemination where there is a clear value added from the regional program. This complements an increasing involvement by bilateral USAID programs in HIV/AIDS prevention. The regional CSM program will continue its focus on correct and consistent condom use in high-risk populations and expanding non-traditional distribution.
Possible Adjustments to Plans: In July 2000, the new Central American Regional Strategic Plan for the period 2002-2006 was approved. The new HIV/AIDS Phase II program will focus more heavily on regional issues and mobile populations that cross borders. This includes information sharing and dissemination; and national and regional strategic alliances among NGOs, policy leaders, business and labor groups, and the media for effective advocacy programs.
Other Donor Programs: UNAIDS contributed $450,000 per year to Central America national programs during 1998-99 and is beginning to provide some financial support to regional activities. Dutch support through a Costa Rican NGO ends in 2001. Norway and Sweden are providing approximately $3.6 million dollars over three years for programs in Guatemala, Nicaragua, El Salvador, and Honduras. The GTZ and Doctors Without Borders have also been active in some countries. Japan and Spain are considering support for a regional initiative to prevent HIV among mobile populations under the Common Agenda with USAID. Great Britain's Department for International Development (DFID) will initiate a regional support program this year. USAID is the leading donor in this sector and coordinates with other donors both directly and through the country theme groups and the national strategic planning processes. This USAID program enjoys a very close relationship with UNAIDS and has leveraged contributions from other donors for specific activities.
Principal Contractors, Grantees, or Agencies: Grantees are the Academy for Educational Development (Policy Dialogue and NGO Strengthening Activities) and Population Services International (Condom Social Marketing).
Central America Program: 596-003
Performance Measures:
Indicator FY97
(Actual)FY98
(Actual)FY99
(Actual)FY00
(Actual)FY00
(Plan)FY01
(Plan)FY02
(Plan)Indicator 1: AIDS Policy Environment Score (PES)/AIDS Program Effort Index (API) NA 51.8 and 53.3** NA 52.7** 54.3* NA NA Indicator 2: Positive policy changes enacted 9 16 positive changes
(4 countries)32 positive changes
(5 countries)50 positive changes(5 countries) 38 positive changes 42 positive changes* 46 positive changes* Indicator 3: Percent of 15 selected NGOs that use a systematic approach to HIV/AIDS. 13%* 61% * 53% ** NA 0.87 0.93 NA NA Indicator 4: Percent of outlets in high-risk urban areas carrying affordable condoms: Costa Rica NA NA 44 45 46 48 50 Indicator 5: Percent of outlets in high-risk urban areas carrying affordable condoms: Panama NA NA 32 25 39 39 45 Indicator 6: Percent of outlets in high-risk urban areas carrying affordable condoms: Honduras NA NA 28 28 31 34 39 Indicator 7: Percent of outlets in high-risk urban areas carrying affordable condoms: El Salvador NA NA 33 38 36 40 44 Indicator 8: Percent of outlets in high-risk urban areas carrying affordable condoms: Guatemala NA NA 34 30 37 41 45 Indicator 9: Percent of outlets in high-risk urban areas carrying affordable condoms: Nicaragua NA NA 29 29 33 38 44 Indicator Information:
Indicator Level (S)or(IR) Unit of Measure Source Indicator Description Indicator 1: S Average percent of Central American countries' score PASCA AIDS PES/API The AIDS PES is an instrument intended to measure the degree to which the policy environment in a particular country supports efforts to prevent the transmission of HIV/AIDS and ensures the rights of people with HIV/AIDS. The aspects of the HIV/AIDS policy and program measured are: political support; policy formulation; organizational structure; program resources; evaluation and research; legal and regulatory policies; and program components. (Program is defined as a group of interventions; i.e. government sponsorship, support, administration, facilities, private efforts, etc.). *The original target for this indicator was an average score of 48.8 across the 5 countries by the year 2000. By the 1988 mid-project review, this target had been exceeded (51.8). Improvement was perceived in most dimensions of the index, particularly in policy formulation and policy support. The index, now known as the AIDS Program Effort Index, was revised this year and is being employed by UNAIDS in 40 countries. The two indices have 37 elements in common.
**These new scores are for the 37 elements common to both indices, which changes the 1996 score to 44.0 and the 1998 result to 53.3. These 37 items are now the basis for tracking changes in the policy environment.
USAID will not report on this indicator for 2001 since this is a biannual indicator.
