Nicaragua

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Activity Data Sheet PROGRAM:  Nicaragua TITLE AND NUMBER:  Better Educated, Healthier, and Smaller Families, 524-003 PLANNED FY 2001 OBLIGATION AND ACCOUNT:  $3,991,000 (DA) $6,858,000 (CSD) PROPOSED FY 2002 OBLIGATION AND ACCOUNT:  $3,870,000 (DA) $7,000,000 (CSD), $5,947,000 (PL 480) STATUS: Continuing INITIAL OBLIGATION: FY 1995    ESTIMATED COMPLETION DATE: FY 2003 Summary:  This strategic objective supports the development of Nicaragua's human capital through basic education, primary health care, nutrition, and reproductive health. The program is designed to achieve the following: further major reductions in total fertility rates nationally; major reductions in infant mortality in target geographic departments; and increased access of Nicaraguan children to quality primary education. This program will cut micronutrient deficiencies sharply at the national level. Children in model schools will complete more years of school. Their teachers will provide better education in the classroom and teach new methods to fellow teachers. In FY 2001, USAID will use CSD funds to improve infant and child survival and nutrition, with emphasis in the rural mountainous departments of Jinotega, Boaco, and Matagalpa, an area including nearly 20% of Nicaragua's population. CSD funds will also be used to support HIV/AIDS activities, and to support infectious disease activities. CSD funds will also support the basic education program through a network of 170 "model schools" throughout the country. USAID will use DA funds to reduce family size by enhancing private sector provision of family planning services, using social marketing to increase demand for these services, and providing contraceptives through public and private outlets. Four US PVOs will use P.L. 480 Title II resources valued at approximately $5 million to implement activities critical to the full achievement of the SO. These include direct feeding for malnourished children, and community education in nutrition and children's health. Key Results: USAID expects the following results under this activity: 1) better nourished women and children; 2) increased use of child survival services and practices; 3) increased use of reproductive health services; and 4) increased active student participation. The first two results will contribute to lowering infant mortality from 40 deaths per 1000 in 1998 to 36 deaths per 1000 in 2002. USAID expects total fertility to decrease from 3.9 children per woman in 1998 to 3.5 in 2002. USAID also expects at least a 5% annual increase in the Active Student Participation Index, a composite index of student participation in the classroom and in student government and the availability and use of classroom materials. Performance and Prospects:  The 1998 Demographic Health Survey (DHS) documented impressive drops in total fertility (TFR) and infant mortality rates (IMR) during the 1993-98 period. Pending results of the next DHS in 2002, USAID is using proxy performance indicators from reliable data sources: Contraceptive Prevalence Rate (CPR), immunization coverage, and percentage of births attended by trained personnel. These indicators show Nicaragua is continuing the strongly positive trends documented by the 1998 DHS. In 1999, the MOH attributed 10.5% of deaths in children under one year of age to diarrhea; this decreased to 9.4% in 2000. Expanded implementation of Integrated Management of Childhood Illness (IMCI) programs and improved treatment of children with oral rehydration salts (ORS) contributed to this decline. DHS-1998 data revealed that 56% of children with diarrhea received ORS from their mothers. Since 1998, USAID PVO partners have pioneered programs bringing IMCI to the community level. In areas where PVOs are working, recognition and treatment of dehydration have increased sharply. The contraceptive prevalence rate increased from 56% in 1999 to 61.6% in 2000. With the launch of the Bodyguard condom, supported by USAID funding, condom sales through social marketing increased from 580,000 in 1999 to 1.6 million in 2000. Last year, in response to concerns about Nicaragua's high rate of maternal mortality, USAID focused on Jinotega and Matagalpa, two departments that have reported the highest numbers of maternal deaths in the country. The number of maternal deaths in the two departments subsequently decreased from 62 in 1999 to 31 in 2000. Nationwide, maternal mortality dropped 27% from its 1999 level. The USAID Prosalud (pro-health) project, working with USAID Global Bureau's Center for Population, Health, and Nutrition, the Quality Assurance project, contributed substantially to this achievement by promoting the use of the partogram (a monitoring device used during childbirth) and pregnancy history to improve emergency obstetric care. Births in hospitals, health centers, and health posts have increased nationally from 46% in 1999 to 61% in 2000, and the percent of registered births attended by trained personnel increased from 72% in 1999 to 81.6% in 2000. The number of maternal deaths decreased by 27% in 2000. Infant mortality rates (IMR) decreased from 58/1000 in 1993 to 40/1000 in 1998. Ministry of Health (MOH) data show a continuation of the downward trend in 2000. USAID has provided technical and financial assistance to the Government of Nicaragua to reduce levels of Vitamin A deficiency and anemia. Preliminary data showed that the prevalence of vitamin A deficiency in children between one and five years old has dropped from 31% in 1993 to 9% in 2000. With the implementation of universal sugar fortification last year, we expect to see significant additional improvement. As a