Study on USAID Non-Project Assistance Programs in

Improvement Project. RHIP financed the recruitment, training, and supervision of village health teams;training of health cadres; and the construction, repair, and equipment for rural health facilities. RHIP wasdesigned primarily to provide budgetary support to the primary health care (especially the village healthteam) program and there was little conditionality associated with the provision of resources to theMOPHSA in its design.Despite the development of a large delivery system infrastructure and supportive health policies,a pre-NPA sector analysis conducted in 1986 identified significant weaknesses in the health care deliverysystem including:Inadequate management and planning, the lack of integration of economic and financialfactors into health plans, and weak central administrative structures and institutions;An imbalance in the allocation of funds between preventive and curative care personneland material, and between rural and urban populations relative to the stated objectives ofpromoting primary and preventive care;A lack of integration of existing services and shortage of services in many areas;Inadequate support of personnel, including in-service training, supervision, materials, andsupplies;Lack of health care financing policies that address the continued prospects for poor (oreven negative) growth in budgetary resources in the near future;Inefficient spending practices and an absence of cost containment measures;Lack of an integrated national health plan, combined with the timely, reliable, andcomprehensive information about services, resources, and the population’s health status.5.2.1 The Niger Health Sector Support Grant (NHSSG)In response to the constraints identified by its analysis of the health sector in 1986, USAIDdesigned and authorized the Niger Health Sector Support Grant (NHSSG) as an NPA program for thehealth sector. As the first health sector NPA program in Africa, it has the longest history of any of thehealth sector NPA programs funded under the DFA. Much of the design and mechanisms forimplementation were modeled on USAID’s experiences with NPA in the agriculture sector in Niger.In 1986 the original NHSSG grant agreement to provide $15 million to the health sector over afive-year period was signed. Release of $10.5 million in tranches over a five-year period was conditionedupon achievement of specified policy review and reform benchmarks ("conditions precedent"). Theremaining $4.5 million was programmed in support of technical assistance and training. An additional $2.2million for project assistance was added to that sum when the NHSSG was extended in 1990 (it has sincebeen extended a second time with completion now scheduled in 1995).The NHSSG was designed to complement and be implemented in close collaboration with otherdonor efforts in the sector. The most important area of collaboration was the World Bank Health Project,which supports policy reform efforts of the Government of Niger undertaken as part of the StructuralAdjustment Credit program.12