2000 trends analysis
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/1.jpg)
2000 Trends Analysis2000 Trends Analysis
Population, Health and Nutrition Team
Bureau for Latin America & the CaribbeanUS Agency for International DevelopmentJune 30, 2000
![Page 2: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/2.jpg)
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
![Page 3: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/3.jpg)
3
Outline for 7 PHN Sub-sectors
Empirical Data Impact Indicators a k a “Long term Performance
Indicators” measure the overall health status in the population
Intervention Indicators a 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
![Page 4: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/4.jpg)
POPULATIONPOPULATION
Impact Indicator: Total Fertility Rate
Intervention Indicator: Contraceptive Prevalence Rate
![Page 5: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/5.jpg)
June 2000 Source: DHS/RHS - 1995-1998
5
Total Fertility Ratebirths per 1,000 women 15-45 or 15-49 years
0
1
2
3
4
5
6
Guatem
ala
Honduras
Haiti
Parag
uay
Bolivia
Nicar
agua
El Sal
vador
Peru
Ecuad
or
Domin
ican
Rep
ublic
Colom
bia
Jam
aica
Brazi
l
Guyana
Mex
ico
Panam
a
DHS/CDC
BUCEN
USAID LAC Average = 2.9
![Page 6: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/6.jpg)
June 2000 Source: DHS/RHS - 1995-1998
6
Contraceptive Prevalence Rate% of women in union using modern methods of
contraception
66
59
59
58
57
57
54
51
41
41
31
25
13
0 10 20 30 40 50 60 70
Jamaica
Colombia
DR
Brazil
Paraguay
Nicaragua
El Salvador
Ecuador
Peru
Honduras
Guatemala
Bolivia
Haiti USAID LAC Average = 54.6
![Page 7: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/7.jpg)
Source: USAID/M/B Archives 7
Average Population Obligations FY93-99
Bol ivia
16%
DR
6%
Ecuador
6%
El Salvador
10%
Guatemala
15%
Hai ti
12%
Honduras
7%
Per u
13%
Par aguay
1%Panama
5%
Nicar agua
6%J amaica
3%
![Page 8: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/8.jpg)
Source: FY99 R4s 8
Planned Pop Obligations
0%
5%
10%
15%
20%
25%
30%
FY00 FY01 FY02
PERU
BOLIVIA
HAITI
GUATEMALA
HONDURASEL SALVADOR
NICARAGUA
PARAGUAY
DR
JAMAICA
ECUADOR
![Page 9: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/9.jpg)
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
![Page 10: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/10.jpg)
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.
![Page 11: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/11.jpg)
Child SurvivalChild Survival
Impact Indicators: Infant Mortality RateUnder 5 Mortality Rate
Intervention Indicator: Vaccination Coverage
![Page 12: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/12.jpg)
June 2000 Source: DHS/RHS and BUCEN: 1987-1999
12
Infant Mortality Ratedeaths < 1 year per 1,000 live births
0
15
30
45
60
75
90
105
DHS/CDC
BUCEN
USAID LAC Average = 36.7
![Page 13: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/13.jpg)
June 2000 Source: DHS/RHS and BUCEN: 1987-1999
13
Under-5 Mortality Ratedeaths < 5 years per 1,000 live births
0
20
40
60
80
100
120
140
160
180
Parag
uay
Colom
bia
Ecuad
or
El Sal
vador
Brazi
l
Nicar
agua
Honduras
Domin
ican
Rep
ublic
Guatem
ala
Peru
Mex
ico
Bolivia
Haiti
DHS/RHS
BUCENLAC Average = 47.7
![Page 14: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/14.jpg)
June 2000 Source: DHS/RHS: 1987-1998
14
Vaccination Coverage Ratefully vaccinated children
78
78
78
69
64
60
53
48
47
38
37
21
15
0 10 20 30 40 50 60 70 80 90
Honduras
Ecuador
Brazil
Colombia
Peru
Guatemala
El Salvador
Paraguay
Nicaragua
Dom Rep
Haiti
Mexico
Bolivia
percent
USAID LAC Average = 54.8
![Page 15: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/15.jpg)
Source: USAID/M/B Archives 15
Average Child Survival Obligations FY93-99
Brazil2%
DR3%
Ecuador4%
El Salvador9%
Guatemala13%Haiti
20%
Honduras4%
Nicaragua14%
Peru16%
Bolivia15%
Jamaica.01%
![Page 16: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/16.jpg)
Source: FY99 R4s 16
Planned Child Survival Obligations
0%
5%
10%
15%
20%
25%
30%
FY00 FY01 FY02
PERU
BOLIVIA
HAITI
GUATEMALA
HONDURASEL SALVADOR
NICARAGUA
PARAGUAY
DR
JAMAICA
ECUADOR
![Page 17: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/17.jpg)
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.
