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Jamaica
>> Regional Overview >> Jamaica Overview Activity Data Sheet
PROGRAM: Jamaica
TITLE AND NUMBER: Improved Reproductive Health of Youth, 532-003
PLANNED FY 2001 OBLIGATION AND ACCOUNT: $1,896,000 (DA), $1,247,000 (CSD)
PROPOSED FY 2002 OBLIGATION AND ACCOUNT: $1,796,000 (DA) $1,322,000 (CSD)
STATUS: Continuing
INITIAL OBLIGATION: FY 1998 ESTIMATED COMPLETION DATE: FY 2004Summary: The overall strategy in the health sector is to implement a comprehensive, decentralized, and multi-sectoral approach to improve the reproductive health (HIV and population resources) of young Jamaicans (aged 10-24 years) including the prevention and control of HIV/AIDS and other sexually transmitted infections, and enhance their transition to adulthood. Jamaica has relatively good health indicators, and total fertility rates have declined significantly from a high of 6.7 births per woman (in the 15-49 age group) in 1960 to 2.8 in 1997. However, birth rates among adolescents remain a concern. Indeed, the age specific fertility rates for the 15-24 year-old cohort increased from 107 live births per 1,000 women in 1993 to 112 in 1997. This birth rate has implications for educational attainment as less than one-third of the adolescent females who gave birth prior to the fourth year of secondary school returned to school after the birth. Furthermore, adolescents (aged 10-19 years) account for 62% of all cases of obstetric complications reported by hospitals. There is also higher HIV seroprevalence (2.1%) among 20-24 year-old antenatal clinic attendees than among antenatal clinic attendees in general (1.6%). The seroprevalence and high fertility rate among this age group has serious implications for mother to child transmission of HIV as well as for pediatric AIDS. USAID's response to these challenges is a program to increase adolescents' use of quality reproductive health and HIV/ sexually transmitted infection (STI) services and preventive practices by making more delivery points youth-friendly; improving knowledge and skills related to reproductive health and HIV/AIDS/STIs; and providing an overall policy environment supportive of adolescents and their reproductive health.
Two major activities support the achievement of this objective: the HIV/AIDS/STI Prevention and Control program and the Adolescent Reproductive Health (ARH) program.
Key Results: Achievements will be tracked by HIV seroprevalence among STI clinic attendees (high-risk group) and antenatal clinic attendees (low-risk group). These two indicators, taken together, provide information on the direction the epidemic is going and more specifically, the direction among adolescents/youth. Data for 2000 (all age groups) show a prevalence among the high-risk group of 4.06% (better than the target of 7.7%) and low-risk group of 1.4% (also better than the target of 1.72%). Although this might appear to be a first step in a downward trend in HIV prevalence, this cannot be said with absolute certainty due to data and logistical problems.
During 2000, a multi-sectoral approach was used to implement interventions to increase use (and knowledge) of reproductive health and HIV/AIDS/STI preventive practices and services. Contact investigation (CI), behavior change communication (BCC) strategies, particularly face-to-face communication, and mass media campaigns along with programs implemented in the workplace and schools, have assisted in increasing condom use, decreasing the number of sexual partners, and have resulted in an apparent leveling off of the HIV epidemic. Parents were also targeted as another avenue for reaching adolescents with reproductive health information.
The 2000 Policy Environment Score (PES - adolescent module) was met with 59.7%, which exceeded the planned score of 58%. The PES for the STDs/AIDS module stands out as having dramatically improved between the baseline and follow-up assessment, with an increase of 9.23%.
Performance and Prospects: A recent external evaluation of the HIV/AIDS program gave high marks to overall program accomplishments, particularly the impact of BCC and CI components in changing high risk behaviors, and on increased public awareness of, and response to, the dangers posed by HIV and other STIs.
One of the ways in which the HIV/AIDS program supports increasing access to quality care is through the contact investigation component, which is widely accepted by health providers and the public. This has been a long-standing intervention (50 years) which has been credited with assisting in curbing the rate of increase first, with STIs and now HIV. On average, approximately 69% of the contacts of those testing positive have been investigated over the past year. Though specific data regarding the contacts is unavailable, these investigations obviously result in earlier treatment of STIs and early diagnosis of HIV, thus increasing the opportunity for counseling related to psychosocial needs and risk reduction. Further epidemiological investigation of contacts is warranted.
