Study on USAID Non-Project Assistance Programs in

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EXHIBIT 4-1DEMOGRAPHIC AND ECONOMIC INDICATORSCountryPopulation(millions,1991)LifeExpectancyat Birth, 1991InfantMortality Rate(per 1,000live births)1991 GDP(billions ofdollars)1991 GNPper capita(dollars)1990 Percentof GDP tohealth1990 Percentof GDP tohealth frompublic sector1990 percapita totalhealthexpenditure(in dollars)Niger 7.9 46 126 2.3 300 5 3.4 16Nigeria 99 52 85 34.1 340 2.7 1.2 9Kenya 25 59 67 7.1 340 4.3 2.7 16Togo 3.8 54 87 1.6 410 4.1 2.5 18Cameroon 11.9 55 64 11.7 850 2.6 1 24Sources: Infant mortality rates from "1994 State of the World’s Children Report," UNICEF; population and economic information from 1993 "WorldDevelopment Report," World Bank.8
The economic, political and health environments in these countries have provided the frameworkand motivation toward action for donor agencies and ministries of health. Overall policy reform goalsfocusing on the emphasis of primary care, decentralization, and health finance reform have been centralto many donor agendas, including the NPA health programs which are examined in this report. While eachof the identified countries—Niger, Nigeria, Kenya, Togo and Cameroon—are unique in their situations,the reform agendas of the health sector NPAs developed for these countries have focused on a limitednumber of important areas for reform. They are:Health finance reform: Each of the reform agendas includes reforms and implementationsteps intended to increase the financial resources available for the delivery of healthservices. Included in this area are reforms to improve the allocation of resources withinthe health sector as well.Increased emphasis on primary care: Several of the programs were developed to supportan increased emphasis on services delivered at the primary level. This is intended toincrease access and efficiency.Decentralization of planning and management of health services. These reform measuresare intended to improve health resource allocation decisions and the ability of the healthsystem to respond to local and community needs.The NPA programs developed for the health sectors in Niger, Kenya, Nigeria, Togo, andCameroon are summarized in Exhibit 4-2 below.9
Page 1 and 2: PN-ABW-490Policy Paper No. 12THE US
Page 3 and 4: ABSTRACTThis policy paper examines
Page 5 and 6: TABLE OF CONTENTSLIST OF EXHIBITS .
Page 7 and 8: LIST OF EXHIBITSEXHIBIT 4-1DEMOGRAP
Page 9 and 10: EXECUTIVE SUMMARYAt the request of
Page 11 and 12: analysis. The development of the NP
Page 13 and 14: 1.0 INTRODUCTIONThe purpose of this
Page 15 and 16: 2.0 METHODSThis is a comparative st
Page 17 and 18: 3.0 BACKGROUNDNon-project assistanc
Page 19: 4.0 EXPERIENCES WITH NPA IN THE HEA
Page 23 and 24: 5.0 NIGER5.1 BACKGROUNDAfter a deca
Page 25 and 26: The NHSSG included numerous benchma
Page 27 and 28: 6.0 KENYA6.1 BACKGROUNDKenya’s ea
Page 29 and 30: The program provides $9.7 million i
Page 31 and 32: 7.0 NIGERIA7.1 BACKGROUNDThe Nigeri
Page 33 and 34: To implement these policies, the FM
Page 35 and 36: 8.0 TOGO8.1 BACKGROUNDTogo experien
Page 37 and 38: Increased availability of essential
Page 39 and 40: The MOPH has taken action to improv
Page 41 and 42: 10.0 SUMMARY OF LESSONS LEARNEDThe
Page 43 and 44: It may be difficult to define, in a
Page 45 and 46: The availability of funds to the MO
Page 47 and 48: Is policy reform, as generally stru
Page 49 and 50: The complexity of the policy reform
Page 51 and 52: In the other examples studied where
Page 53 and 54: e most effective. These discussions
Page 55 and 56: __________. 1993. "Assuring Health
Page 57: Tulane/ABT Team. 1992. "Progress Re

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