result only the youngest children, who generally consume less sugar, will need Vitamin A supplements. The USDA Economic Research Service reviewed food security in Nicaragua, identifying current and projected food gaps in production and imports, with further analysis on food availability vs. requirements for all income levels. According to data, food supplies fell in Nicaragua during the 1990s and are now at critically low levels - reaching only 2,179 calories per person per day in 1997 and only 2,208 in 1998. The data, complemented by a food security assessment, show that people in the lowest income quintile consume only 71% of their nutrition requirements, a gap of 29%. This gap is expected to widen to 36% in 2010. Chronic malnutrition of children is increasing, particularly in rural northern areas. As a result the Mission USAID intends to complement its use of CSD funds with P.L. 480 Title II program implemented by four US PVOs that will include activities to address the root cause: poor infant feeding practices. The Title II program will also contain elements to increase the coverage of Maternal Child Health (MCH) service delivery and to increase access to potable water and improved sanitation. Direct distribution of food to pregnant or lactating mothers, and to children age six months to three years, will reduce chronic malnutrition, now almost 50% in some of the Title II program areas. Nicaragua has an estimated 850 cases of AIDS, and perhaps ten times as many cases of HIV. Further, the number of new cases reported each year is increasing sharply. All the conditions exist in Nicaragua for a serious, general epidemic of HIV/AIDS. USAID will use HIV/AIDS funds (CSD) to curb the trend. With the launch of the new socially marketed condom, TV and radio spots addressed HIV/AIDS prevention for the first time in Nicaragua. USAID also provided a grant to Nimehwatzin, a Nicaraguan NGO that works exclusively on HIV/AIDS prevention, for prevention efforts in Chinandega, a city with the second largest concentration of HIV/AIDS cases in the country. With CSD funds, USAID will also provide support to rural health posts and clinics in the prevention and treatment of a wide range of infectious diseases including upper respiratory infections and dengue fever. For Basic Education, USAID will use FY 2002 CSD funds. Performance of USAID's second Basic Education (BASE II) program in 170 model schools greatly exceeded targets, largely as a result of USAID's support, including intensive teacher training and student-centered materials developed to promote active learning. Longitudinal analysis shows a steady improvement in efficiency of the model schools where fourth grade completion rates have increased 5% since 1997. Other donors will take advantage of USAID's efforts. The World Bank will disseminate BASE II student work-books to all multi-grade students in the country, and the Inter-American Development Bank will use lessons learned from the USAID-supported reform of the primary school curriculum to design its secondary school reform program. USAID has extended its primary education program to include the historically underserved schools in the Atlantic Coast region. The program trained teachers and directors from 28 bilingual model schools in second language teaching, linguistics, and culture. USAID also provided training to Creole teachers in how to teach reading and writing. USAID will use $6,858,000 CSD funds as follows: $2,370,00 CSD will improve infant and child survival and nutrition, particularly in poor rural mountainous areas; $998,000 CSD funds will support HIV/AIDS and infectious diseases activities; $3,490,000 CSD will support the basic education program through teacher training and a nationwide network of model schools. USAID will also use $3,991,000 DA to provide family planning services, through NGOs, the MOH, and a contraceptive social marketing program. USAID will use $7,000,000 FY 2002 CSD funds as follows: $3,450,000 CSD will help address chronic malnutrition of children as well as pregnant and lactating mothers; $500,000 CSD to slow the spread of HIV/AIDS; $550,000 CSD to support rural health posts and clinics, and $2,500,000 CSD to support basic education program. USAID will also use $3,870,000 DA to continue family planning services. Possible Adjustments to Plans:  More than 49% of women are either pregnant or mothers by age 19. USAID is adjusting the focus of its program to target this group specifically. Increasing access to safe water and providing adequate latrines in rural communities, health posts, and rural schools, proven effective in our Hurricane Mitch recovery program, will be incorporated into our regular bilateral program. Although falciparum malaria, the most deadly type, has been rare in Nicaragua, the number of cases is increasing. Permethrin treated bednets purchased under the reconstruction program were unexpectedly effective in reducing malaria rates in Mitch-affected areas. USAID will develop mechanisms, under its on-going health programs, to re-treat bednets with insecticides in order to reduce mortality and morbidity rates. The threat of HIV/AIDS must be addressed before it reaches epidemic levels in Nicaragua. USAID will support educational campaigns to increase the awareness of the risks, both among the high-risk groups and young adults. USAID will also use social marketing techniques to increase the availability of condoms to these groups. Other Donor Programs:  The World Bank's $60 million loan supports pre-school and primary education nationwide through the building of schools, teacher training, distribution of textbooks and supplies, student scholarships, and teacher incentives. Similarly, the $80 