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2000 Trends Analysis

2000 Trends Analysis. Population, Health and Nutrition Team Bureau for Latin America & the Caribbean US Agency for International Development June 30, 2000. Inputs Utilized for the Analysis. Health and Economic Indicators

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2000 Trends Analysis

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  1. 2000 Trends Analysis Population, Health and Nutrition Team Bureau for Latin America & the Caribbean US Agency for International Development June 30, 2000

  2. Inputs Utilized for the Analysis • Health and Economic Indicators • Sources: DHS, CDC, WB/WDI, WHO, LAC Economic & Social Data (mid-1980’s to the present) • Budget Data • Sources: USAID/M/B Obligations FY89-99 and 1999 R4s for FY00-02; cross-checked w/ CPs • Country Profiles • Sources: 1999 R4, G/PHN/OFPS • Special Studies conducted by NEPs

  3. Outline for 7 PHN Sub-sectors • Empirical Data • Impact Indicatorsa k a “Long term Performance Indicators” measure the overall health status in the population • Intervention Indicatorsa k a “Performance Measurement Indicators” measure the efficiency and effectiveness of USAID programs • Critical Assumption--USAID programs target Intervention Indicators which will influence the pop-based Impact Indicators. An improvement in the Impact Indicators reflects the improved health status of a nation • Budget Data (FY89-02) • Country success story; best practices • Recommendations

  4. POPULATION Impact Indicator: Total Fertility Rate Intervention Indicator: Contraceptive Prevalence Rate

  5. Total Fertility Ratebirths per 1,000 women 15-45 or 15-49 years USAID LAC Average = 2.9 Source: DHS/RHS - 1995-1998

  6. Contraceptive Prevalence Rate% of women in union using modern methods of contraception USAID LAC Average = 54.6 Source: DHS/RHS - 1995-1998

  7. Average Population Obligations FY93-99 Source: USAID/M/B Archives

  8. Planned Pop Obligations Source: FY99 R4s

  9. POP Success Stories & Best Practices • Several countries have had rapid decreases in total fertility: • Nicaragua 4.6 (1993) to 3.9 (1999) • El Salvador 3.85 (1993) to 3.54 (1998) • In Brazil, ProQuali represents useful model to improve quality through certification and accreditation

  10. Recommendations for POP • As countries succeed, we must plan for phase out and recognize that more funds may be needed in the short run for responsible leave taking. • As controversy around informed consent has been a big issue in several countries (Peru, D.R., Mexico) more support for fine tuning quality is needed. • Adjustments should be made to budgets in relation to their country and population.

  11. Child Survival Impact Indicators: Infant Mortality Rate Under 5 Mortality Rate Intervention Indicator: Vaccination Coverage

  12. Infant Mortality Ratedeaths < 1 year per 1,000 live births USAID LAC Average = 36.7 Source: DHS/RHS and BUCEN: 1987-1999

  13. Under-5 Mortality Ratedeaths < 5 years per 1,000 live births LAC Average = 47.7 Source: DHS/RHS and BUCEN: 1987-1999

  14. Vaccination Coverage Ratefully vaccinated children USAID LAC Average = 54.8 Source: DHS/RHS: 1987-1998

  15. Average Child Survival Obligations FY93-99 Source: USAID/M/B Archives

  16. Planned Child Survival Obligations Source: FY99 R4s

  17. Child Best Practices • IMCI is becoming institutionalized in several countries. In Honduras, IMCI was incorporated into the MOH operational plans; in Bolivia, IMCI is incorporated into the MOH’s Seguro Basico; in Peru, it was incorporated into the MOH operational plan. • AIN is a model for preventive intervention developed by USAID in Honduras and is being picked up by the World Bank for Bolivia and Nicaragua. USAID DR will also replicate this model.