![Page 18: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/18.jpg)
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.
![Page 19: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/19.jpg)
Maternal HealthMaternal Health
Impact Indicator: Maternal Mortality Ratio
Intervention Indicator: Trained Attendants at Birth
![Page 20: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/20.jpg)
Source: DHS/RHS 1994-1999 20
Maternal Mortality Ratiodeaths per 100,000 live births
120
159
161
190
192
229
265
390
1000
0 200 400 600 800 1000 1200
El Salvador
Ecuador
Brazil
Guatemala
Paraguay
Dom Rep
Peru
Bolivia
Haiti
USA MMR = 8.4
![Page 21: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/21.jpg)
Source: DHS/RHS 1996-1999 (Jam '89)
21
% Trained Attendants at Birthphysician, nurse or nurse-midwife
95.3
93
91.7
84.6
69.2
64.6
58
56.7
56.4
56.3
54.5
46.3
40.6
0 20 40 60 80 100 120
Dom Rep
Brazil
Jamaica
Colombia
Ecuador
Nicaragua
El Salvador
Bolivia
Peru
Paraguay
Honduras
Haiti
Guatemala
USAID LAC Average = 76.2
![Page 22: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/22.jpg)
Source: USAID/M/B Archives 22
Average Maternal Health Obligations FY93-99
Guatemala12%
Haiti24%
Honduras21%
Nicaragua12%
Peru14%
DR2%
El Salvador11%
Ecuador.01%
Bolivia4%
![Page 23: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/23.jpg)
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.
![Page 24: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/24.jpg)
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
![Page 25: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/25.jpg)
NutritionNutrition
Impact Indicator: Under-nutritionChildren < 5 yr underweight-for- age
Intervention Indicator:Stunting
Children < 5 yr below height- for- age
![Page 26: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/26.jpg)
Source: World Bank/WDI 2000 26
Undernutrition% children under 5 below weight-for-age
5.7
5.9
6.1
7.6
7.8
8.4
10.2
11.2
12.2
16.5
16.9
18.3
25.4
26.6
27.5
3.7
0 5 10 15 20 25 30
Paraguay
Brazil
Dom Rep
Panama
Bolivia
Peru
Colombia
Jamaica
El Salvador
Nicaragua
Ecuador
Mexico
Guyana
Honduras
Guatemala
Haiti
percent
USAID LAC Average = 11.2
![Page 27: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/27.jpg)
Source: World Bank/WDI 2000 27
Chronic Malnutrition: Stunting
% children under 5 below height-for-age
9.9
10.5
10.7
15.0
17.0
22.0
23.1
24.9
25.8
26.8
31.9
34.0
38.9
49.7
0 10 20 30 40 50
Jamaica
Panama
Brazil
Dom Rep
Colombia
Paraguay
Mexico
El Salvador
Nicaragua
Peru
Bolivia
Haiti
Ecuador
Honduras
Guatemala
percent
USAID LAC Average = 22.1
![Page 28: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/28.jpg)
Source: USAID/M/B Archives 28
Average Nutrition Obligations FY93-99
Haiti61%
Honduras1%
Nicaragua9%
Peru15%
El Salvador5%
Ecuador2%
Guatemala2%
Bolivia5%
![Page 29: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/29.jpg)
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
![Page 30: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/30.jpg)
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
![Page 31: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/31.jpg)
Infectious DiseaseInfectious Disease
Impact Indicators: Tuberculosis and Malaria
Prevalence RatesIntervention Indicator:
% Countries Adopting DOTS(Direct Observation Treatment Strategy)
![Page 32: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/32.jpg)
Source: WHO Global TB Control: WHO Report 2000, 1998 data
32
Tuberculosis Prevalence rate per 100,000 people
