Study on USAID Non-Project Assistance Programs in

More documents

Recommendations

Info

Provide a firm legal foundation for community-managed cost recovery activities;Provide national standards for delivery of family planning and maternal health services;andMake modern contraceptives readily accessible to the population by including them in thenational essential drugs program.The PHCSR program called for the disbursement of a total of $5 million to the Government ofCameroon in three tranches over a period of three years. It was anticipated that the funds would be useddirectly by the MOPH to support the continued implementation of the redefined primary care strategythroughout the country.9.3 EXPERIENCESThe PHCSR reform program was never authorized by USAID. Instead, USAID chose to directits attention to more fully supporting the implementation of the reoriented primary care strategy in Southand Adamaoua provinces (SESA) and strengthening the delivery of family planning services throughoutthe country (FHSP).Despite the lack of an NPA-based incentive for policy reform, a number of the legal changes insupport of cost recovery and the redefined primary care strategy that were defined by the PHCSR havebeen made by the Government of Cameroon.28
10.0 SUMMARY OF LESSONS LEARNEDThe health sector NPA programs which have been developed and implemented (and summarizedabove) in sub-Saharan Africa represent a wide range of experiences. Each of the countries involved hasmade important policy reforms since 1986, when the Niger Health Sector Support Grant (NHSSG) wasdeveloped (the first of the three). NPA programs have in some way supported many of those reforms.None of the programs was able to demonstrate proof of meeting all of its conditions precedent within itsoriginal time frame. All of the programs, however, should be considered qualified successes based uponthe progress that has been made.In Togo and Cameroon, reform agendas were developed during the design of NPA programs butnever linked to the economic incentives that would have been made available had the NPA programsactually been authorized. None the less, several of the reforms contained in the programs have been carriedout in both countries. The mere fact that developers were able to engage policymakers in a review of thereform process and help focus on priorities and constraints may have influenced their actions.While each country presents a unique environment and story, a number of common threads runthrough the experiences summarized above. As such, they represent lessons that USAID should study inthe use of the NPA mechanism to support health sector policy reform. Consideration of these lessons isimportant if USAID is to continue to support the development of rational, sustainable health systems inAfrica.Despite our ability to learn from these experiences, a multitude of questions remain. There are stilla number of issues related to NPA for which the only lesson learned is that there is no set or formulaanswer available. These issues will be identified and discussed in following section.The issues and lessons learned from current NPA experiences in Niger, Kenya, Nigeria, Togo, andCameroon will be grouped as they relate to issues of: Program Development and Design, ProgramImplementation, and Program Evaluation. Despite a certain amount of overlap among these categories,it is hoped that this discussion may assist developers and planners when they consider health sectorassistance efforts and mechanisms.29
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 and 22: The economic, political and health
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: The MOPH has taken action to improv
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

Study on USAID Non-Project Assistance Programs in

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?