The New Structure of the Child Survival and Health Programs Fund

1. By Dr. Felice Apter, PPC June, 2002 The New Structure of theChild Survival and HealthPrograms Fund Accounts, Guidance, and Coding

2. PAY ATTENTION! First things first...

3. What’s New? Section 1

4. So What’s New? • New Name • New Account Structure • New Notwithstanding Authority • New HIV/AIDS Operational Plan including the new Commodity Promotion Fund

5. New Name In FY 2002, the name of the Child Survival and Disease (CSD) Programs Fund was changed to the Child Survival and Health(CSH) Programs Fund to reflect modifications in the account’s structure. CSH

6. Child Survival/Maternal Health (CS/MH) Vulnerable Children HIV/AIDS Infectious Diseases Family Planning & Reproductive Health (FP/RH) formerly “POP” Child Survival and Maternal Health Vulnerable Children HIV/AIDS Infectious Diseases Basic Education for Children NEW OUT New CSH Budget Categories NEW OLD

7. New expanded authority allows for the use of CSH funds for “child survival activities or disease programs…notwithstanding any other provision of law[e.g., procurement regulations, personnel regulations, competitive process standards, etc.].” Previous legislation limited this provision to overcoming country prohibitions only. IMPORTANT: This new provision does not extend to the use of FP/RH (“POP”) funds. New Notwithstanding Authority

8. New Commodity Promotion Fund This fund is intended to increase condom availability and use for HIV/AIDS prevention by making the condoms free of charge to Missions according to select criteria and by freeing up Mission funds for other critical HIV/AIDS activities

9. What’s NOT New?(The 4 Commandments of CSH) • THOU SHALT always confirm that any use of CSH funds is consistent with guidance for that fiscal year. This includes ensuring that activities demonstrate • Direct and Measurable Impact • Optimal Use of Funds • THOU SHALT use earmarked funds for their intended purpose - no substitutions! • THOU SHALT document your decisions! • THOU SHALT remember to use proper coding!

10. Congressional Interest Section 2

11. The Hill is Interested and Watching! • Congressional Interest • Increased funding • Annual reporting • Strong Interest Groups • Frequent Hill Inquiries • Appropriate use of CSH funds • Integrated programs (e.g., CS/MH and FP/RH) • Internal Inquiries (GAO/IG Audits) “…and this means what to me?…”

12. It Means…Coding is Important! Proper coding... • Tells the story of USAID’s programs • Congress • Other partners • Reveals implications of funding cuts • Answers frequent questions without special field reporting, such as • How much for immunization? • How much for maternal health funding? Faulty coding undermines USAID’s credibility!

13. It Also Means…Use Funds Appropriately! • Congressionally-mandated elements have been established within each of the budget categories of the CSH Programs Fund. These elements are... • Earmarks: fixed $ amounts • Directives: no fixed $ amounts

14. CSH Programs Fund Structure Section 3

15. Child Survival and Maternal Health Infant and child health and nutrition improved and infant and child mortality reduced Deaths, nutrition insecurity, and adverse health outcomes to women as a result of pregnancy and child birth reduced • Primary causes of mortality and morbidity • Polio • Micronutrients • Iodine Deficiency Disorder • Global Alliance for Vaccines and Immunizations (GAVI)

16. MOVED Vulnerable Children Infant and child health and nutrition improved and infant and child mortality reduced • Displaced Orphans and Children Fund • Blind Children • Other Vulnerable Children • Programming in consultation with USAID/W • Vulnerable Children Affected by HIV/AIDS NEW

17. HIV/AIDS Transmission and the impact of the HIV/AIDS pandemic reduced • Children Affected by HIV/AIDS • Mother-to-Child Transmission • Use of NGOs • Microbicides Research • IAVI* • UNAIDS* • Global Fund* NEW * International Organizations

18. HIV/AIDS NEW Special Considerations • Commodities (Commodity Promotion Fund) • Co-Programming and Multi-sectoral Programs • Addressing HIV/AIDS in Military Agencies only if: • Partofa larger public health initiative; • Same as that for civilian groups; and • Cannot be readily adaptable for military purposes.

19. Infectious Diseases The threat of infectious diseases of major public health importance reduced • Tuberculosis • Programming in close consultation with USAID/GH • Malaria • Other Infectious Diseases • Antimicrobial Resistance • Surveillance • Other Infectious Diseases

20. Family Planning & Reproductive Health (FP/RH) Unintended and mistimed pregnancies reduced • New FP/RH budget category with its accompanying new “FP/RH Guidance” • Clarification on co-funding integrated activities with FP/RH funds • NOTE: Tiahrt, Mexico City, and other related FP/RH restrictions remain in force

21. FP/RH, Voluntarism, and Informed Choice • Tiahrt, Mexico City, and other related FP/RH restrictions remain in force regardless of its location in the CSH Programs Fund • Where possible, documenting the impact of these restrictions on programmatic efforts is encouraged.

22. Co-funding Questions Section 4…almost done!

23. $ Integrated Program $ Question: What About Co-funding Integrated Activities? Joint funding of integrated activities is encouraged. However, the funds must be used for their intended purposes.

24. Step 1: What is Appropriate? • You CANNOTuse funds from one CSH funding category to make up for shortfalls in another. • You CANNOTuse CS/MH funds for purchasing contraceptives.* • You CAN use funds from more than one CSH funding category for integrated programs, but you must ensure that the balance of funds is proportionate to the types of activities. * HIV/AIDS funds may be used to purchase condoms for HIV/AIDS prevention activities within an integrated program

25. What is Appropriate? (cont.) • You CAN use CS/MH funds for birth spacing if spacing efforts are part of a predominantly child survival program and part of objective to reduce infant/child mortality. • You CAN use CS/MH funds for maternal health interventions, including maternal survival. • You CAN use FP/RH funding for reproductive health interventions related to maternal health within context of larger FP/RH programs. • You CAN use either FP/RH or CS/MH funds for breastfeeding programs.

26. Step 2: Balance of Funds? ? Q: Once I’ve determined that co-funding is appropriate, What is the appropriate mix of funds to support my integrated program? A: The appropriate mix of funds from respective CSH Budget Categories and/or Other Accounts is determined by the relevant activities within a program…funding must be proportionate to the relevant outputs of the program.

27. Step 3: Proportionality When determining the appropriate funding levels for an integrated program, you should… 1) Determine the most important outputs 2) Quantify those outputs 3) Classify these quantities according to their respective CSH funding categories 4) DOCUMENT YOUR DECISION!

28. Amanda Dick Rene Felice Mark Step 4: When You’re Still Unsure • Read the current CSH Guidance • Read it again!…only try to stay awake this time If that doesn’t work… • Contact your friendly PPC team for help. That’s why we’re here!

29. What if a Planned Activity Falls Outside CSH Guidance? • Operating units must receive prior written approval from PPC and GH, concurrence by Regional Bureau technical staff, and clearance from GC • PPC will coordinate and facilitate the approval process • Remember, the Hill is watching us closely.

30. Conclusion Section 5…finally!

31. Take Home Message • Read the current CSH Guidance (May 2002) • Correct coding is important…very important • Use earmarked funds for their intended purposes • Document your decisions • Document your decisions • Document your decisions • get the point? Happy programming!!