5
8
22
26
28
36
37
51
52
53
54
75
80
124
127
176
0 50 100 150 200
Jamaica
Mexico
Colombia
Guatemala
El Salvador
Paraguay
Guyana
Brazil
Dom Rep
Panama
Nicaragua
Ecuador
Honduras
Haiti
Bolivia
Peru
USAID LAC average = 48 TB cases per 100,000 people
![Page 33: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/33.jpg)
Source: PAHO Basic Indicators 1999, 1998 Data
33
Malaria Prevalence rate per 100,000 people
7
14
19
37
39
256
271
301
307
324
457
526
614
706
4,546
0 250 500 750 1,000
Dom Rep
Mexico
El Salvador
Panama
Paraguay
Ecuador
Brazil
Guatemala
Colombia
Nicaragua
Haiti
Bolivia
Honduras
Peru
Guyana
USAID LAC average = 174 malaria cases per 100,000 people
not to scale
![Page 34: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/34.jpg)
Source: USAID/M/B Archives 34
Average Infectious Disease Obligations FY93-99
Bolivia23%
DR1%
Ecuador2%
El Salvador13%
Guatemala2%
Honduras23%
Jamaica2%
Mexico3%
Nicaragua6%
Peru16%
Haiti9%
![Page 35: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/35.jpg)
Source: FY99 R4s 35
Planned Infectious Disease Obligations
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
FY00 FY01 FY02
MEXICO
BOLIVIA
PERU
NICARAGUA
EL SALVADOR
JAMAICA
GUATEMALA
HONDURAS
![Page 36: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/36.jpg)
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”
![Page 37: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/37.jpg)
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
![Page 38: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/38.jpg)
HIV/AIDSHIV/AIDS
Impact Indicator: Adult HIV Prevalence Rate
Intervention Indicator: Condom use with non-regularpartner (data forthcoming)
![Page 39: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/39.jpg)
Source: UNAIDS, 1997 & 1999
39
HIV Adult Prevalence Rates rate per 1,000 adults 15-49 years
0
1
2
3
4
5
619971999
![Page 40: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/40.jpg)
Source: UNAIDS 1997 & 1999 40
Estimated Number of HIV Infected Adults and Children
0
100,000
200,000
300,000
400,000
500,000
600,000
Brazil
Haiti
Mexico
Dom R
epPer
u
Guatem
ala
Hondu
ras
El Salv
ador
Ecuad
or
Guyana
Jam
aica
Nicara
gua
Bolivi
a
Parag
uay
1997
1999
![Page 41: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/41.jpg)
Source: USAID/M/B Archives 41
Average HIV/AIDS Obligations FY93-99
Bolivia11%
Brazil9%
DR23%
Haiti20%
Honduras12%
Jamaica15%
Mexico5%
Nicaragua1%
Guatemala.01%
Peru2%
El Salvador2%
![Page 42: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/42.jpg)
Source: FY99 R4s 42
Planned HIV/AIDS Obligations
0%
5%
10%
15%
20%
25%
30%
FY00 FY01 FY02
PERU
BOLIVIA
HAITI
GUATEMALA
HONDURASEL SALVADOR
NICARAGUA
PARAGUAY
DR
JAMAICA
ECUADOR
![Page 43: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/43.jpg)
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
![Page 44: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/44.jpg)
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)
![Page 45: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/45.jpg)
Health Sector ReformHealth Sector Reform
Impact Indicator: Health Expenditures as a % GDP
Intervention Indicators: Number of countries with
routine National Health Accounts tracking
![Page 46: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/46.jpg)
June 2000 Source: World Bank WDI 2000 1990-1998 data
46
Total Health Expenditures as a % of GDP
9.7
9.4
8.3
7.7
7.4
7.3
7
5.6
5.4
5.2
4.9
4.7
4.7
3.4
2.6
2.4
0 2 4 6 8 10 12
Nicaragua
