USAID CBJ FY 2002: Haiti

Summary: This strategic objective seeks to improve the health and well-being of Haiti's children, reduce malnutrition rates, address rapid population growth, and slow the spread of HIV/AIDS. Haiti has the highest child mortality rate in the Western Hemisphere. One in eight children dies by age five, and a third are chronically malnourished. Maternal mortality is estimated at 1,000 per 100,000 live births. About 10% of Haiti's urban population are infected with HIV, and almost half the women of reproductive age currently have an untreated sexually transmitted infection (STI).

USAID's health programs in Haiti cover a population of 4.7 million people and contribute to over half of the country's new modern method family planning acceptors. Activities target 183,000 vulnerable mothers and malnourished children and include food supplementation, growth monitoring, health/nutrition education, and community outreach. Technical assistance focuses on HIV/AIDS prevention, population policy and advocacy support, clinical family planning (FP) training, operations research, contraceptive commodity procurement, social marketing of contraceptive products, and selected child survival and maternal health services.

Key Results: Results anticipated under this objective include increased use of quality child survival and nutrition services to reduce infant and child mortality rates; increased use of quality reproductive health services to increase contraceptive prevalence; women empowered so that more girls complete primary school and more women have access to economic opportunities; and youth better prepared for and men more engaged in responsible family life by modifying sexual behavior. A crosscutting factor is the need for an improved public policy environment for child survival and reproductive health, including greater and more effective involvement of civil advocacy groups in public health issues.

With only 34% fully immunized, Haiti's children continue to be plagued by limited protection against the most common childhood diseases. Coverage rates are much higher in departments served by USAID-funded partner organizations (North, North-East, and Grand'Anse), where an estimated 63% of children are fully immunized -- nearly twice the national average.

Considerable progress has been made to increase the use of quality reproductive health (RH) services. Data reveal a growing reliance on safe, effective family planning methods, from a contraceptive prevalence rate (CPR) of only 5% in 1987 to 15.4% in 2000. In departments where USAID-funded partner organizations are the principal source of services, rates are 26.9% to 28.7%, well exceeding the 2000 target. Findings from the third Haiti Demographic and Health Survey (DHS 2000) indicate that the program has met or exceeded maternal health targets as well, as measured by use of prenatal care services (three or more visits) and births assisted by trained personnel. The percentage of women nation-wide who sought prenatal consultation services rose from 68% in 1994/95 to 79% in 2000. Over the same period, the percentage of women delivering with the assistance of trained health personnel rose from 46% to 60%.

Performance and Prospects: USAID programs target the major causes of infant mortality in Haiti (diarrhea, fever, acute respiratory infections, malaria, measles, and malnutrition); maternal health (prenatal, delivery, and postnatal care); and reproductive health care (family-planning information and services; HIV/AIDS prevention; and STI prevention, detection, and treatment). Despite constraints at many levels, USAID's 34 non-governmental organization (NGO) partners have succeeded in expanding access by 4.7 million beneficiaries to quality services nationwide. In 1998, the modern method contraceptive prevalence rate (CPR) in USAID program areas was fully twice the national average (25.2% vs. 13%). In FY 2001, the CPR for all methods is expected to increase further to 31% in USAID-financed sites.

Program performance was disturbed somewhat during the reporting period as political events delayed startup of planned support to the Ministry of Health (MSPP) to strengthen national health systems and extend support for integrated management of childhood illnesses and vaccination programs. Vaccination coverage rates in USAID-funded program areas are almost double the national average but have remained fairly constant and are still unacceptably low. Confronted with periodic measles outbreaks, and recently one of the first confirmed cases of paralytic polio in the Western Hemisphere since 1991, MSPP announced plans for a national vaccination campaign. Strategies to improve national-level vaccination rates will include support for a reliable supply system for vaccines, better department-level public-private collaboration in campaign efforts, and greater engagement with Government of Haiti and PAHO counterparts in the on-going dialogue surrounding this issue.

Begun in 2000, Phase II of this program focuses on improved quality and increased access to the child and reproductive health services currently being provided by a network of local NGOs and private service delivery organizations. Support for improved services will be complemented with strengthening of national systems critical to informed decision-making, judicious planning, and optimal utilization of scarce resources. The Phase II program envisions support for institutional strengthening and service delivery to a network of NGOs and commercial health institutions that provide child and reproductive health services. The program will help local institutions expand access and improve efficiency to achieve a greater level of financial autonomy by 2004. The program will also help slow the transmission of STIs. HIV/AIDS prevention-to-care strategies will be reviewed and redefined for both AIDS and TB activities. Integration of FP/STI services will enable USAID to capitalize upon its existing service delivery infrastructure. Risk-reduction interventions will emphasize sustained behavior change among key at-risk populations.