Indicator 2: IR Net number of policy changes (cumulative) PASCA Legal/Regulatory policy matrix "Policy" refers to a "course of action" evidenced in laws (including related regulations and enforcement mechanisms), formally documented directives and guidelines (such as decrees that exist on a regional, national or local level within the private or public sectors), and actual practices and measures with respect to HIV/AIDS. A "positive change enacted" refers to constitutional provisions, legislation, implementing rules and regulations, judicial decisions, executive orders, ministerial level decrees and other measures of a regulatory nature; formal standards and guidelines for public sector services; standards of practice in professional fields; official goals and plan programs; statements and other expressions of government position which effectively determine direction and course of action, and widespread practices of service providers that effectively govern service delivery and access, and which favor a positive environment for HIV/AIDS prevention. The changes could be the addition of a favorable policy or a deletion or modification of an unfavorable one. By the end of 1999, the year 2000 target was surpassed. USAID is reviewing this indicator and may redefine it to emphasize the more important changes. *Denotes previous targets. USAID is negotiating new targets with partners based on 2000 performance.
Indicator 3: S Percent of 15 selected NGOs that score three or higher on the Systematic Approach Scale (SAS). PASCA NGO Needs Assessment Survey This indicator measures whether an NGO follows a systematic approach to project design and monitoring. Each organization with a score of 3 or more is considered to use a systematic approach to interventions. The Systematic Approach Scale examines the following aspects, (each category receives one point): 1. Project Design: determines whether the project design is based on either behavior investigations or epidemiological investigations; 2. Audience Needs Assessment: determines whether project design utilizes a needs assessment of the target audience; and 3. Monitoring/Evaluation: determines if the project has done at least two of the following: (a) service statistics are utilized for project decision-making; (b) the results of evaluation or research have been used to modify the project in the last year; or (c) the project used information pertaining to client demands (client satisfaction/needs studies) to modify the program in the last year. *A 1998 baseline for 23 NGOs was collected using direct observation methodology.
**A new baseline for the 15 NGOs selected for intensive strengthening was determined and a new 2000 year target was set.
USAID will not report on this indicator for 2001, since this is a biannual indicator.
Indicator 4: IR Percent External distribution surveys Percent of outlets in high-risk urban areas that carry affordable condoms. A high-risk urban area is defined as an area where the members of the target populations live or tend to frequent. To "carry" is defined as a retail outlet having affordable condoms for sale to the general public. For internal purposes, this indicator will be tracked by type of outlet, country, and department. Indicator 5: IR Percent External distribution surveys Percent of outlets in high-risk urban areas that carry affordable condoms. A high-risk urban area is defined as an area where the members of the target populations live or tend to frequent. To "carry" is defined as a retail outlet having affordable condoms for sale to the general public. For internal purposes, this indicator will be tracked by type of outlet, country, and department. Activities were not initiated in Panama until after 2000 data collection. Indicator 6: IR Percent External distribution surveys Percent of outlets in high-risk urban areas that carry affordable condoms. A high-risk urban area is defined as an area where the members of the target populations live or tend to frequent. To "carry" is defined as a retail outlet having affordable condoms for sale to the general public. For internal purposes, this indicator will be tracked by type of outlet, country, and department. Activities were not initiated in Honduras until after 2000 data collection. Indicator 7: IR Percent External distribution surveys Percent of outlets in high-risk urban areas that carry affordable condoms. A high-risk urban area is defined as an area where the members of the target populations live or tend to frequent. To "carry" is defined as a retail outlet having affordable condoms for sale to the general public. For internal purposes, this indicator will be tracked by type of outlet, country, and department. Indicator 8: IR Percent External distribution surveys Percent of outlets in high-risk urban areas that carry affordable condoms. A high-risk urban area is defined as an area where the members of the target populations live or tend to frequent. To "carry" is defined as a retail outlet having affordable condoms for sale to the general public. For internal purposes, this indicator will be tracked by type of outlet, country, and department. Indicator 9: IR Percent External distribution surveys Percent of outlets in high-risk urban areas that carry affordable condoms. A high-risk urban area is defined as an area where the members of the target populations live or tend to frequent. To "carry" is defined as a retail outlet having affordable condoms for sale to the general public. For internal purposes, this indicator will be tracked by type of outlet, country, and department. U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 0 DA 0 DA 0 DA 17,587 CSD 12,008 CSD 5,579 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Fiscal Year 2000 DA DA 3,150 CSD 5,584 CSD 0 ESF 0 ESF 0 SEED 0 SEED 0 FSA 0 FSA 0 DFA 0 DFA Through September 30, 2000 0 DA 0 DA 0 DA 20,737 CSD 17,592 CSD 3,145 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Prior Year Unobligated Funds 0 DA 0 CSD 0 ESF 0 SEED 0 FSA 0 DFA Planned Fiscal Year 2001 NOA 0 DA 1,120 CSD 0 ESF 0 SEED 0 FSA 0 DFA Total Planned Fiscal Year 2001 0 DA 1,120 CSD 0 ESF 0 SEED 0 FSA 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 0 DA 0 DA 0 DA 0 CSD 0 CSD 21,857 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA
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Last Updated on: May 29, 2002 |
