USAID CBJ FY 2002: Honduras

Summary: Honduras faces major challenges to family health associated with rapid population growth (2.7% per year), widespread poverty, and limited access to health information and care, especially in rural areas. Honduras also has the largest concentration of HIV/AIDS in Central America. Hurricane Mitch exacerbated these challenges, particularly in the area of sustainable improvements in family health. Improved child survival -- achieved in part by USAID's 20-year support for expansion of access to safe water supply and sanitation systems -- has been undermined by Hurricane Mitch. Access to safe water/sanitation has declined by 42% in rural areas, presenting a threat already demonstrated by high levels of reported diarrheal disease in the post-Mitch period. Public health efforts focused on accelerating and expanding detection, treatment, and community education to control infectious diseases (e.g., malaria and dengue) are receiving additional support in the aftermath of the hurricane. This effort is complemented by plans to strengthen disease surveillance systems and expand rural access to reproductive health services. Primary beneficiaries of this objective are the over two million women and children in low-income Honduran families who currently lack access to quality reproductive health, child survival, and family planning services, and those without a secure source of water and adequate sanitation. Beneficiaries also include approximately 128,000 children and adults who receive supplemental food rations and the beneficiaries of the AIDS prevention program (for which high-risk groups include young adults in major cities).

USAID is a leader in the health sector, engaging in policy dialogue and providing technical assistance, training, and capital assistance that support a variety of interventions, including vaccination programs, oral rehydration therapy, maternal health care, family planning, and targeted nutrition programs. Particular attention is given to achieving sustainable delivery of services. Activities include technical assistance, training and limited commodity support to the Ministry of Health (MOH), a rural water and sanitation activity, assistance to private- and public-sector family planning programs, and a P.L. 480 Title II food security activity.

Key Results: Efforts to improve the responsiveness of Honduran health systems to contribute to sustainable family health are focused on achieving a number of critical results. Specifically, USAID activities are: 1) increasing use of malaria, dengue, and tuberculosis prevention and control services to reduce current infection levels and prevent epidemics; 2) sustaining use of child survival services via health reform and rehabilitation of facilities; 3) promoting increased use of HIV and sexually transmitted disease prevention practices; 4) increasing use of and access to reproductive health services, particularly in rural areas; 5) improving the sustainability and outreach of the Honduran Family Planning Association (ASHONPLAFA); and 6) improving household food security in target areas. A current policy focus is to facilitate health reforms that improve transparency and efficiency in the public-sector health system. /

Performance and Prospects: With vaccination rates for children under one year exceeding 94%, Honduras has the best record in Latin America. Infant mortality and the proportion of children (age 12 to 23 months) who are seriously malnourished continue to decline with higher rates persisting in the country's poorest regions. Changes in these and other key indicators will be measured this year in the third National Epidemiological and Family Health Survey. Recent data indicate that the spread of HIV/AIDS has started to slow, although growth is still substantial. The national AIDS program, funded by USAID, promotes preventive practices, including early detection and treatment of sexually transmitted diseases and condom use. USAID supports AIDS prevention activities through Honduran NGOs and the MOH.

The total fertility rate declined from 5.1 children per woman (1991) to 4.9 (1993-95), while couple-years of contraception protection increased from 311,724 (1996) to 405,303 (1999). The use of modern methods of contraception increased from 35% (1991-92) to 41% (1996). Total contraceptive prevalence in women increased from 47% (1991) to 50% (1996). USAID's family planning activities through the MOH and ASHONPLAFA are expanding access to quality services, with the goals of increased use of modern family planning methods and greater financial self-sufficiency of ASHONPLAFA. Family planning has been a major factor in reducing infant and maternal mortality; however, efforts are constrained by weak rural promotion of reproductive health and family planning services. USAID is expanding support to greatly strengthen and extend reproductive health and family planning services in rural areas in regions with the highest poverty rates. This effort is being reinforced by health reforms that emphasize local decentralization and community participation.

The Government of Honduras (GOH) is committed to a series of measures to improve quality and efficiency in a decentralized health care system. A key challenge remaining is to greatly increase families' access to effective family planning methods in the rural areas where the average number of children per family is over six and modern contraceptive use is only 35%.

The P.L. 480 Title II program focuses on improving nutritional status and food security in the neediest regions of the country. Related USAID activities, which increase incomes and educational levels of the poor, contribute directly to improved family health.

In FY 2001 Child Survival (CSD) funds will finance the following activities: child survival services ($2,500,000); STI/AIDS prevention practices ($2,566,000); and prevention and control of malaria, dengue, and tuberculosis ($576,000). In FY 2001, Development Assistance (DA) funds will be used to finance reproductive health services including family planning ($5,488,000).

FY 2002 CSD funds will be split between child survival services ($2,867,000), STI/AIDS prevention practices ($1,993,000), and prevention and control of malaria, dengue, and tuberculosis ($440,000). FY 2002 DA funds will be used to finance reproductive health services including family planning ($5,000,000).

Possible Adjustments to Plans: Under a new health reform initiative, USAID will assist the GOH to: 1) improve the quality and efficiency of its public sector primary health services; 2) establish and implement health policies to increase equitable access to primary health care; 3) increase public and private sector resources for primary health care; and 4) address transparency and accountability issues in the public health system.

Other Donor Programs: USAID coordinates with the United Nations on HIV/AIDS prevention assistance, and with Japan, Sweden, the United Nations Children's Fund, the Pan American Health Organization (PAHO), the European Union, and Spanish Technical Cooperation on child survival interventions. USAID coordinates closely with PAHO on health reconstruction plans. USAID participates in regular meetings of a food aid coordinating committee with the World Food Program, CARE, and Catholic Relief Services.

Principal Contractors, Grantees, or Agencies: U.S organizations: CARE, Management Sciences for Health, Family Health International, Population Council, University Research Corporation and Center for Human Services, Abt Associates, The Futures Group, Johns Hopkins University, Centers for Disease Control and Prevention, Partnership for Child Health, World Relief, and Save the Children. Honduran organizations: ASHONPLAFA, Health Promotion Foundation, and the Program for the Development of Women and Children.

Honduras: 522-003

U.S. Financing

(In thousands of dollars)

	Obligations		Expenditures		Unliquidated
Through September 30, 1999	81,784	DA	76,108	DA	5,676	DA
	20,612	CSD	9,564	CSD	11,048	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	3,533	DA	5,550	DA
	4,900	CSD	9,473	CSD
	0	ESF	0	ESF
	0	SEED	0	SEED
	0	FSA	0	FSA
	0	DFA	0	DFA
Through September 30, 2000	85,317	DA	81,658	DA	3,659	DA
	25,512	CSD	19,037	CSD	6,475	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	350	DA
	0	CSD
	0	ESF
	0	SEED
	0	FSA
	0	DFA
Planned Fiscal Year 2001 NOA	5,138	DA
	5,642	CSD
	0	ESF
	0	SEED
	0	FSA
	0	DFA
Total Planned Fiscal Year 2001	5,488	DA*
	5,642	CSD
	0	ESF
	0	SEED
	0	FSA
	0	DFA
			Future Obligations		Est. Total Cost
Proposed Fiscal Year 2002 NOA	5,000	DA	13,500	DA	109,305	DA
	5,300	CSD	13,500	CSD	49,954	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

* This excludes $350,000 NOA swapped for like amount of FY 2000 carryover funds

Honduras

Activity Data Sheet

Honduras: 522-003

U.S. Financing