FY 2001 ESF funds will support HIV/AIDS prevention ($3.0 million), child survival and infectious diseases activities ($860,000) and family planning ($1.74 million). Working through a network of private sector health institutions to support institutional strengthening and service delivery, $1.35 million will help combat HIV/AIDS, $4.11 million will be used for child survival and infectious diseases, and $4.47 million will go toward family planning. An additional $3.77 million will be used to support the large P.L. 480 Title II program.

FY 2002 ESF funds will be used to support HIV/AIDS prevention ($1.5 million), infectious diseases activities ($200,000), and family planning ($800,000). Working through a network of private sector health institutions, funds will support institutional strengthening and service delivery, including $2.25 million for HIV/AIDS support; $3.25 million for child survival and infectious diseases; and $5.2 million for family planning. An additional $4 million will be used to support the large P.L. 480 Title II program.

Possible Adjustments to Plans: The conceptual framework and related strategies and indicators for this objective remain unchanged. However, given budget reallocations and the anticipated continuation of earmarks for HIV/AIDS and TB, USAID will likely reduce its support for ongoing fertility reduction activities. The performance indicators will also be revised. During FY 2000, USAID and other donors provided support for completion of the third Haiti Demographic and Health Survey (DHS), which enables us to report on national health trends. However, USAID has instructed the contractor to discontinue annual population-based surveys. Partner organizations will instead receive increased support to improve the quality and availability of service statistics in order to track program results and impact.

Other Donor Programs: USAID is the leading bilateral donor in the health sector, followed by Japan, France, and Canada. The Pan-American Health Organization (infectious disease and essential drugs, improved maternal and child health, and sanitation), UNICEF (micro-nutrients, child health and STI/HIV), and the World Bank (condoms, TB drugs and other medical supplies, obstetrical emergency care, midwife training) also provide significant levels of assistance.

Principal Contractors, Grantees, or Agencies: U.S. partners include Management Sciences for Health (MSH), CARE, Catholic Relief Services, and World Vision. Non-U.S. partners include the local Haitian firm International Maritime Transport and several Haitian NGOs.

Haiti: 521-003

U.S. Financing

(In thousands of dollars)

	Obligations		Expenditures		Unliquidated
Through September 30, 1999	6,400	DA	6,345	DA	55	DA
	11,842	CSD	11,842	CSD	0	CSD
	64,208	ESF	49,580	ESF	14,628	ESF
	0	SEED	0	SEED	0	SEED
	0	CACEDRF	0	CACEDRF	0	CACEDRF
	0	0	0	DFA	0	DFA
Fiscal Year 2000	0	DA	1	DA
	0	CSD	-43	CSD
	19,550	ESF	14,789	ESF
	0	SEED	0	SEED
	0	CACEDRF	0	CACEDRF
	0	DFA	0	DFA
Through September 30, 2000	6,400	DA	6,346	DA	54	DA
	11,842	CSD	11,799	CSD	43	CSD
	83,758	ESF	64,369	ESF	19,389	ESF
	0	SEED	0	SEED	0	SEED
	0	CACEDRF	0	CACEDRF	0	CACEDRF
	0	DFA		DFA	0	DFA
Prior Year Unobligated Funds*	0	DA
	0	CSD
	2,270	ESF
	0	SEED
	0	CACEDRF
	0	DFA
Planned Fiscal Year 2001 NOA	0	DA
	0	CSD
	19,300	ESF
	0	SEED
	0	CACEDRF
	0	DFA
Total Planned Fiscal Year 2001	0	DA
	0	CSD
	21,570	ESF
	0	SEED
	0	CACEDRF
	0	DFA
			Future Obligations		Est. Total Cost
Proposed Fiscal Year 2002 NOA	0	DA	0	DA	6,400	DA
	0	CSD	0	CSD	11,842	CSD
	17,200	ESF	34,400	ESF	156,928	ESF
	0	SEED	0	SEED	0	SEED
	0	CACEDRF	0	CACEDRF	0	CACEDRF
	0	DFA	0	DFA	0	DFA

Haiti

Activity Data Sheet

Haiti: 521-003

U.S. Financing