Numerous mass media campaigns were carried out in 2000, including radio, television, billboards, and posters that targeted men with multiple partners, sexually active women, and parents of teenagers and pre-adolescents. In addition, CI plays a role in educating the public on HIV/AIDS. They hold training sessions in factories, schools, churches, and community-based organizations. As a result of the above activities, knowledge remains high with respect to HIV transmission (97% men and women correctly name two or more preventive practices). However, there appears to be an increase (three-fold in some cases) in the belief in "myths" on how HIV can be transmitted (e.g. mosquitoes, toilets, sharing food, etc.). Men were much more likely to endorse myths than women. Future program activities will continue to focus on this area.
The ARH program supports Ashe, a creative arts non-governmental organization (NGO), which has played a critical role in getting messages out to adolescents. Ashe continues to expand a very successful, innovative training methodology directed to nurses and guidance counselors in schools, which assists them in teaching and talking to adolescents regarding their reproductive health. The long-term impact of this program on adolescent knowledge and behavior is being evaluated through a longitudinal study comparing persons who participate in the program with Ashe and those which receive the information through the regular program with the Ministry of Health (MOH). During 2000, Ashe developed a similar program directed towards parents. Through this methodology, parents are learning how to communicate and relate to their adolescents using positive parenting tools.
Qualitative analysis of health worker and youth perceptions of existing adolescent services have verified the need to target training to improve the interpersonal communication skills of clinic personnel. In order to identify significant needs, site infrastructure was assessed and existing medical supplies and equipment inventoried. To address some of these needs, USAID collaborated with Food for the Poor to provide donated medical supplies and equipment to all the project sites. 'Youth.now' encouraged a multi-sectoral group to develop "focused certification" criteria for the "youth friendly" sites. These criteria will be further strengthened through a partnership with the Quality Assurance Project that will place this targeted certification within a broader quality assurance program within the MOH.
FY 2001 DA funds will be used as follows: $1.1 million will increase access to quality reproductive health services; $0.500 million will improve knowledge and skills related to reproductive health; and $0.296 million will help enhance national policies and guidelines that support reproductive health of youth. The FY2001 CSD funds will be used as follows: $0.474 million will contribute to increasing access to quality reproductive health services; $0.723 million will go towards the improvement of knowledge and skills related to reproductive health; and $0.050 million will help to enhance national policies and guidelines.
FY 2002 DA funds will be used as follows: $1.024 million will increase access to quality reproductive health services; $0.503 million will improve knowledge and skills related to reproductive health; and $0.269 will help enhance national policies and guidelines that support reproductive health of youth. The FY 2002 CSD funds will be used as follows: $1.297 million to combat HIV, and $0.025 million for other health activities.
Possible Adjustments to Plans: No adjustments are anticipated.
Other Donor Programs: USAID is currently the principal donor in reproductive health/HIV/AIDS. However, the MOH is presently negotiating a loan with the World Bank to provide additional support to the HIV/AIDS program. UNICEF assists the MOH with a pilot program directed towards preventing the mother-to-child transmission of HIV. The United Nations Family Planning Program is implementing a three-year project in three sites on youth advocacy, training peer educators, service delivery for adolescents, and public education. USAID also collaborates with the Pan American Health Organization and other bilateral donors, such as the United Kingdom and Germany, to maintain implementation coordination.
Major Contractors and Grantees: U.S. contractors include the Academy for Educational Development (AED), the Futures Group International, Family Health International, JHPIEGO and Pathfinder International. Non-U.S. partners include the MOH, local NGOs, and the National Family Planning Board.