  18. Recommendations for Child Survival • Because ARIs and dehydration from diarrheal disease remain leading causes of death, IMCI should be supported. • As infant mortality rates decline, perinatal causes become greater % of deaths. Need to explore programming in rural areas and countries where institutional births are still low e.g. WHO/BASICS community mother/baby package. • Slight and moderate malnutrition account for 57% of all child deaths, therefore we need programming models like AIN.

  19. Maternal Health Impact Indicator: Maternal Mortality Ratio Intervention Indicator: Trained Attendants at Birth

  20. Maternal Mortality Ratiodeaths per 100,000 live births Haiti 1000 390 Bolivia Peru 265 Dom Rep 229 Paraguay 192 190 Guatemala 161 Brazil Ecuador 159 USA MMR = 8.4 El Salvador 120 0 200 400 600 800 1000 1200 Source: DHS/RHS 1994-1999

  21. % Trained Attendants at Birthphysician, nurse or nurse-midwife Guatemala 40.6 Haiti 46.3 Honduras 54.5 USAID LAC Average = 76.2 Paraguay 56.3 Peru 56.4 Bolivia 56.7 El Salvador 58 Nicaragua 64.6 Ecuador 69.2 Colombia 84.6 Jamaica 91.7 Brazil 93 Dom Rep 95.3 0 20 40 60 80 100 120 Source: DHS/RHS 1996-1999 (Jam '89)

  22. Average Maternal Health Obligations FY93-99 Source: USAID/M/B Archives

  23. Maternal Health Success Story Through the support of the RSD Regional Initiative to Reduce Maternal Mortality, an 8 member team formed the Rosario Health Committee in Honduras. The members include a nurse, doctor, teachers, local gov’t and NGO leaders. In 6 months they were able to meet the demand for obstetric services and to reduce maternal mortality by: 1. Receiving training and, in turn, training 40 volunteers and teens to recognize the danger signs of pregnancy 2. Negotiating MD coverage in the health center 3. Developing a network of car owners committed to drive pregnant women to the regional hospital at a reduced cost 4. Organizing an agreement to use a municipal car to transport low income women for free Last August, a woman’s life was saved when one of the trainees noticed the woman’s sudden swelling (toxemia) and rushed her to a regional hospital 90 minutes away.

  24. Recommendations for Maternal Health • Additional technical assistance needed to some missions to assess situations and identify most promising program directions • Attention needed to budget coding of maternal health activities • New RSD program should continue to include maternal health with an emphasis on increasing the number of trained attendants at delivery & post-partum

  25. Nutrition Impact Indicator: Under-nutrition Children < 5 yr underweight-for- age Intervention Indicator: Stunting Children < 5 yr below height- for- age

  26. Undernutrition% children under 5 below weight-for-age USAID LAC Average = 11.2 Source: World Bank/WDI 2000

  27. Chronic Malnutrition: Stunting% children under 5 below height-for-age USAID LAC Average = 22.1 Source: World Bank/WDI 2000

  28. Average Nutrition Obligations FY93-99 Source: USAID/M/B Archives

  29. Nutrition Survival Success Story AIN is a community based, preventive health and nutrition program that engages families of children < 2 yr and the community in maintaining adequate growth. AIN focuses on health care seeking & household practices such as breastfeeding, increased feeding, home care of illness, and health referrals. The emphasis is on adequate monthly weight gain--a shift from the traditional focus on nutritional status which is a more static measure of attained growth. The great success in Honduras has led other missions to adopt this intervention. Results in the first year of implementation included: • almost universal participation (98% of < 2 yr) • more children gaining weight • in communities with increased levels of malnutrition at baseline there was a decrease from 39% to 8%; in communities with medium levels of malnutrition--decrease from 25% to 10%, and in communities with low levels at baseline, all children improved