million joint World Bank/IDB Health Modernization Project supports alternative financing systems for providing maternal and child health services, child nutrition, pharmaceutical procurement, hospital autonomy, improved health information systems, and decentralization of health services in two pilot MOH regional health centers. The Swedish Prosilais program complements USAID's Prosalud project by working to improve decentralized delivery of primary health care in target departments. The European Union (EU) supports primary and secondary education through teacher training, infrastructure, and curricular reforms. Japan builds schools and hospitals. The Inter-American Development Bank (IDB) has provided loans to reform both secondary and tertiary education. In bilingual intercultural education, USAID collaborates primarily with the EU and European NGOs, Finland, and the World Bank. Principal Contractors, Grantees or Agencies: U.S. organizations include: Management Sciences for Health, and the Academy for Educational Development. International organizations include: the World Bank, IDB, Pan-American Health Organization, United Nations Fund for Population Activities, United Nations Children's Emergency Fund. Nicaraguan partners include: the Ministry of Health (MOH); Ministry of Education, Culture, and Sports (MECD); and Profamilia. Nicaragua 524-003 Performance Measures: Indicator FY97 (Actual) FY98 (Actual) FY99 (Actual) FY00 (Actual) FY00 (Plan) FY01 (Plan) FY02 (Plan) Indicator 1: Total Fertility Rate 3.8 3.9 NA NA 3.7 3.6 3.5 Indicator 2: Contraceptive Prevalence Rate 47 47 56 61.6 57 58 59 Indicator 3: Infant Mortality Rate 45 40 NA NA 38 37 36 Indicator 4: Vaccination Coverage Rates - DPT3 (including Pentavalent) 91 86 90 93 90 90 90 Indicator 5: Vaccination Coverage Rates - MMR 92 99 97 97 90 90 90 Indicator 6: Vaccination Coverage Rates - Polio3 94 91 93 93 90 90 90 Indicator 7: Composite Active Student Participation Index (A) NA 23 32 41 33 38 43 Indicator 8: Composite Active Student Participation Index (B) NA NA 19 NA 23 27 31 Indicator 9: Births attended by trained personnel NA 65 72 81.6 67 68 69 Indicator Information: Indicator Level (S)or(IR) Unit of Measure Source Indicator Description Indicator 1: IR Average number of children born to a woman over her lifetime 1998 Demographic Health Survey (DHS)1997 figure from DHS with 50% of sample reported Average number of children born to a woman over her lifetime Indicator 2: IR Percent Ministry of Health data Percentage of women of reproductive age (15-49) who are using (or whose partner is using) a contraceptive method at a particular point in time.Proxy indicator for total fertility rate. Indicator 3: IR Number of deaths per thousand live births 1998 Demographic Health Survey 1997 figure from DHS with 50% of sample reported Number of deaths during the first year of life out of 1000 live births. Indicator 4: IR Percent of target population Pan American Health Organization and Ministry of Health This indicator tracks targeted efforts in improving child survival and reflects both outreach activities by the PVOs in promoting immunization and the efforts of the public sector. Indicator 5: IR Percent of target population Pan American Health Organization and Ministry of Health This indicator tracks targeted efforts in improving child survival and reflects both outreach activities by the PVOs in promoting immunization and the efforts of the public sector. Indicator 6: IR Percent of target population Pan American Health Organization and Ministry of Health This indicator tracks targeted efforts in improving child survival and reflects both outreach activities by the PVOs in promoting immunization and the efforts of the public sector. Indicator 7: IR Percent (A) BASE II Project Longitudinal Study/Ministry of Education, Culture & Sports Percent of student-centered participation, materials availability & use, and the level of participation in student government. The highest ASPI was found in the BASE I model multi-grade schools, followed by the model regular schools.A = 15 original BASE I model schools. Indicator 8: S Percent (B) BASE II Project Longitudinal Study/Ministry of Education, Culture & Sports Percent of student-centered participation, materials availability & use, and the level of participation in student government. The highest ASPI was found in the BASE I model multi-grade schools, followed by the model regular schools.B = 20 new BASE II model schools. Indicator 9: IR Percent 1998 Demographic Health Survey Ministry of Health data (between surveys) Percent of births attended by trained personnel. This indicator tracks efforts to improve maternal and neonatal health and promotes safe motherhood. U.S. Financing (In thousands of dollars)   Obligations   Expenditures   Unliquidated   Through September 30, 1999    7,139 DA 4,527 DA 2,612 DA 16,759 CSD 7,077 CSD 9,682 CSD 82 ESF 46 ESF 36 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Fiscal Year 2000 4,300 DA 4,630 DA     6,607 CSD 8,067 CSD     0 ESF 18 ESF     0 SEED 0 SEED     0 FSA 0 FSA     0 DFA 0 DFA     Through September 30, 2000 11,439 DA 9,157 DA 2,282 DA 23,366 CSD 15,144 CSD 8,222 CSD 82 ESF 64 ESF 18 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 3,991 DA         6,858 CSD         0 ESF         0 SEED         0 FSA         0 DFA         Total Planned Fiscal Year 2001 3,991 DA         6,858 CSD         0 ESF         0 SEED         0 FSA         0 DFA               Future Obligations   Est. Total Cost   Proposed Fiscal Year 2002 NOA 3,870 DA 0 DA 19,300 DA 7,000 CSD 0 CSD 37,224 CSD 0 ESF 0 ESF 82 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA

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