Jamaica 532-003
Performance Measures:
Indicator FY97
(Actual)FY98
(Actual)FY99
(Actual)FY00
(Actual)FY00
(Plan)FY01
(Plan)FY02
(Plan)Indicator 1: HIV Seroprevalence among STD clinic attenders: age 20-24 NA NA 6.4 2.7 6.4 6.8 7.3 Indicator 2: HIV Seroprevalence among antenatal clinic attenders: age 20-24 NA NA 2.1 1.62 1.45 1.55 1.66 Indicator 3: HIV Seroprevalence among antenatal clinic attenders: age 15-19 NA NA 1 0.73 1.83 1.96 2.10 Indicator 4: HIV Seroprevalence among STD clinic attenders: age 15-19 NA NA 3.1 3.04 4.6 4.9 5.3 Indicator 5: Policy Environmental Score (Adolescents) NA 54.1 56.3 59.7 58 60 64 Indicator 6: Number of officially certified youth friendly service delivery points NA NA NA NA 0 0 3 Indicator 7: HIV Seroprevalence among antenatal clinic attenders: all age groups NA NA 1.61 1.4 1.72 1.84 1.96 Indicator 8: HIV Seroprevalence among STD clinic attenders: all age groups NA NA 7.1 4.06 7.7 8.3 9.0 Indicator Information:
Indicator Level (S)or(IR) Unit of Measure Source Indicator Description Indicator 1: IR Percentage of STD Clinic Attenders: age 20-24 Ministry of Health Epidemiology Unit Data is gathered through a sentinel surveillance system set up in three (highest HIV prevalence rates) of the 13 STD clinics in the island. The representative sample data has been disaggregated by age groups. Testing is done over a three month period selecting a sample size using the standard formula based on population and prevalence rates (95% confidence limits). Indicator 2: IR Percentage of Antenatal Clinic Attenders: age 20-24 Ministry of Health Epidemiology Unit Data is gathered through a sentinel surveillance system set up in antenatal clinics in 7 parishes. All pregnant women coming for care are tested for HIV. Testing at these sites is conducted between October and April. Indicator 3: IR Percentage of Antenatal Clinic Attenders: age 15-19 Ministry of Health Epidemiology Unit Data is gathered through a sentinel surveillance system set up in selected antenatal clinics in 7 parishes. All pregnant women coming for care are tested for HIV. Testing at these sites is conducted between October and April. Indicator 4: IR Percentage of STD Clinic Attenders: age 15-19 Ministry of Health Epidemiology Unit Data is gathered thorugh a sentinel surveillance system set up in three (highest prevalence rates) of the 13 STD clinics on the island. The representative sample has been disaggregated by age groups. Testing is done over a three month period selecting a sample size using the standard formula based on population and prevalence rates (95% confidence limits). Indicator 5: IR Percentage of Weighted Score Futures Group/Policy Project Measurement of the degree to which the policy environment is supportive of effective reproductive health policies and programs. Indicator 6: IR Number of YFS in target parishes Institutional contractor (Futures Group) for the ARH project (PMP) Critieria (for official certification) have been developed by the contractor in collaboration with the MOH and other relevant organizations/partners. Critieria include trained cadre of personnel (janitor to physician) in clinical and/or interpersonal skills; improved physical environment; appropriate medical supplies and equipment available; clinical standards being implemented, etc. Indicator 7: IR Percentage of Antenatal Clinic Attenders: all age groups Ministry of Health Epidemiology Unit Data is gathered through a sentinel surveillance system set up in selected antenatal clinics in 7 parishes. All pregnant women coming for care are tested for HIV. Testing at these sites is conducted between October and April. Indicator 8: IR Percentage of STD Clinic Attenders: all age groups Ministry of Health Epidemiology Unit Data is gathered through a sentinel surveillance system set up in three (highest HIV prevalence rates) of the 13 STD clinics in the island. The representative sample data has been disaggregated by age groups. Testing is done over a three month period selecting a sample size using the standard formula based on population and prevalence rates (95% confidence limits). U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 20,616 DA 18,198 DA 2,418 DA 2,175 CSD 0 CSD 2,175 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 1,120 DA 1,254 DA 875 CSD 1,060 CSD 0 ESF 0 ESF 0 SEED 0 SEED 0 FSA 0 FSA 0 DFA 0 DFA Through September 30, 2000 21,736 DA 19,452 DA 2,284 DA 3,050 CSD 1,060 CSD 1,990 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 1,896 DA 1,247 CSD 0 ESF 0 SEED 0 FSA 0 DFA Total Planned Fiscal Year 2001 1,896 DA 1,247 CSD 0 ESF 0 SEED 0 FSA 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 1,796 DA 5,448 DA 30,876 DA 1,322 CSD 5,296 CSD 10,915 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 |