  30. Recommendations for Nutrition • Emphasize complementary feeding practices for children 6-36 months. • Develop standard nutrition messages about exclusive breastfeeding, frequency, quality and quantity of food for children 6-24 months adapted to local food sources • Support micronutritient supplementation of iron and Vitamin A for pregnant & post-partum women and children < 5 years • Better coordination of Title II and DA activities • Regional program could focus on quality assurance of fortified foods particularly vis-à-vis trade in Central America. Need regional agreement on standards and regulation

  31. Infectious Disease Impact Indicators: Tuberculosis and Malaria Prevalence Rates Intervention Indicator: % Countries Adopting DOTS (Direct Observation Treatment Strategy)

  32. Tuberculosis Prevalencerate per 100,000 people USAID LAC average = 48 TB cases per 100,000 people Source: WHO Global TB Control: WHO Report 2000, 1998 data

  33. Malaria Prevalencerate per 100,000 people not to scale USAID LAC average = 174 malaria cases per 100,000 people Source: PAHO Basic Indicators 1999, 1998 Data

  34. Average Infectious Disease Obligations FY93-99 Source: USAID/M/B Archives

  35. Planned Infectious Disease Obligations Source: FY99 R4s

  36. Infectious Disease Best Practices • Brazil - DOTS & DOTS Plus programs initiated in one area of Rio de Janiero • Mexico -TB assessment completed, strategy developed & SOAG signed • Regional Anti-Microbial Resistance • Surveillance and rational AM drug use training workshops underway • Book published by PAHO “Antimicrobial Resistance in the Americas: Magnitude and Response”

  37. Recommendations for Infectious Disease • TB - focus attention on countries with: • High TB burden and/or incidence • Multi-Drug Resistance • High HIV/AIDS prevalence • Explore malaria activities in Amazon Basin • Increase attention to use of data for decision making as regional surveillance and rational drug use training activities are well underway

  38. HIV/AIDS Impact Indicator: Adult HIV Prevalence Rate Intervention Indicator: Condom use with non-regular partner (data forthcoming)

  39. HIV Adult Prevalence Ratesrate per 1,000 adults 15-49 years Source: UNAIDS, 1997 & 1999

  40. Estimated Number of HIV Infected Adults and Children Source: UNAIDS 1997 & 1999

  41. Average HIV/AIDS Obligations FY93-99 Source: USAID/M/B Archives

  42. Planned HIV/AIDS Obligations Source: FY99 R4s

  43. HIV/AIDS Best Practices • Formal ratification of National HIV/AIDS Strategic Plans in Guatemala, El Salvador, Honduras, Nicaragua, and Panama. No other region can match this accomplishment. • Jamaica has reduced syphilis rates through its intervention of prevention, detection and treatment. HIV/AIDS prevalence rates have declined from .99 to .71 from 1997-99

  44. Recommendations for HIV/AIDS • Review the needs in the Caribbean and increase funding to address the problem. • Allocate funding according to need (prevalence) and magnitude (population)

  45. Health Sector Reform Impact Indicator: Health Expenditures as a % GDP Intervention Indicators: Number of countries with routine National Health Accounts tracking

  46. Total Health Expendituresas a % of GDP USAID LAC average = 6.6% Source: World Bank WDI 2000 1990-1998 data

  47. Total Health Spending per capita USAID LAC Average = $402 Source: World Bank 1998 ($PPP); Jamaica 1994, Ecuador 1993

  48. Average Health Sector Reform Obligations FY93-99 Source: USAID/M/B Archives

  49. Health Sector Reform Best Practices • MOH now uses USAID-supported NGO certification process as basis for funding in DR • 3.5 million more rural Guatemalans served by NGOs contracted by MOH • 9 countries have implemented National Health Accounts (NHAs), 5 have routine NHA tracking • USAID-supported NHAs contributed to World Health Report inclusion of health spending table for the first time

  50. Recommendations for Health Sector Reform • Monitor coverage of basic services • Expand information synthesis and tools dissemination • Implement pilots and reforms • Focus on policy • Foster South to South exchanges • Strengthen decentralization • Consider addressing HSR in Brazil

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