Study on USAID Non-Project Assistance Programs in

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EXHIBIT 4-2SUMMARY OF NPA PROGRAMSNPA Components Niger Nigeria Kenya Togo CameroonProgram TitleNiger Health SectorSupport Grant(NHSSG)Nigeria PrimaryHealth Care SupportProgram (NPHCS)Kenya Health CareFinancing Program(KHCF)Togo Health andPopulation SectorSupport Program(HAPSS)Primary HealthCare SubsectorReform Program(PHCSR)Authorized July 1986 July 1989 August 1989 — —Funding$17.2 million·$15 millionamended to $17.2$36 million·$25 million amendedto $36$9.7 million ($6 million) ($5 million)Disbursements$4.5 million(1992)$25 million(1992)$4.6 million(1992)Monitoring/Evaluation ComponentNo formal system;responsibilityto technicalassistance teamNo formal systemNo formal system;responsibilityto technicalassistance teamPolicy Reform Areas·Cost Recovery·Cost Containment,especiallyhospitals·Resource allocation·Human resources·Decentralization·Transfer ofresponsibility forplanning, managementand deliveryof services·Shift in emphasisfrom curative topreventive·Promotion ofprivatization·Cost recovery·Social financing·Improved resourceallocation·Expansion of privatesector in delivery ofservices, drugimportation anddistribution·Improved access tofamily planninginformation·Cost recovery·Legal foundationfor cost recovery·Creation ofnational servicestandards·Improved accessto familyplanningmaterials andinformationConditions Precedent 60(in five tranches)18(in three tranches)23(in three tranches)14(in three tranches)8(in three tranches)10
5.0 NIGER5.1 BACKGROUNDAfter a decade of rapid growth, Niger’s economic prospects began to decline in the early 1980s.This was set off by a decrease in the world price for uranium and a number of years of drought.Government expenditures had rapidly risen in the 1970s, with the deficits financed from external sources.During the 1980s, the Government of Niger adopted a number of austerity measures to restrain overallpublic sector spending under both IMF Standby and World Bank Structural Adjustment programs.Together with the IMF Stand-by Arrangements, the government began an adjustment process under theInterim Program of Consolidation (IPC) in 1984-1985. The IPC provided new policy directions in severalareas, including changes in public investment spending, restructuring of state-owned enterprises, and costrecovery measures for public services.The IPC was complemented on a sectoral level by the USAID Agricultural Sector DevelopmentGrant which was authorized in 1984. It was also followed by the World Bank SAC program which wasconcluded in 1986 and focused on changing expenditures in the social service sector, together with thepublic enterprise and agricultural sectors. External aid increasingly became an important source offinancing for all government operations. By 1991, the government was operating using financing fromdonors while barely managing to maintain payments of civil servant salaries.The political shifts toward more democratic forms of government which began in the late 1980shave been encouraging, but have at the same time been a source of significant disruption to the conductof routine business within the ministries. They have created an environment of uncertainty for thoseconcerned with policy and institutional reform, exacting a high toll on policy and institutional developmentefforts undertaken during this period.5.2 HEALTH SECTORHealth services in Niger are provided almost exclusively by the Ministry of Public Health andSocial Affairs (MOPHSA). 3 An extensive publicly operated and financed health care infrastructure existsin the country. This includes hospitals in all the departmental capitals, arrondissement level health centersand over 200 rural dispensaries. Niger attempts to provide access to health services to its people througha strategy which emphasizes primary health care which depends heavily on a number of vertical (largelynon-integrated) disease-specific intervention programs. The formal system of hospitals, medical centers,maternity units and dispensaries is supplemented by a national program of village health teams, whichinclude volunteer village health workers and traditional birth attendants. Although these teams have beenin operation since 1974, their activities and the impact of their presence on the health of the populationis largely unknown.USAID has provided assistance to the health sector in Niger since the mid-1970s and is the majordonor to the primary health care program. In 1978 AID initiated the $15 million Rural Health3 Unlike many other countries in West Africa, the private sector (for-profit, church run and non-profit/NGOoperated) is relatively undeveloped.11
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 and 20: 4.0 EXPERIENCES WITH NPA IN THE HEA
Page 21: The economic, political and health
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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