Colombia
Honduras
Panama
Paraguay
Brazil
El Salvador
Peru
Guyana
Dom Rep
Ecuador
Mexico
Jamaica
Haiti
Bolivia
Guatemala
USAID LAC average = 6.6%
![Page 47: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/47.jpg)
June 2000 Source: World Bank 1998 ($PPP); Jamaica 1994, Ecuador 1993
47
Total Health Spending per capita
$0
$100
$200
$300
$400
$500
$600
$700
Haiti
Bolivia
Guat
emal
a
Ecuad
or
Guya
na
Jam
aica
Honduras
Nicar
agua
Domin
ican
Rep
ublicPer
u
El Sal
vador
Parag
uay
Mex
ico
Panam
a
Brazi
l
Colom
bia
USAID LAC Average = $402
![Page 48: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/48.jpg)
Source: USAID/M/B Archives 48
Average Health Sector Reform Obligations FY93-99
Bolivia9%
DR4%
Ecuador9%
El Salvador31%Guatemala
9%
Haiti8%
Honduras16%
Jamaica2%
Peru12%
![Page 49: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/49.jpg)
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
![Page 50: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/50.jpg)
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
![Page 51: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/51.jpg)
Source: FY99 R4s 51
Planned Other Health Obligations
0%
5%
10%
15%
20%
25%
30%
FY00 FY01 FY02
BOLIVIA
PERU
HAITI
GUATEMALA
ECUADORBRAZIL
JAMAICA
DRELSALVADORHONDURAS
NICARAGUA
MEXICO
PARAGUAY
![Page 52: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/52.jpg)
52
Highlights of AnalysisPopulation
Phase-out needs include:Consistent Graduation StandardsCareful planning for sustainabilityAdequate funding (may need increase)
Child SurvivalDiarrhea and pneumonia, exacerbated
by malnutrition, are the primary killers of infants and children in AID countries
Perinatal and accidental causes of death are increasing in importance
![Page 53: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/53.jpg)
53
Highlights (continued)
Maternal MortalityMissions need to increase internal
technical expertise to provide appropriate programmatic direction
Results Frameworks need a specific focus on maternal health programs
NutritionConsiderably more attention and
funding needed; USAID not a major player among international donors
![Page 54: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/54.jpg)
54
Highlights (continued)
Infectious DiseasesFocus TB programs on countries with:
high disease burden, multi-drug resistant strains, or high HIV prevalencei.e. Haiti, Brazil, Dominican Republic
HIV/AIDS A full-blown epidemic can still be
prevented in LAC by applying the lessons learned to date.
![Page 55: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/55.jpg)
55
Highlights (continued)
Health Sector ReformFocus efforts on USAID’s comparative
advantages at the regional level:
information/tools dissemination South-to-South exchanges monitoring reform impact
at the country level: policy development strengthening decentralization financing mechanisms
![Page 56: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/56.jpg)
Source: USAID/M/B Archives 56
Average PHN Obligations FY93-99
Bolivia13%
Brazil1%
DR6%
Ecuador4%
El Salvador11%
Guatemala10%Haiti
19%
Honduras9%
Jamaica3%
Mexico1%
Nicaragua7%
Panama2%
Paraguay1%
Peru13%
![Page 57: 2000 Trends Analysis](https://reader035.vdocuments.net/reader035/viewer/2022070411/56814749550346895db48941/html5/thumbnails/57.jpg)
Source: FY99 R4s 57
% of Total PHN Planned Obligations by Country
0%
5%
10%
15%
20%
25%
30%
FY00 FY01 FY02
PERU
BOLIVIA
HAITI
GUATEMALA
HONDURASEL SALVADOR
NICARAGUA
PARAGUAY
DR
JAMAICA
ECUADOR