Study on USAID Non-Project Assistance Programs in

10.2 PROGRAM IMPLEMENTATIONUSAID should not underestimate the management burden associated with NPA. This burdenincreases as layers of administration and tracking are added to disbursement mechanisms.Complex policy reform agendas add to the management burden by imposing considerabledemands on the Mission to monitor host government progress against those agendas. It shouldbe remembered that this management burden is also shared by the host government institutionsinvolved in the program and may serve to diminish enthusiasm for the NPA policy reformagenda.NPA is intended to be a mechanism for the quick disbursement of funds, as a means of providingbudgetary support to a national treasury or sector. The end use of the funds is not (or is only loosely)defined, and little tracking of the end use of the funds is anticipated. As such, it should incur minimalmanagement demands on the Mission involved. As the health sector NPAs described here have departedfrom this original "management lite" approach and imposed additional complexity in requirements for theuse of grant funds, or complexity in the policy reform agendas they contain, the management burden hasincreased substantially.In the case of Niger, the NPA design imposed a complicated (and ultimately problematic)institutional structure that required the collaboration of several ministries and the USAID mission toprogram and track NHSSG funds after disbursement. This was intended to target those funds towardMission priority programs in the area of primary care and child survival. This mechanism, however,proved to be cumbersome, time consuming and, in the final analysis, ineffective in facilitating the flowof funds. The process suffered from a lack of clear definition of the desired uses for the funds and theprocedures by which they were to be allocated. The accounting procedures and capabilities of theinstitutions involved were inadequate, and the secretariat created to facilitate transfer of funds, wasdecertified by USAID. The operation of the secretariat, procedures for the allocation of funds and trackinguse of funds consumed considerable amounts of time and energy within the Mission. In the end, theseproblems limited the budgetary impact of the NPA program.The mechanisms employed for the transfer of NPA funds in Kenya and Nigeria were lessburdensome. In Kenya, some time and effort (and consultation with host government) was required toestablish the methodology by which the Government of Kenya would demonstrate to USAID that grantfunds had increased the level of budget support to the Ministry of Health. The concept of additionalityof NPA funds to existing health resources, compared to substitution, was a key facet of the KHCFprogram design.The three NPA programs described here all contain complex policy reform agendas. It has beennecessary for USAID missions in each of the three countries to expend considerable effort to monitor hostgovernment progress toward meeting the policy reform benchmarks. In all three cases this has requiredmuch more effort than anticipated by the Mission. In Niger and Kenya much of this burden was/has beentransferred to the technical assistance team. The team’s participation in assisting USAID to monitor hostcountry success toward meeting benchmarks has had a generally negative impact on the position, role, andeffectiveness of the technical assistance team as resources to the Ministry of Health. In Nigeria, wherethere were no technical assistance resources available, the monitoring of FMOH progress by the USAIDmission proved to be problematic.36